Minimal Scar Parotidectomy
Jul
31
Figure 1. MIPa Incision
Tumors in the parotid gland are not common, as such their diagnosis & treatment requires great expertise. Fortunately, the great majority of parotid tumors are non-cancerous (benign). The graphs below describes the percentage of times the tumor is benign or malignant. Being that most tumors are benign, the extent of surgery can be more limited. As such, the surgeons at the Center firmly believe surgical approaches that not only minimize incisions, but allow less tissue trauma under the surface can be used, which lead to better and faster healing, as well as less pain.
Facial nerve monitoring is used in all cases.
Minimally Invasive Parotidectomy (MIPa)
Figure 2. Parotid Tumor
Figure 3. MIPa Incision 3 weeks after surgery
This approach has come about after many years of experience using the traditional & face-lift incisions to access this very delicate area. It is only with great experience that this approach can or should be done. It involves making an incision that extends from the front of the ear to the back (Figure 1). This incision heals very well and the recovery is much easier and faster. Identifying the facial nerve is done with ease, as well as all the branches. Once the tumor is removed, our reconstructive team will perform a corrective procedure to fill in the defect left behind by removing part of the parotid gland, to avoid a divid on the face. Additionally, reconstructing the area over the nerve during the same procedure puts an extra layer of protective tissue on top of the nerve. The two sides of the face are compared during surgery to create harmony and symmetry. Our team of experts perform this surgery on a routine basis. We feel this approach gives our patients the best results, fastest healing and recovery. The incision is generally not visible several weeks after surgery. (Figure 2-3)
Figure 4. facelift Incision
The face-lift incision (Figure 4), was the approach of choice for years before the minimally invasive technique. It is still used when the tumor is too big to be removed through the minimally invasive approach. It gives wide access to the entire area and can be combined with other reconstructive procedures, if necessary. This is the incision of choice when the reconstructive team feels it necessary to lift the skin due to excessive laxity, because the skin has been stretched by a very large tumor (Figure 5-7) or if the patient would prefer to have facelift at the same time.
Figure 5. Large Parotid Tumor
Figure 6. After Surgery
Figure 7. Facelift Incision 2 weeks After Surgery
Infrequently, parotid tumors occur along the course of the parotid duct that opens into the mouth at the upper cheek (Figure 
. These tumors tend to be deep in the cheek area, close to the inner lining of the mouth; they arise from small fragments of parotid gland that can grow around the duct, called accessory parotid glands. Due the deep position of the tumor it does not tend to involve branches of the facial nerve and is in fact deep to it; as such to remove the tumor a safe approach is to go through the mouth and remove the tumor.
When parotid cancers spread to the lymph nodes, the removal of lymph nodes around the parotid gland in the neck is necessary; a traditional incision is ideal because it gives access to the lymph nodes in the neck, while still allowing for reconstruction of the surgical defect after tumor removal (Figure 9).
Occasionally, deep parotid or parapharyngeal space tumors require this incision so that the branches of the facial nerve are dissected and protected before the deeper tumor can be reached for removal. (Please refer to the parapharyngeal space tumors page for further information.)
Superficial Parotidecotmy – Describes a procedure where all the parotid gland (including the tumor) that is over the facial nerve is removed. The facial nerve is completely dissected and separated from the surrounding tissue and protected.
Total Parotidecotmy - When a total parotidectomy is done, the entire gland is removed while all attempts are made to preserve all the branches of the facial nerve. If this procedure is done to treat a cancer, preserving the branches of the facial nerve is still top priority.
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