Parotid and Submandibular Gland Surgery

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Parotid and Submandibular Gland Surgery
Mr Kim Ah-See MD FRCS FRCS(ORL) Consultant Head
and Neck Surgeon Aberdeen Royal Infirmary
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Anatomy
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Facial Nerve Assessment
House-Brackmann
Grade 1 Normal Facial Nerve Function Grade 2
Mild Facial Nerve Dysfunction Eyes Complete
closure with minimum effort Grade 3 Moderate
Facial Nerve Dysfunction Eyes Complete closure
with effort Grade 4 Moderately Severe Facial
Nerve Dysfunction Eyes Incomplete closure
Grade 5 Severe Facial Nerve Dysfunction
Eyes Incomplete closure Grade 6 Total
Facial Nerve Paralysis
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FNA
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Parotidectomy

• Clinic
• Consent
• Operation planning
• Technique
• Post op care
• Follow up

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Consent

• Wound (cosmesis)
• Drain length of hospital stay
• Greater auricular sensory loss
• Facial nerve
• Freys ?
• Path - tumour type

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Operation planning

• Time taken
• Anaesthetic / Instruments
• Facial nerve monitor
• Assistants
• Lighting
• Microscope ?
• Grafting ?

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Technique

• Position / Prep / Drapes / Lighting
• Incisions
• Soft tissue technique
• Greater Auricular nerve
• Facial nerve
• Extent of surgery
• Haemostasis
• Closure / Drains

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Standard Incision
Cervico-facial modified Blair McCabe
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Modified Incisions
Face lift/Rhytidectomy
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Soft Tissue Surgery

• Monopolar needle tip (15w)
• Bipolar
• Flap elevation (SMAS)
• Great Auricular N.
• Veins and Arteries
• Facial Nerve dissection - monitor

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Extent of Surgery

• Superficial Lobe
• Deep Lobe
• Parapharyngeal Space
• Lymph Node
• Malignant Tumour
• Facial Nerve

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Deep Lobe
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Complications VII damage Haematoma Seroma Woun
d infection Fistula Freys
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Submandibular Gland

• Duct Pathology
• Calculus Disease
• Tumours

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Duct Disease/Calculi

• History/Examination
• Investigations
• Management Options
• Surgery

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Submandibular Duct Surgery

• Calculi
• Dilatation/Marsupialisation
• Duct Endoscopy
• Lithotripsy
• Radiological guided basket

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Submandibular Gland Tumours

• Clinical and Investigations
• Surgical Options
• Technique

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Submandibular Gland Excision