DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Recurrent melanoma, right ear, with palpable lymphadenopathy in the neck.
POSTOPERATIVE DIAGNOSIS: Recurrent melanoma, right ear, with palpable lymphadenopathy in the neck.
OPERATION PERFORMED: Superficial parotidectomy.
SURGEON: John Doe, MD
ANESTHESIA: General with 40 mL of epinephrine, 1:250,000.
SPECIMENS: Right superficial lobe of parotid and postauricular lymph node and overlying skin.
BLOOD LOSS: Minimal.
COMPLICATIONS: None immediate.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old Hispanic male who was seen in consultation after having a recurrence of a melanoma that was previously resected from his ear in the past. He presents with palpable lymphadenopathy along the cervical chain in his neck. He was instructed that in addition to a neck dissection, a superficial parotidectomy would be indicated. The patient understands and accepts the risks that have been explained to him such as persistent facial weakness, injury to the facial nerve, wound healing issues, hematoma, and seroma. The patient signed a written consent stating that he understood the risks and benefits.
DESCRIPTION OF OPERATION: After explaining the potential risks and benefits of the procedure to the patient, a written consent was obtained, and the patient was taken to the operating room by gurney and transferred to the operating room table in the supine position. Endotracheal tube was placed by Anesthesia, and general anesthesia was induced. The patient received 1 gram of Ancef preoperatively. A time-out was performed to indicate the patient, procedure, and site to be operated on.
The face was prepped with Betadine, draped with Blair drape and other drapes in the standard sterile fashion. The first step that was undertaken was marking out a retrotragal facelift incision that extended down the anterior border of the sternocleidomastoid. This was marked out, and the above-listed hemostatic agent of epinephrine 1:250,000 was injected into the subcutaneous field for hydrodissection and hemostasis. After this was allowed to set for approximately 10 minutes, we then started dissection. The previously marked incision was opened with a 15 blade. A subcutaneous undermining was performed distal to the anterior border of the masseter and up to the zygomatic arch and inferiorly down over the platysma to approximately the mid cervical level. After this subcutaneous undermining was performed, we then checked for hemostasis.
Next, we then dissected down staying on the cartilaginous portion of the external auditory canal down to the stylomastoid foramen. The tragal pointer was encountered first, and at this point, we then looked inferiorly and found the main trunk of the facial nerve exiting the stylomastoid foramen. The trunk was then split into two separate entities, one heading cephalad and one heading caudal. The cephalad portion was gently dissected along its path of its branching nerves. The frontal and zygomatic branches were dissected free from overlying parotid lobe. We then connected between the two. We then gently rolled the parotid from a cephalad to caudal direction and freed the underlying nerves from it.
Nerve stimulator was used to ensure the intactness of the nerve, and all five nerves were intact. The dissection of the parotid continued out to the anterior border of the masseter. We next continued our dissection along the inferior branch off of the main trunk of the facial nerve. This included the marginal mandibular, buccal, and the cervical branches. These were likewise dissected along their route, and intervening parotid and overlying parotid was transected and continued to be rolled in a cephalad direction. After the superficial parotidectomy had been completed, we were able to see five intact nerves; the frontal, zygomatic, buccal, marginal mandibular, and cervical branches. The nerve stimulator also assured us that these were all intact. Hemostasis was achieved with electrocautery.
At this point, Dr. Jane Doe took over the completion of the neck dissection. Prior to this, a small ellipse of skin overlying the right mastoid and the underlying lymph node were taken and sent for pathology. At the conclusion of Dr. Jane Doe’s portion of the procedure, hemostasis was once again checked and performed with electrocautery. The skin flaps were then pulled up over the tragus and trimmed of any excess. It was then inset with 3-0 Vicryl sutures deep and a running 5-0 nylon suture in the skin. The patient tolerated the procedure well without any immediate complications.
