Conservative parotidectomy: a new surgical concept

Abstract

Since Janes (1940) introduced the posterior approach for conservative parotidectomy, the method has been eleborated by many authors and various landmarks suggested for the approach to the trunk of the facial nerve. In all these methods the localisation of the nerve trunk proves either difficult or time-consuming. An operative concept is presented herewith which allows safe, quick and relatively simple localisation of the facial nerve. For this purpose only those landmarks are selected which are reliable and above all easy to identify. The main advantage is that position of the nerve trunk is remarkably constant, since cranial or caudal displacement with enlargement of the tumour is hardly possible--and this offers the opportunity to locate the nerve in the retromandibular fossa along an imaginary line joining the angle of the mouth to the mastoid process. The parotid plexus is dissected out completely including the cervical branch, which reinforces the function of the marginal mandibular branch through anastomotic connections and, together with the retained platysma plays an important role in the function of the mimetic muscles of the lower third of the face. The resulting operative depression is filled out by displacing the platysma posteriorly up to the Sterno-cleido-mastoid.