42425 Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve

Name of the Procedure:

Excision of Parotid Tumor or Parotid Gland; Total, En Bloc Removal with Sacrifice of Facial Nerve

Summary

This surgical procedure involves the complete removal of the parotid gland (a salivary gland located near the ear) along with the tumor. The procedure requires the cutting of the facial nerve, which controls facial movements.

Purpose

Medical Condition:

• Parotid gland tumors, including both benign and malignant types.

Goals:

• Complete removal of the tumor to prevent spread or recurrence.
• Relief of symptoms such as pain, swelling, or facial asymmetry.

Indications

• Detection of a tumor within the parotid gland through imaging or biopsy.
• Symptoms such as persistent swelling, facial pain, or facial nerve dysfunction.
• Rapidly growing or suspicious masses indicating malignancy.

Preparation

• Fasting prior to surgery (usually no food or drink after midnight before the procedure).
• Discontinuation of certain medications as advised by the surgeon.
• Pre-operative imaging studies (e.g., MRI, CT scans) to assess the extent of the tumor.
• Blood tests and other assessments to ensure the patient's fitness for surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A curved incision is made in front of the ear, extending down to the neck to expose the parotid gland.
3. Exposure and Assessment: The surgeon isolates the parotid gland and assesses the involved area.
4. Nerve Identification: The facial nerve is carefully identified and traced. Since the nerve will be sacrificed, its course is confirmed.
5. Removal: The entire parotid gland along with the tumor is removed en bloc (in one piece) with the facial nerve.
6. Closure: The incision is closed with sutures, and a drain may be placed to prevent fluid accumulation.
7. Dressing: Sterile dressings are applied.

Duration

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

Setting

The procedure is performed in a hospital’s surgical suite.

Personnel

• Surgeons (Head and Neck Surgeon or Otolaryngologist)
• Anesthesiologists
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Common Risks: Infection, bleeding, and scarring.
• Facial Nerve Damage: Permanent loss of facial movement on the affected side.
• Other Complications: Salivary fistula, which is an abnormal connection that can form between the gland and the skin.

Benefits

• Complete removal of the tumor.
• Potential cure or control of cancer.
• Relief from symptoms associated with the tumor.

Recovery

• Post-Procedure Care: Patients may need to stay in the hospital for a few days for monitoring.
• Pain Management: Pain medications and antibiotics as prescribed.
• Drain Care: Instructions on how to manage the surgical drain if placed.
• Physical Therapy: To manage and adapt to facial nerve damage.
• Follow-Up: Regular appointments to monitor healing and address any issues.
• Recovery Time: Several weeks to months, with gradual improvement in post-surgical symptoms.

Alternatives

• Other Surgical Options: Partial parotidectomy (if the tumor is small and well-contained).
• Non-Surgical Options: Radiation therapy or chemotherapy (for inoperable tumors).
• Pros and Cons: Alternative treatments may be less invasive but might not be as effective in completely removing the tumor.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Post-procedure, patients may experience pain, swelling, and numbness in the face and neck.
• Pain management will be provided through medications.
• Patients might require emotional and psychological support due to changes in facial appearance and functionality.