Parotid Ectomy

PAROTIDECTOMY
• The parotid gland is the largest of the salivary glands

• That produce saliva that is important in the digestion of
food.
• The gland lies under the angle of the jaw just beneath
the ear.
Anatomy and Physiology
• The parotid gland is shaped like an upside-down triangle

and lies in front and below the opening to the ear canal.
• In front of the gland is the posterior (back) surface of the
jawbone and the masseter muscle. The deep surface of
the gland lies alongside the back of the throat, near the
tonsils.
• Normally, the parotid gland cannot be felt
• The facial nerve divides the gland into a superficial and
deep lobe.
• The facial nerve supplies all of the muscles that move
the face.
• It arises in the skull and then exits through a small
opening behind the parotid gland. It then enters the
parotid, runs through it, and divides to supply the
muscles of the face
• Saliva drains through a small duct from the front of the
parotid gland and empties into the mouth near the upper
second molar tooth
Pathology
• The main conditions that effect the parotid gland are:
– Inflammation and infection of the gland
– Tumors of the parotid gland
• Inflammatory and Infectious conditions:
– Stones in the saliva may obstruct the duct that drains the
parotid gland, usually seen in an elderly, dehydrated patient
– The obstructed parotid duct may lead to infection of the
gland, abscess in the parotid gland
– Viral disease may also involve the parotid gland such as mumps
or coxsackie virus
– Illnesses like tuberculosis or the fungus, actinomycoses, may
infect the gland
• Tumors of the parotid
– 70 – 80% of parotid tumors are benign
– The most common benign tumor is the pleomorphic adenoma,
more often in females. About 5 - 10% of patients with
pleomorphic adenoma develop cancer
– The second most frequent benign tumor is called a Warthin's,
seen more often in males and occurs in both parotid glands in
about a 10% of patients
– Cancer of the parotid gland occurs in about 20 - 25% of parotid
tumors.
– The most common cancer of the parotid glad is the
mucoepidermoid carcinoma.
- low grade in which the tumor cells are abnormal but still look
similar to parotid gland cells.
- high grade in which the cells are very abnormal and no longer look
quite like parotid gland cells
– Adenoid cystic carcinoma is a more malignant tumor and has a
tendency to metastasize to the lungs. The tumor may also extend
along the local nerves
Clinical Examination
• Infection and inflammation

– Infections of the parotid from blockage of the parotid duct may
result in fever and pain on eating, which tend to increase the flow
of saliva
– An abscess in the parotid may give rise to a large, swollen mass
over the parotid area
– Other inflammatory conditions of the parotid are usually painless,
seen bilaterally and disappear by themselves
• Cancer
– A lump in front of the ear should be assumed to be from the
parotid. Even if a swelling has been present for years, it may still
be cancerous, as these tumors may be slow growing
– Tumors of the parotid are usually painless and slow growing. Pain
in this area or paralysis of the facial muscles is a poor sign,
suspect a cancer involving the facial nerve
– Another symptom is called formication. as the feeling of ants
crawling over the side of the face. involvement of the facial nerve
with tumor
– Involvement of the facial nerve is almost never seen in benign
tumors
– Spread to lymph nodes may present as swellings along the side
of the neck
Diagnostic Tests
• Fine Needle Aspiration (FNA), cannot reliably tell the

difference between benign and cancerous disease
• Contrast sialography - a small tube is placed in the
parotid duct and a dye is injected that shows up on X-ray
and outlines the duct system. This may demonstrate a
narrowing of the duct or a stone.
• CT scan or MRI scan, helps in planning the extent of
surgery
Indications for Surgery
• Infection causing an abscess in the parotid. This may

involve opening the duct of the parotid gland and
flushing it out or draining the abscess
• Parotidectomies are usually indicated for a suspected
tumor of the parotid gland
Surgical Procedure
• Under general anesthesia

• The patient's head is turned away from the side of the
tumor and the neck extended. The incision starts in front
of the ear, curves around the bottom of the ear and then
down the posterior aspect of the jawbone. The incision
may be continued down into the neck along the front
surface of the sternomastoid muscle
• The ear lobe is lifted up and backward and the posterior
border of the parotid gland is exposed first. The facial
nerve trunk is identified at this stage of the operation.
SKIN INCISION MARKER
SKIN FLAPPING
Membuat Flap kulit ke anterior. Jika tumor kecil, dapat dilakukan

“swing parotidectomy”.
FACIAL NERVE
Tampak “main trunk” dari N.C. VII, dan dibawahnya

Venter posterior m. digastrici, dan m.sternocleidomastoideus
The facial nerve and its branches are slowly
exposed.
Use of baby mosquito forceps to expose and
protect the facial neve.
The nerve tunnels
are almost
completely
dissected.
FACIAL NERVE
“Tunneling” sambil mengikuti cabang-cabang N.C.VII.
Gambaran lapangan pembedahan pasca “subtotal parotidectomy/
Superficial parotidectomy”.
Total Parotidectomy
Pasca subtotal parotidectomy  frozen section carcinoma parotis
Pembedahan dilanjutkan  total parotidectomy.
Superficial lobe pedicled between
the cervical and mandibular
branches of facial nerve prior to
deep lobe dissection on total
conservative parotidectomy.
Gambaran lapangan pembedahan pasca total parotidectomy
Gambaran pasca total parotidectomy.
Gambaran pasca “total parotidectomy”.
• Once this is identified, dissection is done along the nerve
freeing up the parotid tissue lying superficial to the nerve
and making sure not to injure the nerve
• The parotid tumor usually lies in the superficial lobe and
this should be removed with a rim of normal parotid
tissue around it
• The skin is then closed. A drain is usually left in place

Parotid Ectomy

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PAROTIDECTOMY

• The parotid gland is the largest of the salivary glands

• The parotid gland is shaped like an upside-down triangle

• Infection and inflammation

• Fine Needle Aspiration (FNA), cannot reliably tell the

• Infection causing an abscess in the parotid. This may

• Under general anesthesia

Membuat Flap kulit ke anterior. Jika tumor kecil, dapat dilakukan

Tampak “main trunk” dari N.C. VII, dan dibawahnya

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