Extracapsular Dissection with Facial Nerve Dissection for Benign Parotid Tumors.

E xtracapsular dissection with facial nerve dissection (ECD-FND) uses standard surgical landmarks to identify and antegrade dissect the facial nerve trunk at the onset of the procedure. The branches of the facial nerve are dissected up to the anterior extracapsular margin of the tumor; then, the tumor is dissected with a thin layer (1-2 mm) of parenchyma and fascia around it (Figure 1). Extracapsular dissection (ECD) does not dissect the facial nerve. The parotid tumor is dissected in an extracapsular plane with 1 to 2 mm of parotid parenchyma and fascia around the tumor (Figure 2). Enucleation, an abandoned technique, is an intracapsular dissection. Partial superficial parotidectomy (PSP) uses standard surgical landmarks to identify the facial nerve trunk in an antegrade approach at the onset of the procedure. It is distinguished from ECD-FND in that in PSP peripheral branches of the facial nerve are dissected anterior as well as posterior to the tumor. The tumor is removed with a 1to 2cm margin of normal parotid parenchyma around the tumor except where the tumor abuts the facial nerve (Figure 3). Lower complication rates at selected high-volume parotid centers performing ECD for transient facial nerve dysfunction and sialocele, as compared with superficial parotidectomy and PSP, have led to debate regarding the amount of parotid parenchyma to resect around the parotid pleomorphic adenoma (PPA).