The Total Parotidectomy
From Ask Dr Wiki
The Total Parotidectomy Procedure
Introduction & HPI:
The accompanying video demonstrates the steps in performing a total parotidectomy for a squamous cell carcinoma of the gland.
This patient is a 72-year-old gentleman who presented with a hard, fixed lesion of the pre-auricular area. There was no noted VII nerve weakness or ulceration. The patient did complain of pain in the area along with a recent growth spurt, which prompted him to seek medical attention. A CT scan of the neck with contrast showed a large mass emanating from the deep lobe of the parotid gland with attachment to the dermis. A PET/CT scan demonstrated increased uptake of the lesion without any metastatic lesion. A FNAB showed a high grade mucoepidermoid carcinoma. The patient was taken to the operating room and a total parotidectomy with VII nerve preservation was performed. The postoperative course was significant for a mild marginal mandibular nerve weakness that resolved spontaneously. The final pathology was metastatic SCCA of the parotid gland. The patient was brought back to the operating room for formal endoscopy with multiple biopsies & right tonsillectomy. All biopsies were negative as was the earlier whole body PET/CT scan. This patient was then sent for postoperative radiation therapy. A follow-up whole body PET/CT scan will be performed within the next 3 months.