c. Operative Procedure.
(1) A small skin incision is made below and parallel to the mandible,
extending forward to beneath the chin. The platysma is incised with scissors; the skin
flaps and undersurface of the platysma and cervical fascia covering the gland are
undermined, using fine hooks, tissue forceps, and Metzenbaum scissors.
(2) The mandibular branch of the facial nerve is retracted away with a small
loop retractor.
(3) The submaxillary gland is elevated from the mylohyoid muscle. The
edge of the muscle is retracted to expose the lingual veins and nerve and the
hypoglossal nerve.
(4) The gland is freed by blunt dissection, and the submaxillary (Wharton's)
duct is clamped, ligated, and divided.
(5) The external maxillary artery is clamped, ligated, and divided. The
submaxillary gland is removed.
(6) The wound is closed with interrupted fine silk or chromic gut sutures.
The skin edges are approximated with nylon sutures. A Penrose drain is inserted in the
submaxillary bed and secured to the skin. Dressings are applied.
1-40. PAROTIDECTOMY
a. General. This operation involves the removal of a tumor and gland through a
curved incision in the upper neck and behind the lobe of the ear, or through a Y-type
incision in both sides of the ear and below the angle of the mandible. The majority of
benign tumors of the salivary glands occur in the parotid gland. These benign tumors
are of the same types as are those found in soft tissues in other parts of the body. The
closeness of the parotid gland to the facial nerve makes it difficult to remove the entire
tumor. Parotidectomy is indicated for removal of all benign and some malignant tumors,
for inflammatory lesions, for vascular anomalies, and for metastic cancer involving
lymph nodes overlying the gland. When malignant tumors are found to involve adjacent
structures, the operation may have to be extended to become a more radical procedure.
b. Preparation of the Patient. The patient is placed on the operating table in a
dorsal recumbent position with the entire affected side of the face uppermost. The
entire side of the face, the mouth, the outer canthus of the eye, and the forehead are
prepared and left exposed.
c. Operative Procedure.
(1) The incision may extend from the posterior angle of the zygoma
downward in front of the tragus of the ear and behind the lobule of the ear backward
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