parotid

1. PAROTID SURGERY

2. General Relations
• Anterior: Masseter muscle, ramus of the mandible, and
medial pterygoid muscle
• Posterior: Mastoid process, sternocleidomastoid
muscle, and posterior belly of the digastric muscle and
facial nerve
• Superior: External auditory meatus, and
temporomandibular joint
• Inferior: Sternocleidomastoid muscle, and posterior
belly of the digastric muscle

3. Bed of the Parotid Gland
• One Vein: internal jugular
• Two Arteries: external and internal carotid
• Four Nerves: glossopharyngeal (IX), vagus (X),
spinal accessory (XI), hypoglossal (XII)
• Four anatomic entities starting with "S": styloid process,
and styloglossus, stylopharyngeus, and stylohyoid
muscles.
• Parotid Fascia

4. Vascular Supply
• External Carotid divides at the level of the
neck of the mandible into the maxillary and
superficial temporal arteries. The latter
gives rise to the transverse facial artery

5. Facial Nerve
• The trunk of the facial nerve enters the posterior surface
of gland 1 cm from its emergence from stylomastoid
foramen, about midway between the angle of the
mandible and the cartilaginous ear canal
• About 1 cm from its entrance into the gland, the facial
nerve typically divides to form five branches
• styloid process is an unreliable landmark

6. History
1650 and 1750, salivary gland surgery was limited to the
treatment of ranulas and oral calculi.
The utilization of parotidectomy for the treatment of
neoplasms has been attributed to Betrandi (1802).
By the mid-19th century, focus had shifted to facial nerve
anatomy, preservation.
From a historical perspective, the first operation to use
ether inhalation anesthesia performed by Dr. John C.
Warren in Boston in 1846.
The first total parotidectomy with facial nerve preservation
is said to have been accomplished by Codreanu, 1892.
The first attempts at facial nerve grafting date from the
early 1950s.

7. Surgical Technique
• modified Blair incision
• Care is taken to avoid division of the
greater auricular nerve.
• The tail of the parotid gland is dissected
off of the sternocleidomastoid
• The posterior belly of the digastric muscle
is exposed

8. • The preauricular space is opened by
division of the attachments of the parotid
gland to the external auditory canal
• The facial nerve is identified using
anatomic landmarks,
• posterior belly of the digastric muscle,
• the mastoid tip, the tragal cartilage pointer,
and the tympanomastoid suture.
• If the proximal facial nerve is obscured,
retrograde dissection may be necessary

9. Complications
• Early
• Facial nerve paresis
• Bleeding/hematoma Infection
• Skin flap necrosis
• Salivary fistula/sialocele 10%
• External otitis
• Trismus
• Late
• Frey’s syndrome
• Hypertrophic scar or keloid
• Recurrent tumor
• Soft tissue deficit

10. • Temporary paralysis involving all or just one of the
branches of the nerve occurs in 10–30% of superficial
parotidectomies
• Permanent facial nerve paralysis occurs in less than 1%
• nerve at most risk for injury is marginal mandibular
branch of the facial nerve
• Facial nerve reconstruction
• W.korte 1901
• Facio-facial,Hypoglossofacial and combined

11. Deep parotidectomy
• Superficial Parotidectomy with Partial Deep
Lobe Resection
• Superficial Parotidectomy with Total Deep Lobe
Resection
• Extended Total Parotidectomy
• Isolated Deep Parotidectomy
The essence of deep parotidectomy is vascular
control

12. • Superficial Temporal Fascia Flaps,
• Dermal Fat Grafts, and Alloderm
• Superficial Musculoaponeurotic System
(SMAS) Flaps
• Cervicofacial and Cervicodeltopectoral
Flaps
• Pectoralis Major (PMF) and Other
Pedicled Flaps
• Free Flaps

13. THANK YOU