Method
In general, we embraced to open minimally invasive parotidectomy: PP with retrograde facial nerve dissection or ECD. PP refers to facial nerve branches identification within the normal parenchyma 1-2cm from the tumour and are traced along their courses toward the facial nerve trunk prior to tumor removal with 1cm lateral margin [3], [4]. Whereas, during ECD, the facial nerve or its branches are not intentionally identified (unless encountered) and the tumor is extirpated with 1-2mm surrounding normal parenchyma with meticulous dissection [1]. Loupes and intraoperative nerve monitoring device are liberally used. PP or ECD could be conducted under either local or general anesthesia in our institution [5], [6]. Drain is regularly inserted if tissue sealant is not employed.
When tissue sealant is harnessed, before the closure of parotidectomy wound, the instillation catheter is placed under the skin flap. (Figure) The capsule of the remnant parotid is closed with absorbable suture, if possible, to further minimize the cavity resulted from surgery. The subcutaneous layer is then closed with absorbable sutures. Before suturing of the skin layer, tissue sealant is instilled into the wound via the instillation catheter. A gentle, sustained pressure is exerted for 5-10 min on the skin flap to create a thin but even tissue sealant to adhere the skin to parotid bed, so as to eliminate the intervening dead space and thus obviating seroma formation. Tisseel (Baxter, CA, USA) or Floseal (Baxter, CA, USA) were employed as the tissue sealant at surgeons’ discretion. All procedures contributing to this work comply with the ethical standards of the institutional guidelines and with the Helsinki Declaration of 1975, as revised in 2008. Informed consents were obtained from all participants.