over the mastoid process, then downward and forward on the neck parallel to and below
the body of the mandible. (A chin incision may be used.) Bleeding vessels are
controlled by hemostats and fine ligatures.
(2) Using fine-toothed tissue forceps and scissors, the skin flaps are
elevated as described for thyroidectomy. The skin wound edges are retracted away by
means of silk sutures fastened to the clamps.
(3) The upper portion of the sternocleidomastoid muscle is exposed and
retracted, the auricular nerve is identified, and the lower part of the parotid gland is
elevated, using curved hemostats.
(4) The superficial temporal artery and vein and external jugular vein are
identified by means of blunt dissection.
(5) The parotid tissue is dissected from the cartilage of the ear and the
tympanic plate of the temporal bone. The temporal, zygomatic, mandibular, and
cervical branches of the facial nerve are identified and preserved.
(6) The superficial portion of the parotid gland containing the tumor is
removed. In some cases, the entire superficial portion is removed, followed by ligation
and division of the parotid duct.
(7) When the deep portion of the parotid gland must be removed, the facial
nerve is retracted upward and outward by nerve hooks; then the parotid tissue is
removed from beneath the nerve. Kocher retractors are used to retract the mandible.
The external carotid artery is identified. In many cases, the internal maxillary and
superficial temporal arteries are clamped, ligated, and divided.
(8) The wound is closed in layers with fine silk sutures. A small Penrose
drain is inserted, and a pressure dressing is applied.
a. General. This operation involves the opening of the larynx for exploratory,
excisional, or reconstructive procedures. It is performed whenever access to the
intrinsic larynx is necessary. The thyroid cartilages are split in the midline, and the true
vocal cords and false vocal cords are incised at the midline anteriorly.
b. Patient Preparation. The patient is placed on the table in a dorsal
recumbent position. The operative site is prepared and the patient draped with sterile
sheets, as for thyroidectomy.