Parotidectomy

2018 ◽  
Author(s):  
John A. Ridge ◽  
Francis Si Wai Zih
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Nerve Injury ◽  
Main Trunk ◽  
Nerve Monitoring ◽  
Salivary Fistula ◽  
Facial Nerve Injury ◽  
Gustatory Sweating ◽  
Parotid Neoplasm ◽  
Parotid Surgery

When a patient presents with a mass at the angle of the mandible, a neoplasm within the parotid gland is a strong consideration. The parotid is the largest of the salivary glands. Terminal branches of the facial nerve are found within the gland. Their functional preservation is an important goal of parotid surgery. Risks of facial nerve injury rise in reoperative procedures and resection of cancers. Surgical principles apply in parotidectomy. In addition to facial nerve injury, a numb earlobe, contour deficit, salivary fistula, and gustatory sweating should be discussed with the patient before an operation. Most lesions can be removed after identification of the main trunk of the facial nerve, but a retrograde approach after finding a peripheral branch may be required. No randomized trials support a benefit from nerve monitoring. An intact facial nerve will usually begin to function, but months of recovery time may be needed. Permanent paralysis is rare. Salivary fistulae are usually self-limited. Many methods to ameliorate the cosmetic changes after parotidectomy have been described. None has gained ascendency. This review contains 6 figures and 61 references. Key words: facial nerve, facial paralysis, Frey syndrome, gustatory sweating, nerve monitoring, parotid gland, parotid neoplasm, parotidectomy, salivary fistula 

scholarly journals Open Treatment of Mandibular Condyle by Direct Transparotid Approach: Our Experience

2020 ◽  
Vol 13 (2) ◽  
pp. 109-114
Author(s):  
Mohammed Salman Basha ◽  
Hussain AlAithan ◽  
Nyer Firdoose
Keyword(s):  
Surgical Technique ◽  
Facial Nerve ◽  
Nerve Injury ◽  
Mandibular Condyle ◽  
Surgical Practice ◽  
Salivary Fistula ◽  
Facial Nerve Injury ◽  
Major Complications ◽  
Open Treatment ◽  
Condyle Fracture

The fractures of the mandibular condyle are commonly encountered in maxillofacial surgical practice. The controversies to open or not to open are still ongoing. We have used both techniques, to successfully manage our patients. Open treatment of condyle fracture with or without dislocation is technically challenging. We used a “Direct Transparotid” approach in treating 13 condyle fractures over a period of 4 years. The patients were evaluated for facial nerve injury, salivary fistula, scar, function, and occlusion over a period of 12 months. There were no major complications with acceptable scar, both intraoperatively and postoperatively. The script aims at presenting our experience of direct transparotid approach surgical technique.

Patterns of Use of Facial Nerve Monitoring During Parotid Gland Surgery

2005 ◽  
Vol 133 (3) ◽  
pp. 313-318 ◽  
Author(s):  
Thomas R. Lowry ◽  
Thomas J. Gal ◽  
Joseph A. Brennan
Keyword(s):  
United States ◽  
Parotid Gland ◽  
Facial Nerve ◽  
The United States ◽  
Nerve Monitoring ◽  
Patterns Of Use ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery ◽  
History Of ◽  
Training Background

OBJECTIVE: To determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States. STUDY DESIGN AND SETTING: A questionnaire encompassing surgeon training background, practice setting, patterns of facial nerve monitor usage during parotid gland surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between facial nerve monitor usage and dependent variables were examined by using the χ 2 test. Magnitudes of the associations were determined from odds ratios calculated using logistic regression. RESULTS: A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy employed facial nerve monitoring some or all of the time. Respondents were 5.6 times more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed more than 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertent nerve injury if they performed more than 10 parotidectomies per year. Surgeons who employed monitoring in their practice were 20.8% less likely to have a history of a parotid surgery-associated lawsuit. Additional information regarding surgeon demographics, types of nerve monitors used, and reasons for and against monitor usage are discussed. CONCLUSION: Permanent facial nerve paralysis after parotidectomy occurs in 0-7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.

Facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery

2020 ◽  
Vol 277 (8) ◽  
pp. 2315-2318 ◽  
Author(s):  
Se Hyun Jeong ◽  
Hee Young Kim ◽  
Dong Hoon Lee ◽  
Joon Kyoo Lee ◽  
Sang Chul Lim
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Nerve Injury ◽  
Tumor Surgery ◽  
Gland Tumor ◽  
Facial Nerve Injury ◽  
Parotid Gland Tumor

scholarly journals Malignant Mucoepidermoid Tumor Arising in the Accessory Parotid Gland: A Case Report

2003 ◽  
Vol 46 (2) ◽  
pp. 79-83 ◽  
Author(s):  
Demetrio Tamiolakis ◽  
Vasilios Thomaidis ◽  
Ioannis Tsamis ◽  
Theodoros Jivannakis ◽  
Ageliki Cheva ◽  
...  
Keyword(s):  
Case Report ◽  
Parotid Gland ◽  
Facial Nerve ◽  
Mucoepidermoid Carcinoma ◽  
Low Grade ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Parotid Neoplasm ◽  
Parotid Surgery ◽  
Accessory Parotid Gland

Purpose: The head and neck surgeon’s fascination with parotid surgery arises from the gland’s spectrum of histopathological presentations, as well as the diversity of its morphological features. A mass arising in the mid-cheek region may often be overlooked as a rare accessory lobe parotid neoplasm. This report serves to revisit the topic of accessory parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of salivary fistula, facial nerve paralysis, and recurrence are avoided. Case report: We report a case of mucoepidermoid carcinoma which was assessed pre-operatively as arising from the accessory parotid gland of a 11-year-old female. She had complained of a painless and round mass of the left cheek for a duration of 12 months. Sialography, ultrasonography, CT scan and MRI were performed preoperatively. Sialography revealed a small duct separating from the Stensen’s duct. CT and MRI showed that the tumor with smooth outline was lying on the masseter muscle and detached from the main parotid gland. The preoperative diagnosis was an accessory parotid gland tumor. The tumor was removed without facial nerve injury via standard parotidectomy incision. The tumor was composed of mucous, intermediate and epidermoid cells. The pathological diagnosis was low-grade mucoepidermoid carcinoma. Conclusions: Accessory parotid gland neoplasms are rare and may present as innocuous extraparotid mid-cheek masses. A high index of suspicion, prudent diagnostic skills (including fine-needle aspiration [FNA] biopsy followed by computed tomography [CT] imaging), and scrupulous surgical approach (extended parotidectomy-style incision and limited peripheral nerve dissection when possible) are the keys to successful management of these lesions.

Major Congenital Ear Malformations: Surgical Management and Results

1988 ◽  
Vol 97 (6) ◽  
pp. 641-649 ◽  
Author(s):  
Paul R. Lambert
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Ossicular Chain ◽  
Nerve Monitoring ◽  
Aural Atresia ◽  
Facial Nerve Injury ◽  
Proper Patient Selection ◽  
Facial Nerve Monitoring ◽  
Speech Reception Thresholds ◽  
Congenital Aural Atresia

Fifteen patients with major congenital aural atresia underwent operations using an anterior (trans-atretic bone) approach. Facial nerve monitoring was used in all cases and there were no instances of facial nerve injury. Postoperatively, two thirds of the patients had speech reception thresholds of 30 dB or better; the air conduction threshold (averaged for 500, 1,000, and 2,000 Hz) improved at least 25 dB in 80% of the patients and at least 30 dB in 60% of the patients (follow-up, 10 to 29 months). Minor revision surgery was necessary in three patients. On the basis of this series, several conclusions were made. First, one of the most important factors in proper patient selection is the degree of middle ear development on computed tomography, both in terms of size and ossicular formation. Second, every attempt should be made to keep the ossicular chain intact (versus use of a prosthesis), as this appears to optimize hearing results. Third, embryologic considerations and surgical experience predict a mobile stapes in the majority of major atresias. Lastly, facial nerve abnormalities are to be expected, especially in patients with significant microtia, but facial nerve monitoring will help minimize the risk of facial nerve injury.

Stimulation of Trigeminal Afferents Improves Motor Recovery After Facial Nerve Injury

2013 ◽  
Author(s):  
Emmanouil Skouras ◽  
Stoyan Pavlov ◽  
Habib Bendella ◽  
Doychin N. Angelov
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Motor Recovery ◽  
Facial Nerve Injury ◽  
Stimulation Of
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