Difference between revisions of "Parotidectomy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = ETT | ||
| lines_access = | | lines_access = PIV | ||
| monitors = | | monitors = Standard | ||
5-lead ECG | |||
Facial nerve monitoring | |||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = | ||
| Line 9: | Line 11: | ||
}} | }} | ||
A '''parotidectomy''' is a surgical procedure to remove some or all of the parotid gland. | |||
== Overview == | |||
=== Indications === | |||
* Tumor of parotid gland | |||
=== Surgical procedure === | |||
* Superficial: removal of parotid gland lateral to facial nerve. | |||
* Total: removal of parotid gland lateral and medial to facial nerve, often combined with neck dissection. | |||
* Radical: removal of parotid gland with facial nerve | |||
== Preoperative management == | == Preoperative management == | ||
| Line 18: | Line 34: | ||
!System | !System | ||
!Considerations | !Considerations | ||
|- | |||
|Airway | |||
| | |||
|- | |- | ||
|Neurologic | |Neurologic | ||
| Line 44: | Line 63: | ||
|} | |} | ||
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ||
* As indicated by H&P | |||
=== | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->=== | ||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | * Facial nerve stimulator | ||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | |||
* Routine | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->=== | |||
* N/A | |||
== Intraoperative management == | == Intraoperative management == | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | * Standard monitoring | ||
* 18G PIV x 1 | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->=== | |||
* Standard induction avoiding long acting paralytic (succinylcholine or remifentanil) | |||
* ETT taped to opposite side. | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | |||
* Supine | |||
* Head turned to opposite side | |||
* Bed may be turned 90 or 180 degrees | |||
=== | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->=== | ||
* Volatile anesthetic or TIVA | |||
* Avoid long acting paralytic to allow for facial nerve, monitoring, consider remifentanil to maintain a still patient, facial nerve monitoring by surgeon | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ||
== Postoperative management == | == Postoperative management == | ||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ||
PACU | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->=== | ||
* Bleeding | |||
* Infection | |||
* Dysesthesia of greater auricular nerve | |||
* Facial nerve weakness | |||
* Frey's syndrome | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
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|- | |- | ||
|Surgical time | |Surgical time | ||
| | |1.5-2 | ||
| | | | ||
|- | |- | ||
|EBL | |EBL | ||
| | |25-200 | ||
| | | | ||
|- | |- | ||
| Line 109: | Line 156: | ||
|} | |} | ||
== References == | == References: == | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
[[Category:Otolaryngology]] | |||
Latest revision as of 23:54, 4 April 2022
Parotidectomy
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV |
| Monitors |
Standard 5-lead ECG Facial nerve monitoring |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A parotidectomy is a surgical procedure to remove some or all of the parotid gland.
Overview
Indications
- Tumor of parotid gland
Surgical procedure
- Superficial: removal of parotid gland lateral to facial nerve.
- Total: removal of parotid gland lateral and medial to facial nerve, often combined with neck dissection.
- Radical: removal of parotid gland with facial nerve
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
- As indicated by H&P
Operating room setup
- Facial nerve stimulator
Patient preparation and premedication
- Routine
Regional and neuraxial techniques
- N/A
Intraoperative management
Monitoring and access
- Standard monitoring
- 18G PIV x 1
Induction and airway management
- Standard induction avoiding long acting paralytic (succinylcholine or remifentanil)
- ETT taped to opposite side.
Positioning
- Supine
- Head turned to opposite side
- Bed may be turned 90 or 180 degrees
Maintenance and surgical considerations
- Volatile anesthetic or TIVA
- Avoid long acting paralytic to allow for facial nerve, monitoring, consider remifentanil to maintain a still patient, facial nerve monitoring by surgeon
Emergence
Postoperative management
Disposition
PACU
Pain management
Potential complications
- Bleeding
- Infection
- Dysesthesia of greater auricular nerve
- Facial nerve weakness
- Frey's syndrome
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | 1.5-2 | |
| EBL | 25-200 | |
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References:
Top contributors: Olivia Sutton, Ed Nguyen, Chris Rishel and Barrett Larson