Resection Specimens

Surgical resections of parotid glands are classified according to their relationship with the facial nerve. Superficial parotidectomy is performed for tumours lying lateral to the plane of the facial nerve as it courses through the gland. If the tumour lies in contact with but does not infiltrate branches of the facial nerve, it is dissected clear with preservation of the nerve. If infiltrated by malignant tumour, the nerve may be sacrificed and repaired with a graft from the nearby greater auricular nerve if a curative (rather than palliative) procedure is anticipated. Extracapsular resection can be performed when the tumour is small or lies distant to the nerve. The surgeon dissects external to the tumour capsule with preservation of the nerve; although conservative of glandular tissue, there is considerable risk of capsular rupture. Total parotidectomy procedures are divided into nerve-preserving and nerve-sacrificing types. Total parotidectomy with nerve preservation is performed for deep-lobe tumours that can be dissected clear of the nerve. The superficial lobe is removed initially to identify, dissect and preserve the nerve before removing the deep lobe. Total parotidectomy with nerve sacrifice (radical parotidectomy) is warranted for curative excision of clinically malignant tumours of either lobe that infiltrate the nerve. Nerve grafting may be performed if the proximal and distal stumps are free of tumour. Occasionally, access to a deep-lobe tumour is obtained via a median mandibulotomy procedure (splitting the mandible and reflecting the ipsilateral hemimandible laterally to expose the parapharyngeal space); the superficial lobe is conserved.

The submandibular and sublingual glands are removed in their entirety. If tumour is encountered in the deep lobe of the submandibular gland, the dissection can be continued anteriorly into the floor of mouth, including the sublingual gland and all of Wharton's duct, if required. En-bloc resection of either gland with adjacent tissues as required is performed for widely infiltrating malignant tumours.

0 0

Post a comment