Further anatomical approaches to parotid surgery.

The rhytidectomy incision has recently been used to approach the parotid gland and has gained increasing popularity, particularly amongst facial-plastic surgeons. However, as the skin incision is placed further back with this approach than with the traditional incision, many surgeons remain concerned with reference to the adequacy of exposure. We report a further anatomical study to compare the surgical access provided by the two incisions that helps address these concerns. We also discuss our modifications to the incision should it become oncologically necessary. Dissections were performed on formaldehyde-fixed cadavers. A standard cervico-mastoid-facial incision was performed on one side and a rhytidectomy approach on the other. The border of the parotid gland was defined in all cases and the distances from the border of the gland to the edge of the flaps, retracted with two standard Langenbeck retractors were measured and compared between the two incisions. The comparison of the exposure gained with traditional incision and the rhytidectomy approach for parotidectomy showed that the Wilcoxon-signed rank test paired nonparametric t test, P value was 0.3749. This suggests that there was no significant difference in exposure for the two surgical approaches. In conclusion, we would advocate its more widespread consideration for patients undergoing parotid surgery. However, we do not suggest the approach would be appropriate for all patients or pathological entities and the choice of incision should be dependent on circumstances. However, we do advocate a flexibility of surgical thinking in the light of developing anatomicopathological knowledge.