Retrograde approach for the parotid gland tumor - From the zygomatic branch of the facial nerve

Abstract

Conventionally, partial parotidectomy has been performed for benign parotid gland tumor. In this procedure, dissection and preservation of the facial nerve plays an important role. The conventional approach starting from the main trunk of the facial nerve has generally been used. However, when we perform partial parotidectomy for tumor in the anterior part of the parotid gland using the conventional approach, it is necessary to dissect the facial nerve long from the gland. In that case, we have been using the retrograde approach starting from the zygomatic branch of the facial nerve. The zygomatic branch can located easily in front of the gland, below the zygomatic arch and the surface of the masseter muscle. In this method, there is no need to ligate vessels, to use a drain or to cut the great auricular nerve and retromandibular vein. Furthermore, exposure of the facical nerve and parenchyma of the gland is more limited, avoiding facial palsy, frey syndrome and salivary fistula. Based on advantages described above, a retrograde approach starting from the zygomatic branch should be used more often for surgery on parotid gland tumor.