Faculty:
Dr Jagpreet Singh (Consultant - General & Laparoscopic Surgery)
Dr. Mudit Kumar  (Consultant - General & Laparoscopic Surgery)
Dr. Hitesh Arora (Consultant - Anesthesia)

Hospital:
RG Hospitals, Ludhiana, Punjab.

Presenting/Chief Complaints:
A 26/F presented with complaints of progressively increasing swelling on face in Left Preauricular region for last 2 years. Clinical examination was suggestive of a firm and mobile lump in left Parotid gland. The Ultrasonography revealed left Parotid swelling (18x14mm). The FNAC was suggestive of Pleomorphic Adenoma. For preoperative evaluation a MRI Scan of neck showed predominantly solid well defined circumscribed lesion (22x20mm) in the superficial lobe of Left Parotid Gland (? Warthin’s Tumour). 

Diagnosis:
Warthin’s Tumour - Parotid Tumour 

Treatment/Procedure/Surgery:
Excision of swelling along with resection of superficial lobe of left Parotid gland (Superficial Parotidectomy).

Operative Findings:
Modified Blair Incision was made. Thick Flaps of facial skin were created. Greater auricular nerve was identified along the sternomastoid muscle. The Facial nerve trunk was exposed medial and inferior to tragal point. All the branches of facial nerve were identified and preserved carefully. The entire parotid gland superficial to the nerve trunk was mobilized and resected along with the tumor. The skin flaps were closed with subcuticular sutures for a good cosmetic fine scar.

Course of Hospitalization and Condition of Patient at the Time of Discharge:
Postoperative period was uneventful and patient was discharged next day in satisfactory condition.

Highlights:
Parotidectomy is a surgical challenge because of anatomical relations and location of parotid. The main nerve of face (Facial nerve) along with its branches traverses through the middle of the parotid gland. In order to prevent injury and resulting deformity of facial muscles, it is of utmost importance to identify the various branches and preserve them with precise and gentle dissection. Similarly the nerve to ear (Greater auricular nerve) also needs careful dissection and preservation. The scar of incision is carried by the patient all through the life and should preferably be fine and unremarkable.
For pleomorphic adenomas, Superficial parotidectomy is standard of care and almost always curative with excellent long term results.