Parotidectomy - ROJoson's TPORs

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Parotidectomy - ROJoson's TPORs - 2014

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Parotidectomy - ROJoson's TPORs

  1. 1. Parotidectomy ROJoson’s TPORs April 2014
  2. 2. Parotidectomy Incision: Objectives: • Long enough to facilitate accurate intraoperative evaluation and complete extirpation of the parotid tumor without complications. • Place it at an area that will facilitate achievement of treatment goal. • Place it at an area that will be cosmetically acceptable to the patient. • Planning and execution of incision will be based on the above objectives.
  3. 3. Parotidectomy Exposure: Objectives: • To facilitate accurate intraoperative evaluation. • To facilitate complete extirpation of the parotid tumor without complication.
  4. 4. Parotidectomy Exposure: Execution: • Create flaps to such an extent that will facilitate accurate intraoperative evaluation and complete extirpation of parotid tumor without extirpation. • Create flaps not beyond the anterior border of the parotid gland so as to avoid injury to the branches of the facial nerve. • Create viable flaps.
  5. 5. Parotidectomy Intraoperative Evaluation: Objectives: • To determine the exact diagnosis. • To determine the extent of the tumor. • To facilitate decision on specific operative procedure and maneuvers.
  6. 6. Parotidectomy Intraoperative Evaluation: Execution: • Inspect and palpate • To determine whether the mass is really parotid in origin. • If parotid in origin, determine whether benign or malignant, extent of tumor, superficial or deep, inferior pole, superior pole, whole gland, etc.
  7. 7. Parotidectomy Intraoperative Evaluation: Execution: • Decide on extent of parotidectomy – total parotidectomy; subtotal parotidectomy – total superficial parotidectomy; partial superficial parotidectomy; partial superficial and partial deep parotidectomy. • Decide on operative maneuvers.
  8. 8. Parotidectomy Operative Procedure Proper: Objectives: To completely extirpate all grossly evident tumor in such a way that there will be no local recurrence and no complications, particularly, facial nerve paralysis.
  9. 9. Parotidectomy Operative Procedure Proper: Maneuvers: • Identify facial nerve • Main trunk to branches • Branches • Extirpate all gross parotid tumor with a rim of normal parotid tissue (adequately)
  10. 10. Parotidectomy Operative Procedure Proper: Maneuvers: • Avoid cutting or entering into the tumor (cleanly) • Avoid injury to the facial nerve while extirpating which can occur either by cutting, burning (with cautery) or traction • Attack tumor initially through areas of lesser difficulty before entering through dense and difficult areas
  11. 11. Parotidectomy Operative Procedure Proper: Be gentle. Be meticulous and precise. Every move must have a reason!
  12. 12. Parotidectomy Hemostasis Check: Objectives: • To avoid bleeding and hematoma. • To avoid injury to facial nerve during hemostasis check.
  13. 13. Parotidectomy Hemostasis Check: Execution: • Choice of suture-ligature and cauterization. • Avoid injury to the facial nerve during clamping, tying, and cauterization by right choice of hemostatic method and by being meticulous and precise.
  14. 14. Parotidectomy Drain: Objectives: • To prevent unwanted accumulation of fluid (serum and saliva) in the wound space. • To drain continuous salivary secretion into the wound site after a subtotal parotidectomy.
  15. 15. Parotidectomy Drain: Execution: • Choice of tube drain or rubber drain. • Remove when drain is not needed anymore.
  16. 16. Parotidectomy Correct Count: Objective: • To avoid leaving sponges, surgical instruments, and needles in the wound site.
  17. 17. Parotidectomy Correct Count: Execution: • Ensure correct sponge, instrument, and needle count before wound closure.
  18. 18. Parotidectomy Wound Closure: Objectives: • To repair the skin incision used to remove the parotid tumor. • To repair the skin incision in such a way that - a cosmetically acceptable scar is effected - will promote patient comfort (e.g., pain of skin suture removal)
  19. 19. Parotidectomy Wound Closure: Execution: • Use absorbable suture to avoid pain on suture removal, if non-absorbable sutures are used. • Appose wound edges precisely to promote a cosmetically acceptable scar.
  20. 20. Parotidectomy Postop Care Objectives: • Supply basic needs of patient • Comfort • Analgesics • Fluids and Electrolytes • Nutrition • Wound care • Monitoring for complications and treat as indicated • Advice on home care of wound • Advice on follow-up plan
  21. 21. Parotidectomy Follow-up Plan: Objectives: • Evaluate results of treatment. • Provide psychosocial support. Monitoring guidelines Physical examination Symptom-directed investigation
  22. 22. Parotidectomy Frequency of Follow-up Guidelines: Consider • Usual course of disease (recurrence probability and incidence) • Personality of patient • Patient’s convenience
  23. 23. Parotidectomy Outcome of Treatment: If at the end of the treatment, I have achieved all the following: Resolution of the health problem – parotid tumor extirpated with no recurrence Live patient No facial paralysis Satisfied patient No medico-legal suit Then, I can consider myself to be successful in my problem-solving and decision-making in the management of the patient.

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