Anatomy Of Parotid Gland Surgery With Endoscopic-assisted Retroauricular Groove Approach

Objective: Parotid gland surgery was performed with endoscopic assistance via simulated retroauricular groove approach,the anatomical structures encountered during the operation were described and the relevant anatomical data were measured,grasp the endoscopic downward and the conventional process of parotid gland surgery important anatomic marks in the parotid gland were contorts and adjacent anatomic structure,to provide anatomical data for parotid gland related surgery through posterior auricular groove approach,and to explore the endoscopic superficial parotid gland,deep lobectomy and the feasibility of facial nerve dissection,may damage caused by the structure of the related complications.Materials: 10 fresh frozen cadavic specimens(20 sides in total,including the neck),which were infused with red latex from the common carotid artery and blue latex from the internal jugular vein.There were no obvious skin damage,no history of head and neck surgery,no history of radiotherapy,and adult specimens.All the specimens were provided by the Department of Otolaryngology of the Second People’s Hospital of Shenzhen.Experimental instruments and equipment: Storz ultra-high-definition(high definition)endoscope,cold light source system,and Kang Ji laparoscopic surgical instruments,including knot forceps,aspirators,electrode electrocoagulation hooks,unipolar separation forceps,unipolar grippers,long electroknife,retractors,etc.Methods:1.The superficial lobes,deep lobes and facial nerves of parotid gland were dissected through the posterior auricle groove with the assistance of simulated endoscopy on 10 freshly frozen adult specimens(20 sides in total)to master the routine procedures and important anatomical markers of parotid gland surgery under endoscopy.2.Anatomical steps: 1.Fixation of cadaver head(including head and neck);2.The posterior auricular groove incision was made under direct vision,about 3-5cm long,and the lower edge was no more than the root of the earlobe.The skin and subcutaneous tissue were cut successively to establish the surgical space.3.statistical method:Statistical processing: All anatomical structure values were measured for3 times,and the average value was taken.Statistical software SPSS 23.0 was used for data analysis,and the measurement results were expressed as((?)±s)mm.Results: The distance of the great auricular nerve from the puncture point of sternocleidomastoid muscle to the mandibular Angle was(47.5±1.2)mm.The distance between the tip of the mastoid process and the branch point of facial nerve was(20.2±2.5)mm.The distance from the branch point of the great auricular nerve to the mandibular Angle was(29.4±1.8)mm.The distance from the branch point of the great auricular nerve to the root of the earlobe was(22.7±1.7)mm.The distance from the lower edge of the temporomandibular joint to the branch point of the facial nerve was(19.5±1.5)mm.Conclusion: By simulating endoscopic surgery,studies have shown that superficial parotid benign tumor line ear endoscope assisted groove into the road after the feasibility of the parotid gland surgery is higher,the amplification effect of endoscopic and lighting effect,intraoperative can better identify and protect the facial nerve,can smooth the anatomy of the facial nerve and the branches,and hidden sulcus incision after ear,good cosmetic effect;For parotid gland tumors involving deep lobes,endoscopic surgery should be carried out as appropriate.Facial nerve and branches interfere with surgical operation during the dissection of deep lobes of the parotid gland,which significantly affects the operation process.Facial nerve and branches need to be pulled during the operation,and the mechanical stimulation of facial nerve is relatively large.After simulated endoscopic surgery on 10 specimens,the routine procedure of parotid gland surgery under endoscopy can be roughly grasped.However,the absence of intraoperative blood is conducive to surgical operation and improved visual field,and postoperative complications,intraoperative bleeding,postoperative drainage and other conditions cannot be evaluated.Intraoperative exploration showed that the great auricular nerve was parallel to the external jugular vein and the posterior mandibular vein was located below the facial nerve.