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.
SURGICAL TECHNIQUE
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.
POSTOPERATIVE
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.
SUBMANDIBULAR GLAND SURGERY
Xavier and friends who are interested in the submandibular gland surgery, I will briefly explain what this surgery is about and why a person should have surgery to remove the gland.
Las glándulas submaxilares están situadas inmediatamente debajo de la mandíbula, mucha gente confunde estas glándulas con ganglios del cuello y vienen a la consulta un poco asustados por tener unos ganglios grandes desde hace mucho tiempo. The submandibular glands are located just below the jaw. Many people get confused and take submandibular glands for swollen lymph nodes in the neck and come a little scared to the consulting room about having a large lymph for a long time. The main cause of the removal of the submandibular gland is due to LITIASIS SUBMANDIBULAR, which is the same as the formation of stones inside the gland. Why these stones are formed is still unclear but it seems possible that the diet and the high in minerals water intake could favor this condition. When a person has a stone in the submandibular gland is not always necessary to operate, sometimes it can be extracted through Wharton's duct, that carries the saliva from the gland to the mouth (under the tongue) or an endoscopy can be made through this conduit. But sometimes, when this is not possible and the person has recurrent infections, surgical removal of the gland is required.
There are other causes that can make the removal of the submandibular gland necessary, such as tumors, the vast majority benign, that can appear in the gland. The most common of these tumors is the mixed tumor or pleomorphic adenoma, but although this tumor is benign, surgery should be performed because it might become malignant overtime.
GLAND'S SURGICAL TECHNIQUE
Removing the submandibular gland must be performed under general anesthesia , with a 4-5 cm incision in the neck, under the jaw. The surgical technique is not complicated but two major complications can occur, but it is unlikely. The first is bleeding. Surrounding the submandibular gland there is the facial artery supplying blood to the face and sometimes this artery or one of its branches may bleed. This complication, usually is not important, but requires a reoperation. The second complication is the injury of one of the branches of the facial nerve that is responsible for moving the lip, therefore its injury would mean lip paralysis in the same side lower lip.
To avoid this complication, it is very helpful to use magnifying loupes to better identify the nerve and the use of a Neurostimulator to stimulate the nerve without any risk.
