Benign Parotid Tumor Located Directly Above the Main Trunk of the Facial Nerve: Ingenuity in Nerve Identification

Abstract

　The woman patient was diagnosed as having parotid pleomorphic adenoma. Partial parotidectomy is a well-established treatment for benign parotid tumors. The main trunk of the facial nerve is identified in the first step, and then some necessary branches in order to remove the parotid tumor. However, when the tumor is located directly above the main trunk, identification of the main trunk is often difficult. In our case reported herein, after identifying the mastoid process and the tip of the pointer's cartilage, the parotid tissue around the tumor at the cranial and anterior portion was first resected. This improved the mobility of the tumor and provided a sufficient surgical field for identification of the main trunk. Since the parotid tissue around the tumor is resected before identifying the nerve, fine dissection by using electric knife is essential in such cases. As a result, identification of the main trunk became as easy as in conventional partial parotidectomy, and we were able to perform safe and reliable tumor removal.