Parotidectomy

A parotidectomy ( Greek para παρά 'next to'; ous, otos οὖς, ῲτός 'ear'; ek ἐκ 'out'; tome τομή 'cut') is understood to mean a partial or complete surgical removal of the parotid gland ( glandula parotidea , glandula parotis , Parotid ). The procedure is most often performed for benign or malignant tumors , less often for inflammatory or other diseases of the parotid gland.

Indications

The most common indication for parotidectomy are tumors of the parotid gland. In terms of numbers, the pleomorphic adenoma and the Warthin tumor , which are benign neoplasms , are particularly significant . Malignant tumors are in the majority of cases metastatic spread of squamous cell carcinoma , adenoid-cystic carcinoma , malignant ( sialadenitis ) or injuries may require an operation.

Parotid anatomy

Parotid anatomy.

The parotid gland is the largest of the oral salivary glands, weighing 20 to 30 grams . It lies immediately in front of the outer ear , where it extends from the zygomatic arch to just below the angle of the jaw . The gland is enveloped by a connective tissue sac, the parotid fascia , and divided into two parts, the superficial and deep leaf . The cone-like deep glandular lobe slides behind the branch of the lower jaw and extends into the connective tissue space on the side of the throat . It is connected to the superficial part of the gland via the isthmus . The facial nerve ( nervus facialis ) runs between the two lobes in a surgically split plane .

Lateral parotidectomy

In a lateral parotidectomy , the superficial part of the gland is removed while protecting the facial nerve. The procedure usually requires general anesthesia . First the skin is opened with an S-shaped incision starting from the tragus and pulling downwards behind the lower jaw angle and the skin flap is detached from the whitish shimmering parotid fascia. The gland is then mobilized by separating it from the sternocleidomastoid muscle , the mastoid and the cartilaginous ear canal . After exposing the facial nerve, the superficial part of the parotid is removed directly along the facial nerve or its branches. After inserting a Redon drain , the wound is closed in layers.

Subtotal and total parotidectomy

A lateral parotidectomy is performed first. In addition, the facial branches are mobilized from the mat and lifted by rubber reins. Now the deep parts of the gland from the masseter muscle , the bony and cartilaginous base of the ear and the sternocleidomastoid muscle are loosened, rolled out under the facial nerve and removed. The only difference between subtotal and total parotidectomy is the radical nature of the tissue removal. In the latter procedure, the entire parotid tissue is resected. It may be necessary to remove parts of the facial nerve with malignant tumors that have a close spatial relationship to the nerve. In rare cases, the tumor also originates from the facial nerve itself (e.g. facial neuroma ).

Complications

A dreaded complication of parotidectomy is an injury to the facial nerve resulting in partial or complete facial paralysis . A temporary weakness of the facial muscles is observed in a quarter to a half, permanent paralysis in only 1–2 percent of the operations. The risk depends on the radical nature of the operation performed. Up to 90 percent of patients are affected postoperatively to varying degrees by Frey's syndrome , in which there is increased sweating in the area of ​​the operated face while eating. In some cases, a bruise ( hematoma ) or an accumulation of wound exudate in the surgical area ( seroma ) may occur. As with any surgical procedure, wound infection is also possible. Deaths related to the immediate surgery are observed extremely rarely.

Alternatives

Surgical removal of benign tumors of the parotid gland can sometimes be dispensed with, for example if the surgical risk is disproportionately high due to concomitant diseases. However, the possibility of malignant degeneration of the tumor or local complications due to tumor growth must be carefully considered. A limited procedure, for example in the form of enucleation of the tumor, is also possible, but it entails a higher rate of recurrences and can therefore only be considered in the case of less aggressive neoplasms such as the Warthin tumor . In the case of malignant tumors , non-invasive therapeutic methods such as radiation can be used, usually only with palliative goals .

Individual evidence

1. ↑ ^{a b c} R. Bova, A. Saylor, WB Coman: Parotidectomy: review of treatment and outcomes. In: ANZ journal of surgery. Volume 74, Number 7, July 2004, pp. 563-568, ISSN  1445-1433 . doi: 10.1111 / j.1445-2197.2004.02988.x . PMID 15230791 .
2. ↑ A. Rauber , FW Kopsch Human anatomy: textbook and atlas. Volume II: Internal Organs . Thieme, 1987, ISBN 3-13-503401-1 .
3. ↑ PE Böhme: Parotid and facial nerve. In: Langenbecks Arch Klin Chir Ver Dtsch Z Chir. 298, 1961, pp. 920-923. PMID 13870471
4. ↑ ^{a b} J. Theissing, G. Rettinger, JA Werner: ENT Operationslehre. 4th edition. Thieme, 2006, ISBN 3-13-463704-9 .
5. ↑ T. Kirazli, K. Oner, C. Bilgen, I. Ovül, R. Midilli: Facial nerve neuroma: clinical, diagnostic, and surgical features. In: Skull Base. 14 (2), May 2004, pp. 115-120. PMID 16145593
6. ↑ ^{a b} M. K. Fyke, SD Sherk: Parotidectomy . Encyclopedia of Surgery
7. ↑ S. Dubner: parotid tumor, benign. (November 20, 2008)

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