By Vijay P. Khatri MD FACS
Strengthen your surgical services with Atlas of complicated Operative surgical procedure! This new source choices up the place different surgical references depart off, delivering hugely visible, step by step information on greater than a hundred complicated and intricate techniques in either basic and subspecialty parts.
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U The majority of deep lobe parotid tumor resections are generally enucleations. If the tumor is very close to the lower division of the facial nerve, then the nerve should be identified and carefully dissected off the parotid tumor. If the tumor involves the anterior portion of the parotid gland, it may be u Chapter 3 • Superficial Parotidectomy 27 Bipolar cautery Zygomaticotemporal branch Figure 3-4. Buccinator branch Parotid duct Cervical branch Figure 3-5. Deep parotid gland Figure 3-6. Suction drain 28 Section I • Head and Neck an accessory parotid tumor.
The American Academy of Otolaryngology—Head and Neck Surgery has made genuine efforts to standardize the nomenclature and surgical procedure. A variety of modified neck dissections are quite popular; however, modified neck dissection type 1, which preserves the accessory nerve, is described here. A comprehensive neck dissection includes removal of all lymph nodes in the neck with preservation of the accessory nerve, sternomastoid muscle, and jugular vein. Other modified neck dissections include supraomohyoid neck dissection (commonly performed as a staging procedure—elective neck dissection—in patients with cancer of the oral cavity or oropharynx), the jugular neck dissection or anterolateral neck dissection (commonly performed for patients with tumors of the oropharynx and laryngopharyngeal area), and lateral neck dissection (mainly performed for patients presenting with metastatic melanoma or skin cancer posterior to the sternomastoid muscle).
The most common benign tumor of the parotid gland is pleomorphic adenoma, followed by Warthin tumor and oncocytoma. u The most common presentation is a mass in the parotid region. The mass might have been present for a long time, and there may be a recent and rapid increase in the size of the mass. The clinical signs of malignancy include skin involvement, facial nerve palsy, fixation of the tumor to the surrounding structures, and presence of nodal metastasis. u Special preoperative preparation includes a thorough clinical evaluation, including evaluation of the location of the tumor, facial nerve function, and status of the lymph nodes.
Atlas of Advanced Operative Surgery by Vijay P. Khatri MD FACS