This document outlines the objectives and steps for performing a parotidectomy surgery. The key objectives are to completely remove the parotid tumor while avoiding injury to the facial nerve. The surgery involves making an incision, exposing the parotid gland, evaluating the tumor, extirpating the tumor safely, checking for hemostasis, draining fluid, closing the wound, and following up with the patient. The overall goal is to resolve the health problem of a parotid tumor without complications or recurrence.

1. Parotidectomy
ROJoson’s TPORs
April 2014

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.

5. Parotidectomy
Exposure:
Objectives:
• To facilitate accurate intraoperative evaluation.
• To facilitate complete extirpation of the parotid
tumor without complication.

6. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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)

14. 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

15. Parotidectomy
Operative Procedure Proper:
Be gentle.
Be meticulous and precise.
Every move must have a reason!

27. Parotidectomy
Hemostasis Check:
Objectives:
• To avoid bleeding and hematoma.
• To avoid injury to facial nerve during
hemostasis check.

28. 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.

29. 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.

30. Parotidectomy
Drain:
Execution:
• Choice of tube drain or rubber drain.
• Remove when drain is not needed anymore.

33. Parotidectomy
Correct Count:
Objective:
• To avoid leaving sponges, surgical
instruments, and needles in the wound site.

34. Parotidectomy
Correct Count:
Execution:
• Ensure correct sponge, instrument, and
needle count before wound closure.

35. 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)

36. 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.

40. 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

42. Parotidectomy
Follow-up Plan:
Objectives:
• Evaluate results of treatment.
• Provide psychosocial support.
Monitoring guidelines
Physical examination
Symptom-directed investigation

43. Parotidectomy
Frequency of Follow-up Guidelines:
Consider
• Usual course of disease (recurrence probability
and incidence)
• Personality of patient
• Patient’s convenience

44. 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.