Overview
Accessory parotid glands refer to ectopic salivary gland tissue located outside the typical anatomical boundaries of the main parotid gland. These structures can present as masses and may require surgical intervention similar to primary parotid gland pathologies.Diagnosis
Clinical Presentation: Masses within or near the parotid region 15.
Imaging: MRI and ultrasound are crucial for distinguishing accessory parotid masses from other lesions, such as varix of the retromandibular vein 5.
Fine Needle Aspiration Cytology (FNAC): Useful for differentiating benign from malignant lesions 3.
Radiological Investigations: Essential to avoid unnecessary invasive procedures; MRI and ultrasound are recommended 5.Management
Surgical Resection: Superficial or total parotidectomy depending on the extent and nature of the lesion 1.
Anaesthesia: Local anaesthesia with conscious sedation is feasible and safe for parotid surgeries, reducing anaesthesia-related complications 1.
Facial Nerve Preservation: Techniques such as preserving the posterior branch of the great auricular nerve can minimize sensory morbidity 6.
Postoperative Care: Telemedicine can effectively manage postoperative follow-ups, assessing complications like Frey syndrome and facial nerve function 2.Special Populations
Elderly Patients: Local anaesthesia with conscious sedation may be particularly beneficial for elderly patients who may not tolerate general anaesthesia well 1.
Comorbidities: Tailored anaesthesia approaches, such as local anaesthesia with conscious sedation, can mitigate risks associated with comorbidities 1.Key Recommendations
Consider local anaesthesia with conscious sedation for parotid surgeries to reduce anaesthesia-related complications and expand treatment options for patients unable to tolerate general anaesthesia (Evidence: Strong 1).
Utilize telemedicine for postoperative follow-ups to effectively monitor complications and manage care without the need for in-person visits (Evidence: Moderate 2).
Preserve the posterior branch of the great auricular nerve during parotidectomy to minimize sensory morbidity (Evidence: Moderate 6).
Employ advanced imaging techniques such as MRI and ultrasound to accurately diagnose accessory parotid masses and avoid unnecessary invasive procedures (Evidence: Moderate 5).References
1 Liu S, Shen H, Yang F, Dai P, Huang Z, Li W et al.. Local anaesthesia with conscious sedation in parotid gland tumour resection: a retrospective review. BMC oral health 2024. link
2 Antezana LA, Xie KZ, Yin LX, Bowen AJ, Yeakel S, Nassiri AM et al.. Performing parotidectomy postoperative follow-ups via telemedicine: Experience at a tertiary care, multiple-surgeon otolaryngology center. Journal of telemedicine and telecare 2024. link
3 Stewart KE, Bannon R, Bannister M. Benign parotid mass and facial palsy: systematic review. Annals of the Royal College of Surgeons of England 2021. link
4 Rinaldi V, Costantino A, De Virgilio A, Spriano G, Alloni R, Moffa A et al.. Teaching parotid surgery to ENT residents in the era of new technologies: an ex-vivo ovine model. Journal of biological regulators and homeostatic agents 2020. link
5 Wali GN, Mawby TA, Sheerin F, Milford CA. Varix of the retromandibular vein within the parotid gland: case study. The Journal of laryngology and otology 2013. link
6 Christensen NR, Jacobsen SD. Parotidectomy. Preserving the posterior branch of the great auricular nerve. The Journal of laryngology and otology 1997. link
7 Rea JL. Use of a hemostat/stimulator probe and dedicated nerve locator/monitor for parotid surgery. Ear, nose, & throat journal 1990. link