Total parotidectomy under local anesthesia: a novel technique

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Anesthesiology

Background:

• Parotidectomy is a common surgical procedure for parotid masses requiring histological diagnosis.
• Typically performed under general anesthesia, it often involves nerve stimulators for facial nerve identification.
• General anesthesia poses risks, especially for patients with comorbidities.

Purpose of the Study:

• To describe a novel technique for performing total parotidectomy under local anesthesia.
• To evaluate the feasibility and safety of this technique in a small patient cohort.
• To present an alternative to general anesthesia for parotid surgery.

Main Methods:

• Local anesthesia was achieved by anesthetizing the ascending cervical branch of the cervical plexus and the auriculotemporal nerve.
• Anesthetic agents used included bupivacaine 0.25% and lignocaine with adrenaline.
• Patient cooperation for facial nerve identification through on-command movements was utilized.

Main Results:

• The technique successfully enabled total parotidectomy under local anesthesia in three cases.
• Anesthesia onset occurred within 15-25 minutes, with procedures lasting 2-3 hours.
• No complications were reported, and facial nerve identification was facilitated by patient movements, obviating the need for nerve stimulators or dye injections.

Conclusions:

• Total parotidectomy can be safely performed under local anesthesia using this described technique.
• This method is particularly advantageous for high-risk patients unsuitable for general anesthesia.
• The technique supports outpatient management and facilitates early patient discharge, reducing healthcare burdens.