parotidectomy

Salivary gland cancer is a malignant tumor that occurs in the parotid gland and belongs to the malignant tumor with the highest incidence of salivary gland cancer. More clinically than inadvertent or experience, there is a slow-growing painless mass below or behind the earlobe, mostly nodular, flat or slightly rounded, with different texture hardness, activity, and size is generally 3 -5 cm, with a capsule, a long history, in addition to local soreness, no facial nerve damage, regional lymphadenopathy and other discomfort. Malignant tumors of the salivary gland are rare, with malignant mixed tumors, followed by mucoepidermoid tumors, adenocarcinoma, acinar cell carcinoma, and papillary cystadenocarcinoma. The clinical manifestations are short course of disease, rapid growth, pain in the lesions, numbness and discomfort, hard mass, adhesion to deep tissues, poor mobility, difficulty in opening the mouth, some patients have some or all facial nerve spasm, infiltrating skin can be broken, wound Unhealed, the secretions are stinky, and cervical lymph node metastasis or distant metastasis (lung, bone, liver, brain, etc.) may occur. The cause of this disease in modern medicine is not yet clear. Some scholars believe that it is related to viruses or infections. Clinical diagnosis is mainly based on medical history, symptoms, systemic and local examination; salivary X-ray angiography shows that the main and branch catheters are distorted, dilated, stenotic, intermittent, interrupted; acinar filling or defect or contrast agent spillover is flaky; When the main catheter is infarcted, the branch duct and the gland are not developed at all. Live tissue aspiration or intraoperative biopsy can be confirmed by pathological examination of frozen sections. Modern medical treatment of this disease mainly uses surgical resection. The 5-year survival rate after salivary gland cancer surgery is reported to be around 95%. When the patient's malignant tumor has invaded the surrounding tissue and there is residual cancer left in the postoperative margin, additional radiation therapy should be considered. The disease belongs to the categories of "acne", "rogue" and "shiji" in traditional Chinese medicine. The motherland medicine believes that the disease is caused by the accumulation of heat, blood stasis, and dampness accumulation. Treatment of diseases: parotid mixed tumor chronic suppurative mumps Indication 1. Parotid mixed tumor: 90% of the parotid adenoma is a mixed tumor of the parotid gland, which is benign, but it is easy to relapse due to incomplete capsule (up to 30% to 40%), and the tendency to malignant is also high (30%). It should be operated early. resection. The parotid gland must be completely removed during surgery, but the facial nerve should be preserved as much as possible. Giant parotid mixed tumors often grow to the outside of the parotid gland, and surgical resection is easy. Sometimes, no facial nerve is needed to complete the resection. 2. When the salivary gland cancer is removed, the cervical lymph nodes must be removed while the entire parotid gland is removed. At this time, the facial nerve is often sacrificed. 3. Other parotid tumors: hemangioma must be removed together with the parotid gland; papilloma, lymphoma-like cystic adenoma is not easy to relapse, only the tumor can be removed. 4. Parotid gland stones: Single-shot stones can be removed by the parotid duct; when multiple stones and chronic inflammatory changes cause the parotid gland to atrophy, the parotid gland should be removed. 5. Chronic mumps recurrent, non-surgical treatment is invalid, can be used for parotidectomy. Preoperative preparation 1. Check the facial nerve for tumor infiltration or compression. 2. Check the mouth of the parotid gland (next to the second molar) and inject 1 to 2 ml of the methylene blue solution with a flat needle to distinguish the glands during surgery. 3. Shave the hair within 5 cm around the side of the diseased side. Surgical procedure 1. Position: supine position, head to the healthy side. The diseased side of the external ear canal is protected by cotton balls. 2. Incision: An s-shaped incision is used. Hold the tumor with your left hand and pull it down to the front. The assistant pulls the earlobe upwards. The incision starts from the root of the ear canal, down the tragus to the earlobe, then bends toward the mastoid, and then down. Stop at the mandibular angle. If the tumor is too large to be revealed, the incision can be extended forward and downward along the lower edge of the lower jaw. 3. Separate the flap: lift and sharply separate the flap in front of the incision; the cheek incision can be directly divided into the parotid fascia, and the neck incision must be cut open to reveal the posterior border of the parotid gland. 4. Find the facial nerve trunk (1) Indirect search method: Lifting the parotid lobe upwards, separating the sternocleidomastoid muscle and the auricular nerve across it along the posterior margin; and separating the external jugular vein into the deep layer. Along the external jugular vein, the venous branch branches into the shallow part of the gland, and the facial nerve neck and mandibular limb branch can be found. From then on, the facial nerve trunk can be found. (2) Direct search method: the facial nerve trunk is 1 to 1.5 cm deep on the lateral side of the mastoid, and can be directly separated deep along the leading edge of the mastoid, and then bluntly separates the capsule along the posterior edge of the parotid gland to push the parotid gland forward. After pulling the posterior abdomen of the second abdominal muscles to the rear, the facial nerve can be seen just above the mastoid attachment part of the posterior abdomen of the second abdominal muscle. Further, the facial nerve trunk is separated forward a little, and then it can enter the parotid gland (also occasionally bifurcation before entering the gland, the upper branch after the bifurcation is the sacral branch, and the lower branch is the cervical branch). When the facial nerve trunk is clearly separated, the parotid gland can be separated forward. At this point, special care must be taken to avoid damage to the facial nerve. 5. Excision of the shallow leaves: After finding the main nerve of the facial nerve, the sacral branch and the sacral branch can be further identified from the main nerve of the facial nerve and protected. The parotid gland is then separated from the cartilage of the external auditory canal to remove the tumor and the entire parotid gland. 6. Treatment of parotid gland: The parotid gland is in the horizontal direction in front of the parotid gland and 1.5 cm below the zygomatic arch. Cut the gland tube as close as possible to the oral end and secure the distal stump with a medium wire. 7. Excision of deep leaves: If deep leaves need to be removed, the facial nerve should be carefully separated from the deep leaf tissue, and the facial nerve should be pulled up and out with a small nerve hook, and then the important tissues around the deep leaves (such as the external carotid artery, jaw) Internal artery), do not cause damage; the upper superficial temporal artery needs to be ligated and cut. Finally, the deep leaves are removed. 8. Drainage and suture: the facial nerve was repositioned, the wound was washed with saline, and a rubber sheet was drained into the parotid fossa. The parotid fascia and platysma were sutured with fine silk thread, and the skin was sutured. The rubber sheet was drained from the lower end of the slit, and the slit was pressure-wrapped with gauze. complication 1. Facial nerve paralysis: Facial nerve paralysis oppressed by inflammatory edema after surgery, and can be restored after the inflammation subsides. The paralysis caused by injury should be corrected by face formation or sublingual nerve transplantation. 2. Salivary fistula: Small saliva can heal itself, large fistulas need to be operated again, and the damaged parotid ducts are ligated.