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Parotid extracapsular dissection—a modification of the cruciate parotid fascia incision
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British Journal of Oral and Maxillofacial Surgery 51 (2013) 570–571
Technical note
Parotid extracapsular dissection—a modification of the cruciate parotid fascia incision A. Kanatas a,∗ , C. Perisanidis b , G. Fabbroni a a b
Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds General Infirmary, LS1 3EX, UK Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
Accepted 12 February 2013 Available online 6 March 2013 Keywords: Parotid tumours; Extracapsular dissection
Fig. 1. Markings involving the edge of the tumour and a 1 cm circle overlying the tumour.
Fig. 2. The four artery forceps have been attached, and the fascia incised along the cruciate lines but leaving a 1 cm diameter parotid fascia still attached to the tumour.
The benefits from an extracapsular approach in the removal of parotid tumours have been well established and presented elsewhere in the literature.1,2 The intra-operative technique as described in the literature involves the edge of the tumour been marked together with the lines of a cruciate incision over the lump.2 Here we present a modification of that incision which in our experience may be of benefit in selected patients.
We start by performing the same incision of the superficial parotidectomy (Blair incision or a face-lift incision) and then we lift a skin flap down to the level of the parotid fascia and extend it up to 1 cm peripheral to the tumour. We then mark the edge of the tumour but, additionally we mark a 1 cm circle overlying the tumour (Fig. 1). At the periphery of this 1 cm circle we mark the cruciate incision. The parotid fascia is then tented upwards with four artery forceps, and the fascia is incised along the cruciate lines but leaving a 1 cm diameter parotid fascia still attached to the tumour (Fig. 2). Then, as it has been described previously1 we maintain traction on the adjacent soft tissues and hence identify a natural plane of dis-
∗
Corresponding author. Tel.: +44 7956603118. E-mail addresses: [email protected] (A. Kanatas), [email protected] (C. Perisanidis), [email protected] (G. Fabbroni).
0266-4356/$ – see front matter © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2013.02.005
A. Kanatas et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) 570–571
section around the tumour. In our experience this technique is beneficial in two ways. Firstly, it provides a point of application of tissue holding forceps and hence the surgeon is able to apply gentle traction without the risk of tumour rupture. Secondly, at the end of the operation this cuff of tissue allows placement of a marking suture without disturbing the tumour capsule or its architecture. In addition, we advocate hydro dissection and we inject saline with 1:200,000 adrenaline as well as routinely using the intraoperative continuing facial nerve monitoring. Finally, this 1 cm defect in the parotid fascia can be easily repaired at the end of the operation.
571
Conflict of interest The authors have no conflict of interest to report.
References 1. Albergotti WG, Nguyen SA, Zenk J, et al. Extracapsular dissection for benign parotid tumors: a meta-analysis. Laryngoscope 2012;122(9):1954–60. 2. George KS, McGurk M. Extracapsular dissection – minimal resection for benign parotid tumours. Br J Oral Maxillofac Surg 2011;49(6): 451–4.
British Journal of Oral and Maxillofacial Surgery 51 (2013) 570–571
Technical note
Parotid extracapsular dissection—a modification of the cruciate parotid fascia incision A. Kanatas a,∗ , C. Perisanidis b , G. Fabbroni a a b
Leeds Teaching Hospitals, St. James Institute of Oncology, Leeds General Infirmary, LS1 3EX, UK Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
Accepted 12 February 2013 Available online 6 March 2013 Keywords: Parotid tumours; Extracapsular dissection
Fig. 1. Markings involving the edge of the tumour and a 1 cm circle overlying the tumour.
Fig. 2. The four artery forceps have been attached, and the fascia incised along the cruciate lines but leaving a 1 cm diameter parotid fascia still attached to the tumour.
The benefits from an extracapsular approach in the removal of parotid tumours have been well established and presented elsewhere in the literature.1,2 The intra-operative technique as described in the literature involves the edge of the tumour been marked together with the lines of a cruciate incision over the lump.2 Here we present a modification of that incision which in our experience may be of benefit in selected patients.
We start by performing the same incision of the superficial parotidectomy (Blair incision or a face-lift incision) and then we lift a skin flap down to the level of the parotid fascia and extend it up to 1 cm peripheral to the tumour. We then mark the edge of the tumour but, additionally we mark a 1 cm circle overlying the tumour (Fig. 1). At the periphery of this 1 cm circle we mark the cruciate incision. The parotid fascia is then tented upwards with four artery forceps, and the fascia is incised along the cruciate lines but leaving a 1 cm diameter parotid fascia still attached to the tumour (Fig. 2). Then, as it has been described previously1 we maintain traction on the adjacent soft tissues and hence identify a natural plane of dis-
∗
Corresponding author. Tel.: +44 7956603118. E-mail addresses: [email protected] (A. Kanatas), [email protected] (C. Perisanidis), [email protected] (G. Fabbroni).
0266-4356/$ – see front matter © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.bjoms.2013.02.005
A. Kanatas et al. / British Journal of Oral and Maxillofacial Surgery 51 (2013) 570–571
section around the tumour. In our experience this technique is beneficial in two ways. Firstly, it provides a point of application of tissue holding forceps and hence the surgeon is able to apply gentle traction without the risk of tumour rupture. Secondly, at the end of the operation this cuff of tissue allows placement of a marking suture without disturbing the tumour capsule or its architecture. In addition, we advocate hydro dissection and we inject saline with 1:200,000 adrenaline as well as routinely using the intraoperative continuing facial nerve monitoring. Finally, this 1 cm defect in the parotid fascia can be easily repaired at the end of the operation.
571
Conflict of interest The authors have no conflict of interest to report.
References 1. Albergotti WG, Nguyen SA, Zenk J, et al. Extracapsular dissection for benign parotid tumors: a meta-analysis. Laryngoscope 2012;122(9):1954–60. 2. George KS, McGurk M. Extracapsular dissection – minimal resection for benign parotid tumours. Br J Oral Maxillofac Surg 2011;49(6): 451–4.