Superficial Parotidectomy

Anatomy
 Major Glands
 Parotid, submandibular and
sublingual glands
 Minor Glands
 Hundreds residing in the oral
cavity, pharynx and paranasal
sinuses.
Parotid Gland
 Pyramidal in shape and lies in pre
auricular area, inferomedial to external
auditory meatus

 Posterior: mastoid and tympanic

processes of temporal bone, external
auditory canal and styloid process
 Lateral: Parotid fascia, SMAS
(superficial musculoaponeurotic
system)
 Medial: Masseter
 Superior: Zygomatic arch
 Inferior: Sternocleidomastoid,
posterior belly of digastric
 Facial nerve divides the gland into the
superficial (80 %) and deep lobe (20%)
 Parotid duct (Stensons) is 5 cm long and
opens opposite the second molar.
Epidemiology

 Salivary tumors 7% of head and neck tumors

 Parotid tumors 10x more common then submandibular and 100x more
common then lingual
 Parotid 80% benign (pleomorphic adenoma)
 Equal incidence between sexes
 Risk Factors: nutritional deficiency, exposure to ionizing radiation, UV
exposure, genetic predisposition, EBV
Symptoms

 Painless mass
 Facial Paralysis: inability to move one
side of face, one shoulder, one side of
tongue.
 Trismus
 Dysphagia
Physical examination

 Inspection
 Extraoral
 Intraoral
 Palpation:
 Painless or painfull mass
 Soft, firm, hard or cystic mass
 Mobile or fixed to the deep tissue
or skin
 Neck palpation for adenopathy
Physical examination

 Intraoral examination:
 tonsillar fossa and soft palate.
 Inspect the Stensen duct for the
character of the salivary flow
(clarity, consistency, purulence)
 Evaluate the skin, oral cavity,
oropharynx, and neck for possible
primary lesions or nodal disease.
Pathology

 Benign Tumors
 Pleomorphic Adenomas, Warthin tumors, monomorphic adenomas, oncocytomas
 Malignant tumors
 Mucopidermoid carcinoma (most common )– low grade, slow growing cured by
surgery alone
Treatment
 Surgery -Parotid
 90% confined to superficial lobe – perform superficial
parotidectomy
 If adjacent to deep lobe - total parotidectomy
 If invades adjacent soft tissue – radical parotidectomy
 Never perform piecemeal excision in an attempt to preserve
facial nerve
 Nerve grafting can be performed and RT can start3-4 wk post
op without adverse affects
 Frey’ssyndrome – (gustatory sweating) due to redirection of
parasympathetic and sympathetic nerve fibers to the dermal
sweat glands
Superficial Parotidectomy

“Lazy-S” incision
The anterior skin flap is raised sharply in a supraplatysmal
plane, above the parotid fascia, to the anterior border of gland.
The subcutaneous fat is elevated with the skin flap.

The posterior skin flap is then elevated, exposing the anterior

border of the SCM muscle and the mastoid process
The operation begins in the plane deep to the tail of the parotid.

The great auricular nerve and external jugular vein are identifi ed at this time

As the dissection proceeds anteriorly, the tail of the parotid is dissected from the
SCM muscle and mastoid process, and the posterior belly of the digastric muscle is
exposed
The posterior aspect of the gland is now dissected from the external auditory
canal.

The main trunk of the facial nerve is now close by. It is approximately 1 cm
deep to the tip of tragal pointer (anterior and inferior), 6 to 8 mm below the
end of the tympanomastoid fissure , and just above and on the same plane as
the attachment of the digastric muscle in the digastric groove
Facial Nerve Identification
 Cartilaginous pointer
 Posterior belly of the digastric
muscle
 Mastoid tip
Following identification of the main trunk, dissection proceeds in a plane
superficial to the nerve.

A curved hemostat or scissors, with tips facing upward, is used to spread the
tissue immediately superfi cial to the nerve, keeping the nerve under direct
vision at all times.

The main trunk is dissected anteriorly until the pes anserinus is reached.
Dissection of individual facial nerve branches to the periphery of the gland
is performed.

A fine curved hemostat or scissors is used to dissect just on top of the nerve,
elevating the parotid tissue off the nerve.

This is done until all the branches are exposed and the gland is removed
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