Parotidectomy

Parotidectomy

Anesthesia type	General
Airway	ETT
Lines and access	PIV
Monitors	Standard 5-lead ECG Facial nerve monitoring
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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Editor rating	In development
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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

Postoperative management

Disposition

PACU

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