Joseph Victor Gnanadurai, T (2008) Functioning of Deep Lobe of the Parotid Gland after Superficial Parotidectomy. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Salivary fistula rarely occurs after superficial parotidectomy, an incidence of 0.02%. This is an unusually low incidence considering the surgical procedure of cutting across the gland. It is postulated that: 1. The innervation of the deep lobe is through the superficial lobe, branches from the auriculo-temporal nerve. While removing the superficial part these nerves are severed and the deep lobe loses its innervation. As a result of this there is no secretion of saliva and the deep part gradually atrophies. 2. The duct arises mainly from the deep lobe and the superficial lobe secretions drain into the main duct via small ductules that cross the facio-venous plane of Patey to enter the deep part. Hence there is preferential flow which remains intact. 3. Fistula formation is based on multiple branching pattern of the Stenson’s duct. There are no definite studies or trials on the above postulates. This study attempts to focus on the reduction in function of the deep part of the parotid gland following superficial parotidectomy, proving hypothesis number one. AIMS AND OBJECTIVES: To assess the functioning of the remnant deep lobe of the parotid gland after superficial parotidectomy. MATERIALS AND METHODS: Based on this background knowledge, a prospective analytical study was designed to assess the function of the remnant deep lobe of the parotid gland after superficial parotidectomy in the Department of General Surgery, Christian Medical College and Hospital, Vellore. Lesions were confirmed clinically and all of them had Fine needle aspiration Cytology done prior to surgery. The same surgical technique of superficial was adapted in all the cases. During the period , May 2006 to July 2007, men and women undergoing superficial parotidectomy for all diseases of the parotid gland fulfilling the inclusion criteria were subjected to a prospective trial to assess the functioning of the remnant deep lobe of the parotid gland as compared to the opposite non-operated side deep lobe after superficial parotidectomy by Technetium - 99 scan on the tenth day and sixth week after surgery and on the on the same days, salivary secretion from the remnant gland was quantified by modified Saxon’s test. All patients were included in the trial after obtaining written informed consent. Details were documented in the proforma made for the purpose. Exclusion criteria: 1. Recurrent disease, 2. Patients requiring post operative radiation, 3. Patients who had previous radiation in the head and neck region, 4. Deep lobe involvement, 5. Malignancy – intermediate and high grade, 6. Pregnancy, 7. Subtotal superficial parotidectomy, 8. Tuberculosis of the parotid gland. Sample size: Based on the criteria set out, 20 patients were enrolled in the study after obtaining written informed consent. Statistical methods: The data was described using summary statistics such as mean, median, range and standard deviation. Univariate and bivariate graphs were plotted. Mann – Whitney test was used for analyzing unpaired groups and Wilcoxon signed rank test was used for paired data analysis. A ‘p’ value of less than 0.05 at 95% confidence intervals was considered significant. The data analysis was performed using SPSS 11.0 for windows. CONCLUSIONS: 1. The deep lobe of the parotid gland has significant decrease in function at six weeks following superficial parotidectomy but there is no atrophy, disproving the hypothesis. 2. There is significant decrease in the function if duct is ligated. 3. Long term assessment may be required to show whether there is regeneration of the remnant gland or if it remains the same. 4. The auriculo-temporal nerve is in same plane of the facial nerve or medial to it or communicating with it, hence the fibres are not likely to be severed during superficial parotidectomy. 5. There was no salivary fistula in any of these cases.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Functioning ; Deep Lobe ; Parotid Gland ; Superficial Parotidectomy. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 04 May 2018 02:52 |
| Last Modified: | 04 May 2018 02:52 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7422 |
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