1st Parotidectomy Experience

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Family Doctor

The first doctor you are likely to consult is your family doctor or general practitioner.  Since tumors of the parotid are relatively rare, you are likely to be referred to an ENT specialist.  My doctor made little or no effort to diagnose the lump but strongly recommend I see the ENT specialist..

Ear Nose and Throat

The ENT doctor examined the lump with his fingers and suggested I have it removed even though it seemed to be only the size of a pea..  I was informed that the majority of the tumors associated with the parotid are benign, but could become malignant.  The prudent thing was to remove it.

The location was LaCrosse, WI.  No preliminary tests or x-rays were taken.  The surgery was scheduled about two weeks after the first examination by ENT.

Pre-Op

The pre-op procedure was conducted at the hospital a few days before surgery.  I was registered at the hospital and blood samples were drawn.  I was shown where to check in the day of surgery and generally informed of what to expect.  I was instructed not to eat or drink after midnight the day of surgery.

Operation

This first operation was 11 years ago.  I will give you my recollection of the experience followed by a copy of the surgeons actual operation and pathology reports.

I arrived at the hospital with my wife in the late morning and checked in.  I was then  taken to my room and given a gown to change in to.  About an hour later I was put on a gurney and wheeled to the operating room.   A nurse set to work on establishing an IV line.  I was first given a numbing shot in the back of the hand and then the IV was inserted.  Almost immediately afterwards I was put to sleep by an injection into the IV line.  Count backwards from 10, 9, 8, 7..zzzzzz

The hospital reports read as follows:


HISTORY AND PHYSICAL

DATE OF ADMISSION: 4/20/90

HISTORY: He is 30 years old. He has had a lump in the right preauricular area for about three months. Occasionally there is some fluctuation in size but generally has been quite stable during this time. He has otherwise been feeling normal. It was observed for a little while with the possibility that this might be a preauricular lymph node but due to the lack of significant improvement, he is now being admitted for excision.

PAST MEDICAL HISTORY: is negative for any medical or surgical problems.

ALLERGIES: none.

CURRENT MEDICATIONS: None. He doesn’t drink or smoke.

FAMILY HISTORY: Is noncontributory and his review of systems is generally negative.

PHYSICAL EXAMINATION: His blood pressure is 160/88. He looks well. There is no visible evidence of a tumor. His ears look normal.

NOSE, MOUTH, THROAT: Are all normal. He has about a 1cm lump just anterior and inferior to the right tragus. The margins of the lump are indistinct as is its depth. It is mobile. The remainder of the parotid exam was negative.

His lungs are clear. His heart is regular rhythm; no murmur.

ABDOMEN: is soft; no masses.

EXTREMITIES: Unremarkable.

IMPRESSION: Small early parotid tumor.

PLAN: Right superficial parotidectomy under general anesthesia. He is aware of the risks and alternatives. He has no further questions and willing to undergo the procedure. He is especially aware of the risks to the facial nerve if this is extending deep.


REPORT OF OPERATION

Preoperative Diagnosis: Right parotid tumor.

Postoperative Diagnosis: Right pleomorphic ademoma.

Surgeon: XXXX

Operation: Right superficial parotidectomy

OPERATIVE TECHNIQUE: After general anesthesia was established with nonparalyzing agents, the right side of the face was prepped and draped. The proposed incision line was locally infiltrated with 1% Xylocaine, 1:100,000 Epinephrine. A curvilinear incision was made in the preauricular area extending down horizontally through the neck. Anterior skin flap was elevated. The tumor did not feel as superficial as it was originally thought. It appeared that there was a mass deep that was pushing the normal parotid tissue outward. Initial dissection confirmed that. Now the posterior margin of the gland was separated from the external auditory canal and from the sternocleidomastoid muscle down deep in the sulcus. The main trunk of the facial nerve was identified. Its identity was confirmed with the nerve stimulator. The lower-most branch was dissected free with cuts made above that. The upper-most branch appeared to be heading just superior and deep to the tumor mass. The tumor was elevated off the nerve. The anterior margin of the dissection, portion of the parotid duct was encountered. It was cross-clamped and ligated. Now the tumor was removed. It appeared to be only about1 to 1 ˝ cm in diameter. Frozen section indicated it to be a benign pleomorphic adenoma. Now the bleeders were controlled with ligation with 3-0 chromic. One small bleeder along the buchal branch was cauterized with bipolar. The wound was irrigated, and then a small Penrose drain was laid deep in the wound. The flaps were laid back down in place and sutured with interrupted sutures of 3-0 chromic and 5-0 and 6-0 nylon. It was dressed with Bacitracin, Tefla followed by Fluffs, 4 x 4’s and aKling wrap around the head. A 4 inch Ace bandage was also used. He was then awakened, extubated and transferred to Recovery in satisfactory condition.

Blood loss was about 20cc.

XXX: 4-2-90:

xxx: 4-2-90:2245

ST. Francis Medical Center

LaCrosse, Wisconsin


PATHOLOGY REPORT

Lab No: XXX

Nature of Tissue: Right parotid tumor.

Patients Name: XXX X. XXXXXXX

Date Rec’d: 4-2-90 Date Reported: 4-3-90

DOB 1/4/60 Room No: XXX Attending Physician: XXXX

Clinical Diagnosis: Small early parotid tumor.

Received and labeled "right parotid tumor", is a fragment of tissue which measures 3 x 1.8 x 1cm. It has been partially excised revealing a whitish whorled, relatively well circumscribed nodule measuring 1.3cm. in maximum size. A section is taken for frozen section and a diagnosis of "pleomorphic adenoma" is rendered. This tissue is submitted in block No. 1. More tumor is submitted in block No. 2. The remaining portion of the tissue consists of yellowish tissue consistent with parathyroid tissue and supporting stroma. This tissue is submitted in block No. 3.

MICROSCOPIC DESCRIPTION: Sections from the right tumor reveals a relatively well circumscribed nodule composed of a myxoid stroma in which are numerous epithelial elements as well as spindling cells consistent with myoepithelial cells. The findings are those of a pleomorphic adenoma The lesion is bordered by benign appearing salivary gland tissue.

DIAGNOSIS: Pleomorphic adenoma, right parotid tumor.

CODE 1

XXXXXX, M.D./kl


I awoke in the recovery room, unaware of the length of time I had been in surgery.  I found out later the procedure had taken about 2 1/2 hours.  After an hour in recovery I was taken to my room.  The doctor met me there shortly afterwards and I was asked to move my mouth, nose, eyebrows.  Everything was functioning properly.  The IV was removed.  I spent the night in the hospital and was released the first thing the next morning.

Recovery

I arrived home bandaged around the chin and over the top of my head with an ace bandage.  They had instructed me to keep the bandages on for one day and then remove the bandages but keep the wound dry for 1 week.  I took pain medication for two days and then aspirin for another two days.  The sutures were removed after one week.  I returned to work 3 days after the surgery.

Complications

At the same time the sutures were removed, fluid was drawn of by a needle and syringe.  A "bubble" had formed in the area of the wound, much like blister about 2cm in size.  I was told the fluid was saliva. 

A few months after the surgery I noticed that I would sweat in the area of the surgery when I ate.  This continued until my second surgery 11 years later.   I was informed at that time that this was called Frey's Syndrome and is caused by the nerves of the parotid gland, cut during the operation, regenerating and mixing with the nerves of the sweat glands.

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