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.