Skip to main content Accessibility help
  • Print publication year: 2012
  • Online publication date: November 2012

Chapter 21 - Anesthesia for parotid surgery

from Section 3 - Anesthesia for head and neck surgery


Functional endoscopic sinus surgery is among the most challenging of ENT procedures for a variety of reasons including the need for immobility, hemostasis, and, especially, gentle emergence from anesthesia. Anesthesiologists have contributed significantly, using anesthetic techniques to mitigate intraoperative hemorrhage into the surgical field, thus significantly improving visualization of the surgical field. Functional endoscopic sinus surgery (FESS) strives to enable direct examination in situ with subsequent correction of encountered chronic changes and barriers which limit sinus drainage and aeration. The use of supraglottic airway (SGA) over endotracheal tubes (ETT) appears additionally advantageous, providing reduced incidence and severity of coughing intraoperatively and during emergence. Propofol/remifentanil total intravenous anesthesia (TIVA) with spontaneous respiration (PRTSR) is considered by some an optimal strategy to avoid emergence problems and provide flexibility, and minimize nausea, vomiting, and estimated blood loss (EBL), while ensuring rapid induction and emergence.


1. HegazyMA, ElNW, RoshdyS. Surgical outcome of modified versus conventional parotidectomy in treatment of benign parotid tumors. J Surg Oncol 2011;103:163–8.
2. LaingMR, McKerrowWS. Intraparotid anatomy of the facial nerve and retromandibular vein. Br J Surg 1988;75:310–2.
3. ColellaG, RausoR, TartaroG, BiondiP. Skin injury and great auricular nerve sacrifice after parotidectomy. J Craniofac Surg 2009;20:1078–81.
4. ZumengY, ZhiG, GangZ, JianhuaW, YinghuiT. Modified superficial parotidectomy: preserving both the great auricular nerve and the parotid gland fascia. Otolaryngol Head Neck Surg 2006;135:458–62.
5. PorterMJ, WoodSJ. Preservation of the great auricular nerve during parotidectomy. Clin Otolaryngol Allied Sci 1997;22:251–3.
6. BiorklundA, EnerothCM. Management of parotid gland neoplasms. Am J Otolaryngol 1980;1:155–67.
7. EmodiO, El-NaajIA, GordinA, AkrishS, PeledM. Superficial parotidectomy versus retrograde partial superficial parotidectomy in treating benign salivary gland tumor (pleomorphic adenoma). J Oral Maxillofac Surg 2010;68:2092–8.
8. YooGH, EiseleDW, AskinFB, DribenJS, JohnsME. Warthin's tumor: a 40-year experience at The Johns Hopkins Hospital. Laryngoscope 1994;104:799–803.
9. EiseleDW, WangSJ, OrloffLA. Electrophysiologic facial nerve monitoring during parotidectomy. Head Neck 2010;32:399–405.
10. DelgadoTE, BucheitWA, RosenholtzHR, ChrissianS. Intraoperative monitoring of facial muscle evoked responses obtained by intracranial stimulation of the facial nerve: a more accurate technique for facial nerve dissection. Neurosurgery 1979;4:418–21.
11. ReaJL. Use of a hemostat/stimulator probe and dedicated nerve locator/monitor for parotid surgery. Ear Nose Throat J 1990;69:566, 570, 573.
12. JellishWS, LeonettiJP, BuoyCM, et al. Facial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth. Anesth Analg 2009;109:551–8.
13. KheterpalS, MartinL, ShanksAM, TremperKK. Prediction and outcomes of impossible mask ventilation. A review of 50,000 anesthetics. Anesthesiology 2009;110:891–7
14. ReillyDJ. Benign transient swelling of the parotid glands following general anesthesia: “anesthesia mumps”. Anesth Analg 1970;49:560–3.
15. ThiedeO, KlusenerT, SielenkamperA, et al. Interference between muscle relaxation and facial nerve monitoring during parotidectomy. Acta Otolaryngol 2006;126:422–8.
16. CaffreyRR, WarrenML, BeckerKE Jr. Neuromuscular blockade monitoring comparing the orbicularis oculi and adductor pollicis muscles. Anesthesiology 1986;65:95–7.
17. KizilayA, AladagI, CokkeserY, et al. Effects of partial neuromuscular blockade on facial nerve monitorization in otologic surgery. Acta Otolaryngol 2003;123:321–4.
18. BaldoBA, McDonnellNJ, PhamNH. Drug-specific cyclodextrins with emphasis on sugammadex, the neuromuscular blocker rocuronium and perioperative anaphylaxis: implications for drug allergy. Clin Exp Allergy 2011.
19. SasakawaT, IwasakiH, KurosawaA, et al. A case report: a normal dose of rocuronium achieved the desired effect in a short time after the administration of sugammadex during reoperation. Masui 2011;60:621–4.
20. WadhwaRK, TantisiraB. Parotidectomy in a patient with a family history of hyperthermia. Anesthesiology 1974;40:191–4.
21. YasudaT, OtomoN, MatsukiA, et al. Total intravenous anesthesia for two patients complicated with myotonic dystrophy. Masui 1999;48:181–4.
22. SoodS, QuraishiMS, BradleyPJ. Frey's syndrome and parotid surgery. Clin Otolaryngol Allied Sci 1998;23:291–301.
23. NahlieliO, BaruchinAM. Endoscopic technique for the diagnosis and treatment of obstructive salivary gland diseases. J Oral Maxillofac Surg 1999;57:1394–401.