42426 Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection

Name of the Procedure:

Excision of parotid tumor or parotid gland; total, with unilateral radical neck dissection
Common name(s): Parotidectomy with neck dissection, Parotid tumor removal with neck dissection

Summary

This procedure involves the complete removal of a parotid gland (a major salivary gland located near the ear) along with a radical neck dissection, which means removing lymph nodes and surrounding tissues on one side of the neck to treat or prevent the spread of cancer.

Purpose

The primary purpose of this surgery is to treat cancers of the parotid gland and prevent the spread of cancer to the lymph nodes in the neck. The goal is complete removal of the tumor and any potentially affected lymphatic tissue, aiming for a cure or significant reduction in cancer spread.

Indications

• Presence of a malignant tumor in the parotid gland.
• Enlarged lymph nodes in the neck that may indicate metastasis.
• Recurrence of cancer in the parotid gland.
• Patient symptoms such as facial pain, a noticeable mass, or nerve dysfunction.

Preparation

• Fasting for 8 hours prior to surgery.
• Stopping certain medications (e.g., blood thinners) as directed by the doctor.
• Pre-operative imaging tests like MRI or CT scans to evaluate the extent of the tumor.
• Blood tests and a pre-surgical physical examination.

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free.
2. An incision is made near the ear and extended down the neck.
3. The parotid gland is carefully dissected, with care taken to avoid facial nerve damage.
4. Lymph nodes and surrounding tissues on the affected side of the neck are removed.
5. The surgeon checks for and removes any additional tissues if necessary.
6. The incision is closed with sutures, and a drain may be placed to prevent fluid buildup.
7. The surgical site is bandaged.

Duration

The procedure typically takes 4 to 6 hours, depending on the tumor's size and complexity, as well as the extent of the neck dissection.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Head and neck surgeon (often an otolaryngologist)
• Surgical nurse
• Anesthesiologist
• Possibly an oncologist for cancer management

Risks and Complications

• Common risks: Infection, bleeding, temporary facial nerve weakness.
• Rare risks: Permanent facial nerve paralysis, salivary fistula, seroma formation, shoulder dysfunction.
• Management involves antibiotics for infection, drainage of fluid collections, and physical therapy for shoulder issues.

Benefits

• Complete removal of the malignant tumor.
• Reduced risk of cancer spread to lymph nodes.
• Significant improvement in survival rates and quality of life. Benefits are often realized weeks to months post-surgery, following recovery.

Recovery

• Hospital stay of 2-3 days post-surgery.
• Drain usually removed within a week.
• Instructions to avoid heavy lifting and strenuous activities for 4-6 weeks.
• Follow-up appointments for wound check, suture removal, and monitoring recovery.
• Possible physical therapy for shoulder and neck mobility.

Alternatives

• Radiation therapy: May be used as a primary treatment or in combination with surgery.
• Chemotherapy: Often used for advanced cases or when surgery is not an option.
• Pros: Non-surgical options can be less invasive.
• Cons: May not be as effective in completely removing the tumor as surgery.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not experience any sensations. Post-surgery, they may experience pain and swelling, which can be managed with pain medications and cold compresses. Some facial numbness or weakness is common but usually improves over time. Comfort measures include pain management and careful monitoring for complications to ensure a smooth recovery.