www.surgicalnotes.co.uk

Indications

• Benign tumours confined to superifical part of parotid gland

Superficial parotidectomy Procedure

1. GA + supine + slight head-up tilt
2. Dissect down to parotid
   • S-shaped pre-auricular incision (as close to ear as possible to avoid facial nerve) extending unde the ear and down anterior border of SCM
   • Incision curved around ear lobe to extend for 2-3cm into postauricular groove
   • Angled acutely over mastoid to be continous with cervical part of incision
   • Deepen incision down to bony external auditory meatus
   • Deepen through subcutaneous fat, platysma to stylohyoid muscle
   • (anterior branch of great auricular nerve usually sacrificed - causes parasthesia of earlobe)
3. Identify branches of facial nerve
   • Reflect parotid forwards
   • Dissect divisions and branches of facial nerve (TZBMC)
4. Dissect out parotid duct, ligate
   • Raise skin flaps superiorly to just above zygomatic arch, anteriorly to anterior border of masseter muscle and inferiorly to anterior border of SCM
   • Parotid duct dissected forwards as far as anterior border of masseter muscle, then ligate and divide [normally opens 2nd molar]
5. Remove superficial parotid
6. Close
   • Ensure haemostasis
   • Close skin with subcuticular suture

Complications

1. Bleeding / haematoma
2. Infection
3. Damage to facial nerve
4. Salivary fistula
5. Frey's syndrome: gustatory sweating, hyperhidrosis, pain, flushing in distribution of auriculotemporal nerve. Thought to be due to disorganised post-ganglionic sympathetic fibres and preganglionic parasympathetic fibres following trauma

Parotid duct stomatoplasty

Indications

• Obstructive parotitis

1. GA + supine position
2. Nasophryngeal ETT
3. Mouth kept open with dental prop, tongue retracted to contralateral side by assistant
4. Identify parotid papilla (opposite upper 2nd molar)
5. Insert 2 stay sutures above and below papilla
6. Pass dilator through parotid duct and then incise longitudinally down to dilator