42420 Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve

Name of the Procedure:

Excision of Parotid Tumor or Parotid Gland; Total, with Dissection and Preservation of Facial Nerve

Summary

This surgical procedure involves the removal of the entire parotid gland, which is one of the major salivary glands located near the ear. During the operation, the surgeon carefully dissects and preserves the facial nerve, which controls facial muscle movements.

Purpose

The procedure is primarily performed to remove a tumor in the parotid gland, which could be benign or malignant. The goals include eliminating the tumor to prevent further growth or spread and preserving facial nerve function to maintain normal facial movements.

Indications

• Presence of a parotid tumor (benign or malignant)
• Rapid growth of a mass in the parotid gland
• Pain or discomfort in the area of the parotid gland
• Facial nerve dysfunction or weakness

Preparation

• Patients may be instructed to fast for 8-12 hours before the procedure
• Comprehensive medical evaluation, including blood tests and imaging studies like MRI or CT scans, to assess the tumor
• Discussion with the anesthesiologist regarding medical history and anesthesia plan
• Discontinuation of certain medications, as advised by the doctor

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made near the ear, extending along the natural skin creases to minimize visible scarring.
3. The surgeon carefully identifies and dissects the facial nerve and its branches.
4. The entire parotid gland, along with the tumor, is removed while preserving the facial nerve.
5. The incision is closed with sutures, and a drain may be placed to prevent fluid accumulation.

Duration

The procedure typically lasts between 3 to 5 hours, depending on the complexity and size of the tumor.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Otolaryngologist or head and neck surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Temporary or permanent facial nerve weakness or paralysis
• Infection at the surgical site
• Bleeding or hematoma
• Salivary fistula (abnormal connection between the gland and skin)
• Scarring
• Seroma (fluid accumulation)

Benefits

• Complete removal of the tumor, reducing the risk of cancer spread or recurrence
• Preservation of facial nerve function, maintaining facial symmetry and movement
• Relief of symptoms such as pain or facial discomfort

Recovery

• Hospital stay of 1-2 days post-surgery
• Instructions on wound care and drain management, if applicable
• Regular follow-up appointments to monitor healing
• Restriction on strenuous activities for a few weeks
• Facial exercises may be recommended to aid nerve recovery
• Full recovery typically occurs within 4 to 6 weeks

Alternatives

• Observation or active surveillance for small, asymptomatic benign tumors
• Partial parotidectomy (removal of part of the gland)
• Radiation therapy, particularly in cases of malignant tumors when surgery is not feasible
• Pros: Less invasive options may reduce immediate recovery time.
• Cons: May not fully eliminate the tumor or prevent recurrence, especially in malignant cases.

Patient Experience

• Patients may feel discomfort or swelling around the surgical site.
• Mild to moderate pain managed with prescribed painkillers.
• Temporary numbness or weakness in facial movements, which typically improves over time.
• Emotional support and reassurance regarding facial nerve function and appearance.
• Majority of patients report significant relief of symptoms and satisfaction with the procedure outcomes after recovery.