The Advantages of Microsurgical Dissection Applied to Parotidectomy for Benign Lesions

Abstract

Preservation of facial nerve function is a fundamental principle of parotid gland surgery. Microsurgical dissection has been applied to the resection of benign parotid tumors in 21 cases. One of them was AVM and the other cases were pleomorphic adenoma. The results showed that only 1 (6.25%) had minimal facial weakness in the group of superficial parotidectomy and 2 (40%) in the group of parotidectomy. In this study, only 3 patients (14.3%) encountered temporary weakness of the facial nerve and no permanent paralysis or weakness noted. The asymmetry disappeared at 3 months of follow-up. The average operation time was 3 hours for superficial parotidectomy and 3.5 hours for total parotidectomy. Dissection under microscope for parotidectomy has the following advantages: (1) Meticulous identification and preservation of all nerve branches. (2) Preservation of blood supply to the nerve branches, even in total parotidectomy. (3) Avoidance of inadvertent cauterization to minor branches, especially in recurrent cases. (4) Minimal traction. (5) Achieving same good results with basic microsurgical technique and experience. Dissection under microscope has the disadvantages of longer operation time. We propose a meticulous method for parotidectomy of benign lesions, which can reduce the incidence of temporary facial paresis and resultant psychological impact, especially in large tumors or recurrent cases.