Atlas of Advanced Operative Surgery by Vijay P. Khatri MD FACS

By Vijay P. Khatri MD FACS

Improve your surgical services with Atlas of complex Operative surgical procedure! This new source choices up the place different surgical references depart off, supplying hugely visible, step by step information on greater than a hundred complex and intricate systems in either normal and subspecialty components.

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Deep parotid gland Figure 3-6. Suction drain 28 Section I • Head and Neck an accessory parotid tumor. This requires careful dissection along the branches of the facial nerve, identifying and preserving the lower and upper divisions of the facial nerve, carefully dissecting the accessory parotid tumor off the masseter muscle. The chances of injuring the buccal branch in this situation are quite high. However, it may not have a major functional impact. u An accessory parotid tumor may present as a cheek mass, and the best approach is the preparotid skin incision approach, rather than incision into the cheek mucosa using a transmucosal approach.

There may be troublesome bleeding in the tail of the parotid that is best left alone or controlled by bipolar cautery. u As dissection continues on the tail of the parotid, the posterior facial vein may be identified and may require ligation. The posterior belly of the digastric is exposed (Fig. 2-7). u The dissection continues anteriorly to the midline of the chin area. The anterior belly of the digastric is exposed, and the submental region is dissected. There are multiple tiny venous tributaries in this area that require bipolar coagulation.

Quite often no specific bleeding point can be identified, and there is a diffuse ooze that requires a conservative approach and close follow-up. u Chyle Leak Another concerning complication of neck dissection is persistent chyle leak. A minor chyle leak is fairly common. However, a persistent chyle leak may occur in 2% to 5% of patients. u The drain is generally left in place for an extended period of time until the drainage slows down. Very rarely, the wound may need to be reexplored if there is more than 500 to 700 mL of drainage every day.

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