chapter  70
6 Pages

OPERATIONS ON THE PAROTID GLAND INTRODUCTION

The technique of surgery on the parotid salivary gland is largely conditioned by the presence of the facial nerve and its branches within the gland. Because a majority of parotid tumours occur in the superficial part of the gland (lateral lobe), closer to the skin than the facial nerve, the standard operation which has developed is the superficial parotidectomy, otherwise referred to as conservative parotidectomy or lateral lobectomy of the parotid gland. In this operation the facial nerve is identified and the superficial part of the gland is carefully dissected away from the main trunk and branches of the nerve, together with the tumour. Where there is a tumour of the deep lobe lying beneath the branches of the facial nerve, this may be treated by enucleation, where the tumour is mobilised and delivered between the branches of the nerve without injury, or by a conservative total parotidectomy in which all or most of the gland tissue is removed but the facial nerve is conserved. Finally, high-grade malignant tumours of the gland are treated by radical parotidectomy in which the entire gland is removed together with the facial nerve, which may then be reconstituted by grafting.