1. Parotidectomy
Pg. 678

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

3. 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

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

5. 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.

6. Incision: Inverted T or Modified Y

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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

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

14. 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