PAROTID GLAND SURGERY
The parotid gland is a salivary gland that are two in number, located behind the jaw. Its function is to provide saliva to the oral cavity, especially during meals. Maxillofacial surgeons treat the disorders of these glands.
The main anatomical connection of the gland is the facial nerve. The facial nerve or VII cranial par is responsible for giving motion to the face, therefore its injury would result in facial paralysis.
The most common cause of surgery of the parotid glands are tumors and the vast majority are benign. The most common tumors are the pleomorphic adenoma or mixed tumor and the tumor of Warthin or Cistadenolinfoma. Both are benign but pleomorphic adenoma could become malignant over the years, that is the reason why these tumors always have to be operated.
When operating the parotid gland because of a tumor, we can not remove only the tumor, because if we did, we would highly increase the chances of reappearing (relapse), therefore the surgical technique will remove the superficial part of the gland above the facial nerve. This is called Suprafacial Parotidectomy. As you may think, its most feared complication will be facial paralysis.
The incision is made in the frontal part of the ear, much like how it is done in facelifts, minimizing the risk of leaving a scar on the face.
Depending on the size of the tumor, the incision is extended more or less to the neck, being almost imperceptible in case of small tumors.
Then you have to find the facial nerve in its nearest portion and follow along the nerve while extracting the gland and the tumor.
There could be a temporary facial paralysis, but the patient will recover mobility in weeks or in months, depending on the speed of the nerve regeneration and depending on the handling or the amount of nerve injury during surgery.
To avoid temporary facial paralysis, we use magnifying loupes and a neurostimulator to stimulate the nerve during surgery without damaging it.