Infantile parotid hemangioma is a common benign tumor of the maxillofacial region, which usually appears after birth or 1 to 2 months and grows rapidly. The surgical method is to use an arc-shaped incision in front of the ear screen, and after revealing the tumor, the tumor is separated along the pseudopapillary membrane to avoid damaging the nerve fibers. The main trunk of the facial nerve is isolated in the triangular area consisting of the anterior border of the sternocleidomastoid muscle, the posterior superior border of the bicipital muscle and the inferior border of the mandible, the discolored tumor is separated along the main trunk, and the branches of the facial nerve are freed. The skin lesion can be excised until the wound can be pulled together and sutured, and the lesion that cannot be excised can be treated by injection or laser in the second stage. All wounds were closed with continuous intradermal sutures and a continuous negative pressure drainage tube was placed. Wuhan Women’s and Children’s Health Care Center Plastic Surgery Department Zhou Qixing Characteristics of infantile parotid hemangioma Infantile parotid hemangioma has early onset, mostly after birth, and the masses appear within 1 month after birth, and the tumor rapidly increases in size within 1-2 months, causing facial deformation. The pathological type of the tumor is capillary hemangioma or capillary endothelial hemangioma, which easily invades the entire lobe of the parotid gland, with no or little parotid tissue and few parotid ducts in the tumor. It is difficult for parotid hemangioma to subside spontaneously, and because of the rich blood supply and rapid growth of the tumor, the pressure and invasion of the external auditory canal often occur, affecting the hearing of the affected side, which requires attention. Timing of surgery Some scholars believe that pediatric hemangioma has the possibility of natural regression and advocate conservative observation, but there is no effective detection means to predict which tumors can be regressed, and we often encounter some cases in which the tumor expands due to blind observation and the best treatment time is lost. We believe that infant parotid hemangioma should adhere to the principle of early detection, early diagnosis and early treatment, and the observation period should be short, and any tumor that increases rapidly within a short period of time should be treated promptly. At present, many non-surgical methods are popular for treating hemangioma, such as laser, sclerosing agent injection, radiological intervention, isotope dressing, X-ray irradiation, etc. However, the efficacy of treatment for infant parotid hemangioma is still not as good as that of surgery, and if surgery is performed after sclerosing agent injection, it is easy to cause damage to facial nerve due to serious adhesion of tumor tissue, unclear anatomy and difficult separation. We advocate surgery first and non-surgical treatment for the residual tumor in the second stage. The first-stage surgery is usually thorough and rarely results in recurrence of the tumor. Facial nerve anatomical features of parotid hemangioma (1) Location of facial nerve trunk The facial nerve exits the skull through the stem mammary foramen and enters the parotid gland through the triangular gap formed by the anterior border of the sternocleidomastoid muscle, the superior border of the posterior belly of the bicipital muscle and the inferior border of the mandible. In the other case, the facial nerve trunk comes out of the triangular space and enters the tumor directly, and the nerve trunk is not visible outside the pseudo-envelope of the tumor. (2) The branches of the facial nerve are usually about 1-2 mm thick, and the branches are less than 1 mm. (3) The mandibular margin branch is shallow and most easily damaged. The mandibular margin branch is thinner than the buccal branch and zygomatic branch, and it penetrates the parotid gland and enters the muscle after a section of the superficially traveling mandibular muscle group. In addition, there is also a trigeminal nerve running through the parotid gland, which governs the secretion of the gland, so attention should be paid to screening during surgery. The blood supply to the parotid gland is generally composed of the superficial temporal artery, the transverse facial artery, the anterior facial artery, and the posterior facial vein, and these vessels constitute the main trophoblastic vessels of the parotid gland when the parotid gland is tumorized. In order to reduce bleeding during surgical separation of the aneurysm, some authors have ligated the external carotid artery before performing the separation procedure. Our method is to separate and ligate three arteries and one vein along the upper, lower and medial deep surfaces of the tumor, and then separate the tumor from the facial nerve trunk after the tumor turns dark red or purplish-red, at which time the tumor is no longer bleeding and can be easily excised in small pieces for easy separation and protection of the facial nerve. Causes and prevention of facial palsy (1) Disconnection injury of facial nerve branches When separating the edge of the tumor body by mistake when the blood vessel is ligated or broken during separation, the most likely injury is the injury of the mandibular margin branch and branches, because the mandibular margin branch is shallow and slender, this injury immediately after surgery, facial palsy symptoms appear; (2) Swelling injury of facial nerve branches The nerve sheath membrane of the facial nerve trunk and branches is mechanically injured during separation, and edema appears, which can also appear Facial palsy symptoms, which mostly appear within a few hours or days after surgery, are usually mild and disappear within 1-2 weeks. Our experience is that by being familiar with the anatomy of the parotid gland, the travel characteristics of the facial nerve, and good ligation and hemostasis, the risk of parotid hemangioma surgery can be reduced to a very low level, and the incidence of facial paralysis can be greatly reduced.