Parotidectomy Pg. 678

Surgical Intervention The surgical excision of part or all of the parotid gland

Relevant Anatomy & Physiology Parotid Gland- Assists with the excretion of saliva Stensen's Duct- Duct that excretes saliva to the oral cavity Facial nerve and relevant branches

Pathophysiology & Diagnostic Exams Cancer Stones (Sialolithiasis) or blockages that are too large H&P CT MRI

Anesthesia, Positioning, Prep, Draping General Supine with operative site up and arms tucked to the sides with a donut headrest Prep operating side of the face over past the midline including the ear extending to the hairline to the axilla -to prevent prep solution from entering the ear gently place a cotton ball Turban-style with towels to cover hair Bar drape across the forehead and opened superiorly to cover the head U-drape or split sheet and placed along the bottom of the neck using the clavicle as landmarks.

Incision: Inverted T or Modified Y

Supplies, Equipment, Instrumentation Basin Set Blades #10x1, #15x3 Suction tubing ESU pencil and cord, holder, scraper, and needle tip Dissectors (e.g. peanuts or kittners) Umbilical tape, vessel loops Bulb syringe with saline Padded Head Rest Suction ESU Nerve Stimulator/Locator e.g. Concept Fiber Optic Headlight and light source Fiber Optic Microscope Viewing Tower and Equipment Basic/Minor Procedures Tray Thyroid Tray Tracheostomy Tray Right-angle Clamps x 4, Yankauer Suction, Nerve Hook, and Skin Hooks. Sterile Wires x 2 With Needle Electrodes

Procedural Steps Incision of choice is made Skin flaps are established by carefully elevating the skin and fat. For the upper flap, provide traction upward and medially on the dissected skin, and laterally toward the external auditory canal Form the lower flap by dissection of the skin downward and posteriorly toward the mastoid process.

Procedural Steps The gland is identified and dissected free from the sternocleidomastoid muscle with Metzenbaum scissors, electrocautery, and DeBakey forceps. The gland is dissected free from its attachments to the external auditory canal which then reveals the facial nerve and relevant branches

Procedural Steps All branches are identified by Place the distal phalanx of the left index finger on the mastoid, pointing to the eye of the patient. Carefully incise the parotid fascia and further mobilize the superficial part of the parotid Insert a hemostat between the mastoid and the gland and bluntly spread the gland medially The stem of the nerve will always be found at the depth of less than 0.5 cm. If there is any doubt about identifying the nerve, use electrical stimulation . Exert upward traction on the superficial lobe and , with a curved hemostat, begin dissection over the nerve. Identify all five branches Facial, temporal, zygomatic, mandibular, and cervical

Procedural Steps Dissection is continued until the superficial lobe is excised. the deep lobe is resected, keeping in mind the Pterygoid venous plexus external carotid artery maxillary nerve superficial temporal nerve posterior facial vein Must be ligated using fine chromic catgut The deep lobe is removed

Procedural Steps The deep lobe is removed the wound is thoroughly irrigated and suctioned and checked for bleeding A closed-wound drainage system is placed Wound is closed in layers and a bulky dressing is placed

Counts, Dressing Materials, & Specimen Care Initial After layers Closing DPC Excised portions must be marked and sent to pathology

Prognosis, Complications, & Classification No complications- return to normal activities in 2-3 week SSI Hemorrhage Farcical nerve weakness or paralysis, temporary or permanent Class 1- Clean