Parotidectomy - ROJoson's TPORs - 2014

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.