Chapter 10: Retromandibular Approach Flashcards
The retromandibular approach is aimed to be between what branches of the facial nerve?
Buccal and marginal mandibular
What two veins give rise to the retromandibular vein?
superficial temporal vein maxillary vein
Near the apex of the parotid gland, the retromandibular vein gives off an anteriorly descending communication that joins to ____ vein just below the angle of the mandible
facial vein
The retromandibular vein then inclines backward and unities with the _______ _______ vein to form the _______ jugular vein
posterior auricular
external
What is the benefit of placing the incision approximately 2 cm posterior to the ramus?
Allows parotid gland to be sharply dissected from the SCM and retracted anteriorly and superiorly which avoids all branching facial nerves.
How far below earlobe do you place the incision? How far down does the incision extend?
0.5cm
3-3.5cm
What are the layers of dissection down to the ramus?
Skin Subcutaneous Scant platysma SMAS parotid capsule parotid gland Pterygomasseteric sling
What plane is the platysma, SMAS and parotid capsule incised?
Vertical, like the skin
What branch of facial nerve is most commonly encountered?
Marginal mandibular
What vessel is most commonly encountered?
Retromandibular
Does the retromandibular vein routinely need to be ligated?
No
What is one technique applied when the ramus must be distracted inferiorly (in the event of a condylar process fracture)?
Bicortical screw through gonial angle. Pass 14 gauge needle into field, then 24 gauge wire through the field. Loop the screw and retract inferiorly with the needle driver
What layers are sutured?
1. Pterygomasseteric sling parotid 2. capsule/SMAS/platysma 3. Subcutaneous 4. Skin
In order to prevent complications with the parotid, what type of closure must be performed for the parotid capsule/SMAS/platysma?
Watertight closure (usually via running horizontal mattress)
