Extracapsular parotidectomy – How we do it?

Abstract

Benign tumors of the parotid gland are the most common salivary tumors. Pleomorphic adenoma is the most common benign neoplasm of the parotid gland. Benign salivary gland tumors can undergo a malignant transformation, the reason for which the salivary tumors need to be excised. Pleomorphic adenomas extend their microscopic pseudopods into the surrounding capsule mainly composed of compressed normal tissue. The facial nerve traverses through the substance of the gland. Although the nerve injury could be avoided, the earlier treatment of pleomorphic adenoma with enucleation was fraught with an unacceptably high incidence of multicentric tumor recurrences. Superficial parotidectomy or excision of the portion superficial to the facial nerve evolved as the procedure of choice for benign parotid lesions. Formal identification of its trunk at the stylomastoid foramen and tracing its branches peripherally up to the facial muscles was an essential component of the procedure. With further understanding, it became evident thatsuperficial parotidectomy (SP) was overkill for small benign lesions in the superficial lobe of the gland with an unnecessary risk to the facial nerve. Extracapsular excision (ECE) of a benign parotid tumor is a procedure that has evolved in the last two decades with the recurrence rates comparable to those following SP with reduced facial nerve dissection-related morbidity. The senior author (PG) has adopted the technique for nearly a decade and has also been involved in conducting a randomized controlled trial comparing the outcomes after SP and ECE. Through this article, the authors would like to share their technique and experience with ECE.