Parotidectomy

Preop Considerations:
  1. Oral intubation
  2. Do not use paralytics so that facial nerve can be identified
  3. Position the patient with the head turned to the contralateral side with neck extended
  4. Elevate the head of the bed slightly to decrease venous pressure
Procedure:
  1. The incision starts in front of tragus of the ear, curves around the lobe and lies in the highest neck crease
  2. Elevate the subplatysmal skin flap
    1. Cartilage of the ear superiorly
    2. Sternocliedomastoid muscle (SCM) posteriorly
    3. Digastric muscle and stylohyoid muscle medially
  3. Locate the facial nerve
    1. Retract SCM posteriorly and parotid anteriorly
    2. Lies 5mm inferior to the tip of cartilage from the ear canal (Tragal Pointer)
    3. Can follow the digastrics posteriorly from the SCM and the facial nerve will be deep to the anterior border of the posterior belly of the digastrics muscle.
  4. Dissction
    1. Free the parotid from the facial nerve
    2. Superficial parotidectomy= remove the parotid that is above the facial nerve
    3. Total parotidectomy= dissect the parotid away from the facial nerve
    4. Ligate Stensen’s duct
    5. Standard closure with drain