ABSTRACT
Extracapsular dissection (ECD) is an example of the general move towards minimally invasive procedures. Historically, pleomorphic adenomas in the parotid gland have had a reputation for tumour recurrence. The parotid gland is a vascular structure and the risk of post-operative haematoma is always present. There does not seem to be any greater or lesser risk with ECD. With ECD, the incidence of transient facial nerve injury is reduced from 20% to 8% and permanent damage is the same as superficial parotidectomy. Most of the surgical techniques deployed in ECD are also used routinely in traditional parotid surgery. Hypotensive anaesthesia is not necessary for ECD. The standard approach for ECD is a pre-auricular incision with cervical extension along a natural skin crease. A new approach that has transformed the approach to the parotid lump, especially those towards the posterior aspect of the parotid and wedged between the mandible and mastoid is to approach the procedure like an upper neck dissection.
