This case report describes performing a superficial parotidectomy under local anesthesia for a patient with uncontrolled hypertension and a difficult airway. Nerve blocks were used to anesthetize the maxillary nerve, superficial cervical plexus including the greater auricular nerve, as well as incision site infiltration. The surgery was performed successfully using these nerve blocks with mild sedation. Local anesthesia allowed preservation of the facial nerve and avoidance of risks from general anesthesia for this high risk patient.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
A case report of open reduction, internal fixation and platting of clavicle f...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
A case report of open reduction, internal fixation and platting of clavicle f...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Clinical Experience in Maxillary and Mandibular division block for Trigeminal...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Bilateral vocal fold paralysis is a rare condition. The commonest cause identified is mostly iatrogenic. It can be extremely debilitating for the patient who usually suffers from severe breathlessness on slightest exertion. Many of them requires a tracheostomy to maintain airway. The treatment of bilateral vocal cord palsy is a balance between phonation, airway and swallowing. Several surgical modalities have been described for cases which doesn't improve with conservative management. However transoral CO2 laser endoscopic arytenoidectomy has become the standard of management today for this condition. CO2 laser is arguably the most appropriate tool for cordectomy with the advantage of increased precision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using transoral CO2 laser in two patients who were successfully managed for this condition in our centre.
Management of iatrogenic bilateral vocal cord paralysis by endoscopic transor...Apollo Hospitals
Bilateral vocal fold paralysis is a rare condition. The commonest cause identified is mostly iatrogenic. It can be extremely debilitating for the patient who usually suffers from severe breathlessness on slightest exertion. Many of them requires a tracheostomy to maintain airway. The treatment of bilateral vocal cord palsy is a balance between phonation, airway and swallowing. Several surgical modalities have been described for cases which doesn’t improve with conservative management. However transoral CO2 laser endoscopic aryte-noidectomy has become the standard of management today for this condition. CO2 laser is arguably the most appropriate tool for cordectomy with the advantage of increased pre-cision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using transoral CO2 laser in two pa-
tients who were successfully managed for this condition in our centre.
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
A Prospective comparative study of Local anaesthesia & Spinal anaesthesia for...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Caudal Anaesthesia for CTEV with Post-Op Analgesia in Paediatric Patient- A C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated.
Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated.
Intracranial surgery refers to various medical procedures that involve repairing structural problems in the brain.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. MUHAMMAD TAYYAB
IPMS KMU PESHAWAR
DEPT ANESTHESIA
Superficial parotidectomy under local anesthesia, case
report
Open Access funded by Society of Egyptian Anesthesiologists
Under a Creative Commons license
Abstract
For superficial parotidectomy general anesthesia is ideal, but certain patients
may be unfit. The present case had uncontrolled hypertension together with
difficult airway. To avoid any suspected complications, we decided to do the
operation under local anesthesia. We planned to block the maxillary nerve
and superficial cervical plexus with greater auricular nerve together
with incision site infiltration. A mixture of bupivacaine 0.25%
and lignocaine 1% with adrenaline 1: 200,000 was prepared. The block was
effective after about 15–20 min and the surgery was performed uneventfully
using only the nerve blocks with mild sedation.
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1. Introduction
The percentage of occurrence of primary parotid malignancies is about 1–3%
of all head and neck malignancies. The surgical management is individualized
due to wide variability in the clinical behavior and presentation and influenced
by tumor location, histological grade, extent, and spread. The surgical
management includes superficial parotidectomy, total conservative
parotidectomy, and radical parotidectomy, palliative biopsy only, and neck
dissection [1].
One of the most common procedures of the parotid is superficial
parotidectomy. General anesthesia is ideal but certain patients may be at risk
or unfit for general anesthesia [2].
2. A method of obtaining an effective anesthesia for such cases is nerve block.
To effectively block the parotid area, the maxillary, superficial cervical
including greater auricular nerve block and local skin infiltration were planned
to be performed. A written consent had been obtained from the patient for the
publication of this case report.
2. Case description
62 years old male complained from swelling just below angle of mandible right
side which was gradually increasing for 6 months, with no relation with meals.
The swelling was cystic in some and solid in other areas, non-tender, non-
fluctuant, and partially mobile swelling. Stensen’s and Warthin’s duct openings
were normal. Ultrasound examination revealed 2.3 × 5.3 × 3.4 cm well-defined
lobulated margined soft tissuemass with cystic component and multiple tiny
irregular sponge like anechoic areas.
Preoperative evaluation showed the following: 1- Obese patient weighed
130 kg with BMI of 47.8. 2- history of obstructive sleep apnea. 3- Poorly
controlled chronic hypertensive (BP was 200/110 mmHg) on
double antihypertensive medications (Calcium channel blocker and
angiotensin converting enzyme inhibitor). 4- Poor R wave progression and left
ventricular hypertrophy in ECG. 5- Airway evaluation revealed short neck,
large tongue, Mallampati score of III, limited neck mobility and mentosternal
distance of 9.5 cm.
All Laboratory investigations were within normal except mild elevation in
serum creatinine (1.6 mg/dl).
The patient postponed twice for blood pressure control. On the day of surgery
his BP was 160/100 mmHg.
The increased risk for complications from a general anesthetic, gave rise to
use local or regional anesthesia. We decided to perform maxillary, superficial
cervical including greater auricular nerve block and local skin infiltration
for excision biopsy of the parotid tumor, after a discussion with the patient and
surgeon to avoid general anesthesia and complications related to
hypertension and difficult airway (see Fig. 1).
3. 1. Download high-res image (125KB)
2. Download full-size image
Fig. 1. Preoperative assessment a- patient characteristic b- parotid ultrasound
image.
3. Operation technique
The surgery was done in a fully equipped operation theatre with full support
of general anesthesia and all emergency resuscitation measures. A plan was
made to manage the suspected difficult airway according to ASA guidelines.
Different blade sizes, Mc Coy’s laryngoscope, fiberoptic, and an assistant
anesthesiologist were all ready.
Premedication with midazolam 3 mg with 40 μg fentanyl and Ringers
lactate 1000 ml. Patient was positioned with head turned to the opposite side
on a headrest. An injection of bupivacaine 0.25% (2 mg/kg) and lignocaine 1%
with adrenaline 1: 200,000 (7 mg/kg) was prepared.
The plan was to block the maxillary nerve and superficial cervical plexus with
greater auricular nerve together with incision site infiltration. The posterior
border of sternomastoid muscle was marked at the middle and at the junction
of the upper and middle one-third (Fig. 2).
4. 1. Download high-res image (631KB)
2. Download full-size image
Fig. 2. Anesthesia technique and intraoperative condition.
3.1. Superficial cervical plexus and Grater auricular nerve block
Technique
After cleaning the skin with povidine iodine solution, the needle was inserted
at midpoint of posterior border of the sternomastoid, and behind it three
injections of 5 mL of local anesthetic are injected subcutaneously,
perpendicularly, cephalad, and caudal in a 'fan' fashion.
Then at the junction of the upper and middle one-third another three injections
in three directions, first cephalad at the posterior border of sternomastoid
5. muscle and then anterior and upwards superficial to it and then posterior and
upward.
3.2. Maxillary nerve block (V2 block)
Technique: external approach
A needle was inserted just below the zygomatic arch midway between the
coronoid and condyle of the mandible. It was inserted perpendicular to the
skin until the pterygoid plate was felt (fig.2B (1)). The needle was then
withdrawn and guided anteriorly towards the eye to enter the pterygopalatine
fossa (fig.2B (2)). Five ccs of local were injected when paraesthesia of the
upper jaw is elicited.
3.3. Wond site infiltration
Skin wound site infiltration of local anesthesia with 10 cc mixture of local
anesthetic prepared before.
Onset of anesthesia occurred within 15–20 min. The facial nerve and its
branches were saved. No other lymph nodes were identified during surgery.
Superficial parotidectomy was done. The surgery was performed uneventfully
using only the nerve blocks.
4. Discussion
Parotidectomy is generally indicated for histopathological diagnosis of
a parotid mass. Parotid masses are generally benign, the incidence of which
is around 2.4 per 100,000 [3].
Factors determining the extent of surgery include tumor size and degree of
local extension. Facial nerve and its peripheral branches are at risk during
superficial parotidectomy surgery under GA. About 30–65% of patients suffer
from transient facial nerve paralysis and 3–6% has permanent dysfunction of
the facial nerve following total superficial parotidectomy [4].
Preservation of facial nerve peripheral branches requires high surgical skills
and it can be done by using nerve stimulator which is costlier and usually
available at tertiary care hospitals. Local or regional anesthesia can be used
to preserve facial nerve. Under LA, patient complaints of pain and discomfort
6. if dissection involves facial nerve sheath or its peripheral branches thus
helping in its identification and prevention of iatrogenic nerve injury [1].
There have been a few reports of parotid surgeries under local anesthesia [5–
7] using different techniques [5–7] with the use of a mixture
of bupivacaine and lidocaine for local anesthesia [8].
Bupivacaine is four times more potent than lidocaine and has a longer
duration of action of 6 h. However, lidocaine has a faster onset of action within
3–5 min. Offering a mixture of both to the patient provides a quick onset with a
larger duration of action, adequate for the surgery. Recently parotidectomy
under LA has come in vogue [8–10].
Surgical anesthesia or supplemental pain control can be provided for any
surgery involving the inferior portion of the external ear, the area overlying the
mastoid process, procedures of the parotid gland, or procedures involving the
angle of the mandible by blocking greater auricular nerve [11].
We found that LA technique can be really helpful if patient is at risk during
general anesthesia like in our case of uncontrolled high BP. It also had an
advantage of avoiding airway manipulations in case of suspected
difficult intubation as in our case. Smooth recovery postoperatively with less
usage of narcotics and other drugs with less pain and complications leading to
shorter hospital stay with early healing are added advantages.
Steckler [12] had enumerated the advantages of a parotidectomy using local
anesthesia:
(1)
No muscle relaxants are required as the surgery is conducted in a
relatively superficial plane. This allows for easy testing of the integrity of
the facial nerve.
(2)
Various manoeuvres for identifying the facial nerve, such as use of a
nerve stimulator or injecting a dye into the parotid duct are rendered
superfluous.
7. (3)
Chances of drug overdose are minimised as not more than 20–25 ml of
0.5% of bupivacaine are required.
(4)
The present-day concept of out-patient parotidectomy is promoted, as a
procedure under local anesthesia facilitates early discharge.
The performed technique was different as none of
previously described techniques used the
combination of maxillary, superficial cervical with
greater auricular nerve block together with wound site
infiltration. I think that incision site infiltration and
overlaps in sensory innervation between maxillary
nerve from above with that of superficial cervical
plexus and greater auricular nerve from below helped
in dispensing the block of mandibular nerve.
5. Conclusion
Parotidectomy under LA is an effective alternative
to general anesthesia that can be considered in
patients who are at high risk during GA. It gives the
advantage as patient is conscious and awake thus
maintaining good airway. Discomfort if dissection is
too near to the facial nerve help in protection of it from
injury.