PAROTID SURGERY AND TYPES

1. LESS THAN TOTAL PAROTIDECTOMY
Dr. KUNAL RANJAN
SENIOR CONSULTANT
DEPARTMENT OF HEAD & NECK ONCOLOGY
MAHAVIR CANCER SANSTHAN AND RESEARCH CENTRE
PATNA

2. Classification of Parotidectomy
• Snow’s classification
• Tweedie and Jacob classification
• Japanese classification
• Spanish classification
 very clumsy and difficult to use and
remember
 hardly used in practical purposes in day to
day

5. Still this system is not used very frequently in
day to day practice

6. Superficial parotidectomy/ Lateral lobectomy
Adequate Parotidectomy/ Partial superficial
parotidectomy
Extracapsular dissection
Enucleation: Historical imporatnce, should not
be done.

7. Indications:
Benign tumors
Low grade , early stage ( T1, T2)
Superficial lobe disease

8. Superficial parotidectomy: Implies complete
removal of the parotid gland superficial to the
plane of the facial nerve.
Facial nerve is identified at main trunk
All branches of facial nerve are to be identified

10. Adequate parotidectomy / Partial superficial
parotidectomy: Implies removing the tumor
completely, taking care to avoid capsular rupture or
nerve damage, with approximately 0.5– 1-cm tumor-
free margins.
 Facial nerve identified at main trunk
 FN branch adjacent to the tumor site is dissected and
preserved
 Preserves the uninvolved parotid parenchyma
 Obviates the need for more extensive FN dissection
 Benign tumors, limited to superficial lobe, preferably
small pleomorphic adenomas in tail parotid

12. Extra capsular dissection:
same incision of the superficial parotidectomy
 Respecting and preserving the tumor capsule
 Without identification of the facial nerve.
 Facial nerve monitoring is must

14. • 14 cohort studies( n=3194)
• No significant difference in tumor recurrence
rate between ECD & SP
• Significant lower incidence of transient FN
dysfunction, permanent FND, Frey’s syndrome
in ECD compared with SP.

15. • n= 102
• Limited partial parotidectomy( 49)
• Superficial or total parotidectomy( conventional)
• duration of operation was 0·7 h shorter and the overall
complication rate significantly lower in the functional
surgery group
• more patients were satisfied with their scars ,facial
contours, the auricular nerve sensory recovery rate was
high, and transient facial paralysis ,Frey’s syndrome were
infrequent (12 and 6 per cent respectively)

16. • Study investigated complication rates and effectiveness
of ECD versus superficial parotidectomy for the
treatment of primary benign parotid neoplasms.
• 1882 patients
• Tumor recurrence – no difference
• Lower rate of transient facial nerve paresis in ECD
group 8% vs 20.8%
• No difference in permanent facial nerve palsy
• Frey's syndorme4.5% vs. 26.1%
• ECD has a similar recurrence rate as SP with fewer post
op complications

17.  There is little evidence to recommend
less than comprehensive lateral parotid
lobectomy for known low-grade primary
malignant parotid tumors.
Little evidence to
recommend less than
superficial parotidectomy

18. Symptom specific quality of
life in benign disease various
types of parotid surgery
the value for sensory
impairment after extra capsular
dissection with 84.2
 the values for sensory
impairment, Frey’s syndrome, and
fear of revision surgery after
superficial parotidectomy with 87,
87, and 89.8, respectively, are
lower than 90 on the 100-point
scale
Most values are above 90,
indicating a high symptom-
specific QOL.

19. MINIMU
Partial
superficial
parotidectomy
Subtotal
parotidectomy
Superficial
parotidectomy
Total
parotidectomy
Extracapsular
dissection
Enucleation
Identification of
main trunk
+ + + + _ _
Branches
exposure
Minimum,
running to
tumor
> 2, most
of them
All 5
100%
All 5
100%
_ _
Parotid tissue Part of Major
portion
Superficial
portion
removed
Superficial
and deep
lobe
Small cuff
of
surroundi
ng tissue
Leaving
capsule,
not
practiced
contour normal lost lost lost normal normal
Frey’s
syndrome
No,10% high high high low low
Facial nerve
palsy
permanent
1 to 2% 1 to 2% 1 to 2% 4 to 6% 1 to 2% 1 to 2%
Temporary
palsy
10 to 15% 20 to 30% 20 to 30% 60% 10% 10%
Recurrence 1 to 2% 1 to 2% 1 to 2% 1 to 2% 1 to 2% 40 to 60%

20. Conclusion
• Facial nerve main trunk identification must in
Parotidectomies
• In ECD ( Extra capsular dissection) nerve not identified at
main trunk but facial nerve monitoring is always necessary
• Enucleation never to be practiced
• Partial superficial parotidectomy gives lesser complication
with better QOL without increase recurrence .