Surgery for Parotid tumors - Head & Neck Cancer Operative Surgery скачать в хорошем качестве

Surgery for Parotid tumors - Head & Neck Cancer Operative Surgery

This video illustrates tips and surgical techniques to follow when performing surgery for Parotid tumors. Surgery of the parotid gland is challenging despite the small size of the gland due to the fact that the facial nerve & its branches traverse the gland. Damage to this nerve results in facial disfiguration & other morbidity. 3 types of tumors can involve the parotid. 1. Primary Parotid tumors 2. Secondary tumors 3. Extensions from regional head & neck malignancy Based on the plane of which the nerve travels through the gland, the gland is divided into superficial & deep lobes. There are 3 main types of resections 1. The Conservative Superficial Parotidectomy - where all tissue superficial to the nerve & its branches is excised en bloc together with the tumor. This can be done for superficial lesions. This is the least invasive parotid surgery since we no longer justify unscientific resections like enucleation of parotid lesions. 2. The Conservative Total Parotidectomy - when the tumor extends to the deep lobe, this can be performed. Often due to the position of the facial nerve, it is very difficult to excise both superficial & deep lobes intact. In either above sometimes it may be necessary to sacrifice a branch of the nerve to resect the tumour completely. 3. Radical Parotidectomy is fairly easy to perform since we completely disregard the presence of the nerve within the gland & excise the entire gland en bloc with the nerve. The time honored incision is the modified Blair incision. Anterior flap is raised but care must be taken not to raise the flap beyond the anterior border of the parotid to prevent damage to flimsy terminal branches of the nerve. As we said in our video on how to be a great surgeon, we must tackle the facial nerve head on. The nerve lies deep in a valley of tissues between the external acoustic meatus & the posterior border of the parotid. When we start digging between the cartilaginous part of the ear canal & the posterior border of the parotid, a spiky cartilaginous protrusion appears pointing anteriorly & inferiorly. This tells us to proceed with caution since the nerve can be found approximately 1 cm anteriorly & inferomedially to this pointer. Dissecting the area directly posterior to the pointer takes us to the styloid process, the posterior limit of our dissection since the nerve travels just lateral to the lower part of the process. Once the nerve is located, then all that is left is to carefully dissect just over the plane of the nerve in the case of a Superficial Parotidectomy & around the nerve & its branches in the case of Conservative Total Parotidectomy. Sacrificing the nerve or en block resection of the gland together with the nerve is carried out only in three instances. 1. Pre or peri-operative evidence of involvement of the nerve trunk 2. In case of extensive infiltration by a regional tumor 3. When solitary metastatic lesions of tumors of high malignant potential like melanoma involves the gland This channel is dedicated to everyone who is interested in the field of Oncological surgery & is conducted by Dr. Anuruddha Thewarapperuma MBBS MS, a Consultant Cancer Surgeon from Sri Lanka. This includes a series of video classes & lectures on operative surgery with illustrations, valuable tips and advice. Please feel free to comment, give suggestions & ask questions in the comment section below. We hope this channel will be thought provoking and inspiring to all the surgeons, medical students, aspiring doctors, nurses and anyone in the surgical community who is interested in Cancer Surgery. We wish you all the best! Thank you! Contact us [email protected]