PAROTIDECTOMY

Operative Technique

Patient supine under General Anesthesia

Asepsis and antisepsis technique

Sterile drapes placed

“Y” incision made, with the anterior limb done just anterior to the tragus and posterior limb over the mastoid process in the caudal direction roughly parallel to the underlying sternocleidomastoid muscle down to a point about 1 cm below the angle of the mandible. Incision made from skin through platysma.

Anterior flap made to the level of the zygomatic process and anteriorly to the anterior margin of the parotid gland

Posterior flap made to expose 1-2cm of underlying sternocleidomastoid muscle, mastoid process, and cartilage of the external auditory canal

Branch of great auricular nerve that enters the parotid gland divided

External jugular vein posterior to the parotid gland divided and ligated

Dense layer of temporoparotid fascia elevated and divided, exposing tympanomastoid fissure

Branch of posterior auricular artery identified, divided, and ligated

Posterior portion of the parotid gland retracted away from the mastoid process

Main trunk of the facial nerve identified

Traction applied to the superficial lobe of the parotid gland

Dissection carried carefully just superficial to the facial nerve creating a plane until each of the branches of the facial nerve has been separated from the overlying parotid tissue.

On the anterior margin of the parotid gland, Stensen’s duct identified, divided, and ligated

Superficial lobe of the gland removed

Removing the Deep Lobe of Parotid Gland

Lower division of the facial nerve carefully freed from the underlying tissue

Piecemeal removal of deep lobe carefully undertaken

Posterior facial vein separated from the marginal mandibular nerve branch then divided and ligated

Superficial temporal artery and vein divided and ligated

Lower border of the gland elevated

External carotid artery divided and ligated

Internal maxillary and the transverse facial arteries at the anterior border of the gland divided and ligated

Deep lobe removed.

Closure

NSS wash

Hemostasis

Closed suction drain placed (feeding tube Fr. 8)

Platysma and Subcutaneous tissue closed using vicryl 4.0 interrupted sutures

Skin closed subcuticularly using vicryl 5.0

Betadine paint

Dry sterile dressing placed.