Based on the traditional parotid tumor and parotidectomy surgery, parotid surgery techniques have been greatly improved in recent years. In order to ensure complete resection of the tumor, individualized methods are used to maximize the preservation and restoration of normal parotid tissue and adjacent normal tissue function in the operative area, choosing cosmetic incisions or using speculum surgery, and using ultrasonic knife to improve patients’ quality of life and reduce complications. After partial parotidectomy with preservation of the dominant parotid duct, the residual gland has a strong regenerative capacity and compensatory effect, and glandular function is preserved or partially preserved [1]. The results of radiographic autoradiography showed that the function of the remaining gland was completely normal after partial parotidectomy with preservation of the dominant duct [2]. In recent years, many scholars at home and abroad have reported that for benign or low-grade malignant adenocarcinoma of the parotid gland, the use of complete resection of the tumor and the minimum amount of normal glandular tissue necessary not only does not increase the chance of tumor recurrence, but also has the significant advantages of simplifying the surgery and reducing postoperative complications [3-4]. Therefore, preserving the dominant parotid duct and part of the gland can preserve the function of the remaining glandular tissues. In surgery for benign parotid tumors, emphasis should be placed on preserving the dominant duct of the parotid gland. Xie Jinghua et al. found that the maximum depth of extraperitoneal infiltration of the tumor was only 0.26 mm in 25 consecutive pathological sections of primary mixed parotid tumors [5], and Wen Yuming et al. found that primary multicentric pleomorphic adenomas were extremely rare, and partial excision of the 5-10 mm gland outside the parotid pleomorphic adenoma body could achieve radical results [6], which was also confirmed by Qiu Jiaxuan’s study, which provides a pathological basis for regional resection provides a pathological basis [7,8]. Jincheng Xie et al. concluded that even recurrent mixed deafness of the parotid gland can be treated with regional parotidectomy without tumor recurrence [9]. Aesthetic integration and implementation of aesthetic concepts in plastic surgery 1. Improvement of incision Aesthetic incision combined with a modified facial wrinkle incision: the preauricular postauricular hairline approach, which follows the design of the facial wrinkle incision, is an N-shaped parotidectomy incision, starting from the root of the pedicle of the ear wheel along the posterior lateral surface of the free edge of the ear screen down to the earlobe, bypassing the earlobe to the posterior sulcus of the earlobe and curving upward from the posterior sulcus of the earlobe to the lower third of the cranioauricular sulcus and turning downward posteriorly into the intertriginous margin of the mastoid occipital area and extending downward at the intertriginous margin for a length depending on the exposure [10]. The design of the concealed incision allows for maximum preservation of the normal tissue structure and facial appearance while eradicating the tumor, and the staggering of the operative area from the incision minimizes the effect of scar formation due to deep tissue pulling on the incision, basically achieving the aesthetic effect of no visible scar [11-12]. The use of endoscopy can complete the resection of benign tumors in the superficial lobe of the parotid gland with a diameter of less than 3 cm using only a small incision of less than 3 cm in length, and the operative cavity does not need to be filled with air, and only a small pulling hook is used to construct the surgical space [13,14]. 2. Functional resection is advocated for benign tumors Wen Yuming et al. made serial sections of parotid pleomorphic adenoma specimens to observe and record extraperitoneal infiltrating tumor buds and primitive multicentric lesions, and the results showed that the extraperitoneal infiltrating tumor buds were confined to 0.09-0.285 mm outside the tumor envelope, much smaller than the safe incision margin of 37.5 px for partial parotidectomy [6]. There is no difference in recurrence rate between superficial lobectomy and total parotidectomy for pleomorphic adenoma, therefore most scholars recommend partial parotidectomy for benign tumors instead of superficial total parotidectomy [8-9,15-16]. Most of the parotid glands are located in the posterior maxillary fossa and some of the superficial lobes cover the surface of the chewing muscles. Surgical excision of some or all of the glands in the premaxillary and postmaxillary submandibular regions will leave a significant depressed deformity, especially in the auricle and submandibular area. Currently, soft tissue flaps are commonly used to fill soft tissue depressions in the earlobe and posterior maxillary area, including superficial temporalis fascial flap, diastasis flap, broad cervical muscle flap, buccal fat pad and sternocleidomastoid flap, etc. The sternocleidomastoid flap is the most widely used because of its convenience and small trauma; the broad cervical muscle flap provides less tissue and is thinner, while the temporalis fascial flap provides a large amount of tissue but requires a longer auxiliary incision in the donor area, which is more traumatic and has the risk of damaging the facial nerve. The sternocleidomastoid muscle is located under the posterior parotid gland and its anterior margin needs to be exposed during parotidectomy, so no additional incision is needed. The branches of the paramedian nerve in the sternocleidomastoid muscle are concentrated in the middle of the muscle, while the branches at the two ends of the muscle are sparse. Therefore, cutting off the sternocleidomastoid muscle one centimeter above the midpoint can protect the nerve and its branches better and does not affect the function of the sternocleidomastoid muscle after surgery. The tipped sternocleidomastoid flap can be rotated to the depression after parotidectomy, and the severed end of the flap can be fixed to the occlusal fascia with a transverse mattress suture [10]. Alternatively, the muscle flap was filled in a fan shape on the surface of the facial nerve and the inner surface of the subcutaneous tissue to form a natural barrier in the surgical field, which protected the facial nerve and covered the residual glandular vesicle tissue, so that the temporary paralysis of the facial nerve caused by the same surgical strain could be recovered as early as possible after surgery, which greatly reduced the chance of facial paralysis and salivation, and greatly reduced the occurrence of auriculotemporal nerve syndrome [17]. Guo Xiju et al. used expanded polytetrafluoroethylene implantation to rectify post-parotidectomy depression deformity also achieved good cosmetic results [18]. 4, the application of postoperative cosmetic sutures In the suturing process, great attention should be paid to the suture in the subcutaneous tissue, the knot must be tied well inward and minimize tension, which is an effective way to reduce the healing of the incision scar, the choice of cosmetic sutures is also important, the purpose of surgical sutures is to keep the tissue close together until the natural healing process has progressed to the point where suture support is no longer needed. Polylactic acid hydroxyacetic acid thread is a copolymer of polylactic acid (PLA) and polyglycolic acid (PGA), and its decomposition product hydroxyacetic acid is an effective antimicrobial agent. These sutures have satisfactory antitension strength, good operability, material homogeneity, stability, non-toxicity, non-collagenicity and non-carcinogenicity, small reaction to antibody tissue, and strong anti-acid and anti-infection effects, and still maintain after two weeks more than 55% of the original thread strength after two weeks and is completely absorbed in 60-90 days, making it a good material for surgical suturing [19]. III. Preservation of the greater auricular nerve In traditional parotid tumor resection, the anterior parotid branch of the auricular branch is actually removed during surgery, and the posterior branch of the ear is also often easily damaged, resulting in postoperative numbness and discomfort in the auricular and mastoid areas of the patient’s ear, and even frostbite due to loss of consciousness. The sensation of the outer ear and its surrounding skin is very sensitive, which affects the patient’s quality of survival to varying degrees, and may also associate the patient with tumor recurrence due to local discomfort, increasing the patient’s psychological burden [20]. In parotid tumor surgery, preservation of the auricular nerve can reduce postoperative numbness complications and improve the quality of life, which is in line with modern principles of minimally invasive surgery, so the auricular nerve should be preserved as much as possible in parotid tumor surgery [21, 22] The branches and distribution of the auricular nerve have their own regularity, and after penetrating the anterior border of the sternocleidomastoid surface, they travel between the surface of the parotid fascia and the deep surface of the vastus cervicis muscle, and are divided into posterior auricular branches above the level of the angle of the mandible in turn The anterior branch of the parotid nerve is divided into the posterior branch of the ear, the anterior branch of the ear, the main trunk of the parotid nerve near the bifurcation, and the beginning of each branch travels on the superficial surface of the parotid fascia and is distributed to the skin of the mastoid region, the occlusal region of the auricle, the cranial surface of the ear, the anterior region of the earlobe, and the skin of the cheek. By preparing a fan-shaped parotid occlusal fascial flap with the tip posteriorly and keeping it in place, Zumon et al. achieved a good result by turning up the auricular nerve together with the flap to avoid dissection of the auricular nerve, and also had some effect on the prevention of Fery’s syndrome and salivary fistula [24]. IV. Advances in facial nerve protection and repair after facial nerve injury 1. The use of microscope for early detection of the nerve and to reduce the pulling of the facial nerve and reduce the occurrence of facial palsy [25]. The surgical microscope provides good magnification for surgical operations, facilitates observation and discrimination of tiny blood vessels and nerve branches, clear anatomical levels under the microscope, fine and accurate surgical operations, less damage to nerve and parotid tissue, maximum precise hemostasis and protection of the facial nerve and its branches, and complete resection of the tumor. The advantages of microscopic surgery over traditional surgery include: the light source is bright, and the tissue under the microscope is about 2~10 times larger than that seen under the naked eye in traditional surgery. The nerve under the microscope is silvery white and shiny, with obvious contrast with surrounding tissues, easy to identify with parotid ducts, arteries and veins, fascia, etc. The intraoperative field of vision is clear and hemostasis is complete; the brightness and magnification can be adjusted at will in areas that need careful separation; if the nerve branches are inadvertently damaged or must be sacrificed, they can be anastomosed or transplanted at any time; the operator operates in a sitting position, with little physical exertion. The observation angle and field of view of the assistant and the operator are exactly the same, which can be more effectively coordinated with the surgery and teaching demonstration [26]. 2. Immediate end-to-end anastomosis repair of facial nerve defects Peripheral nerve defects that do not exceed 3% of the total nerve length or are less than 4 times the nerve diameter are expected to have tension-free end-to-end sutures, and this method has the best results [27]. That is, if the facial nerve defect is < 25px,< span=""> end-to-end sutures can be obtained. The main advantage of this method is that the donor nerve is not sacrificed and the axon buds only need to span one anastomosis. Therefore, nerve lengthening can replace nerve grafting within a certain defect area [28]. In patients with facial nerve defects of 75 px, Zumeng Tooth et al. applied linear loading and chordal loading methods to rapidly lengthen the facial nerve and then performed end-to-end tension-free sutures with satisfactory overall results. 4. Bridging graft repair of facial nerve defects For cases with facial nerve defects of 3~150px, bridging graft repair of facial nerve defects becomes the best choice, which includes autologous nerve graft, allogeneic nerve fiber tissue bridges, autologous non-neural other tissue bridges, synthetic material bridges and tissue engineering. For example, artificial catheter bridging containing Chevron cells and various neurotrophic factors; venous, degenerated skeletal muscle bridging; pre-treated (cryopreservation, lyophilization, radiotherapy, pre-collapse and ethanol immersion and embryonic nerve graft) allogeneic nerve grafts [30]. V. There has been a great progress in the prevention of Frey’s syndrome Frey’s syndrome, also known as gustatory sweating syndrome, is the most common complication after parotid surgery, which is clinically manifested by flushing and sweating of the skin in the parotid surgical area during eating or gustatory stimulation, causing great mental distress and life and social It causes great mental distress and life and social inconvenience. The cause of Frey’s syndrome is the postoperative misalignment of the postganglionic parasympathetic nerve, which governs parotid secretion, with the sympathetic nerve, which governs sweat gland secretion and subcutaneous blood vessels. s syndrome. Sternocleidomastoid muscle flaps, temporalis fascia flaps, forearm free flaps, broad fascial flaps of the lateral thigh, and biomaterials are often used as coverings to prevent the wandering or misplaced regeneration of the two nerve dissections [ 31-33]. However, these muscle flaps or broad fascia flaps require additional surgical incisions, which are highly traumatic, increase bleeding, and leave additional scars after surgery, which are not easily accepted by many patients, especially young patients. In recent years, some scholars in China have adopted the Superficial musculoaponeurotic system SMAS (Superficial Musculoaponeurotic System) to prevent the misaligned growth of nerve fibers, which is a separate tissue structure between the subcutaneous fat and the parotid fascia, continuing upward with the superficial temporal fascia and moving downward to the broad cervical muscle flap. It has a dense and tough texture with good elasticity, while the deeper surface is a thin, loose layer of fascia covering the parotid gland, which is easy to dissect and separate. This layer of fascia is dense and tough, and preserving the parotid cheek muscle fascia during surgery can isolate the trauma between the residual parotid gland and the subcutaneous tissue, and block the cross-regenerative association between the parasympathetic fibers distributed in the parotid gland and the sympathetic fibers distributed in the sweat glands and skin vessels in the wrong direction, with good results [34,35]. There are currently 2 methods of preserving the SMAS, namely the non-free preserving method, in which the fascia is not separated from the flap, and the free preserving method, in which the flap is separated on both the superficial and deep sides of the SMAS, with the latter providing better protection [36]. VI. use of ultrasonic knife in parotid surgery The mechanism of ultrasonic knife cutting tissue is mainly transient impact acceleration, in addition to microacoustic flow and acoustic cavitation effects. The ultrasonic knife converts the electrical energy of the generator into ultrasonic mechanical energy through the converter, and uses the ultrasonic frequency generator to make the metal blade vibrate mechanically at an ultrasonic frequency of 55 kHz, which then causes the water in the tissue to vaporize, the protein hydrogen bonds to break, the cells to disintegrate, and the tissue to be cut or coagulated so as to achieve the cutting and hemostatic effects. Compared with traditional scalpel and electric knife, ultrasonic knife has many advantages: (1) small local damage. The ultrasonic knife can damage 1 mm of surrounding tissue. (2) Rapid and reliable coagulation. For blood vessels with a diameter of 3 mm or less can be cut directly and hemostasis can be achieved immediately [37 -38]. (3) Clear surgical field. The ultrasonic knife cuts the tissue, breaks the protein hydrogen bonds, and vaporizes the water inside, with little smoke and crusting. (4) Safe to use. There is no need to stick conductive adhesive pole plate on the patient’s body, so that no current passes through the patient’s organism, which not only prevents the patient and medical staff from tissue electrical burns, but also produces no electrical interference with various monitoring instruments. In 2003, German scholars Koch et al [39] were the first to use the parotid gland of pigs to determine the effect of temperature on the surrounding glands and facial nerves during ultrasonic knife use, and they considered a tissue range of 3 mm to be the safe limit. The application of ultrasonic knife in parotid surgery mainly takes advantage of its low local injury and safety, which can effectively protect the branches of the facial nerve from damage and reduce the risk of postoperative facial palsy; at the same time, the rapid and reliable coagulation can quickly and effectively operate in the parotid region where the distribution of blood vessels is relatively dense [40]. In 2009, Huang et al. performed endoscopic-assisted ultrasonic knife parotidectomy for parotid tumors through two small 20-25 mm incisions around the ear to complete the surgery. Compared with the experimental group, the bleeding was significantly lower, and all 18 patients expressed satisfaction with the cosmetic results of the small incisions [13]. The hemostatic principle of ultrasonic knife can help to occlude the tiny ducts and alveoli of the parotid lobules at the same time, which effectively reduces the occurrence of postoperative salivary fistula; together with the use of endoscope, the facial scar is reduced, which also meets the requirements of patients’ facial aesthetics. Only on this basis can the core value of functionality be reflected, i.e., to maximize the preservation and restoration of normal parotid tissue and adjacent normal tissue function in the operative area, and to improve the patient’s quality of life. The unilateral pursuit of function and aesthetics, such as arbitrarily narrowing the scope of resection, forcing the incision to be hidden, and ignoring the characteristics of the tumor, will affect the therapeutic effect. The future development of parotid surgery will depend on new diagnostic imaging techniques for preoperative evaluation, the development of endoscopic techniques, and the use of new instruments and materials, not only for complete resection of the tumor, but also for aesthetic and functional preservation. References: [1] Li Yang, Wang Dazhang, Zheng Guangyong. Animal experimental study of regeneration and compensation after partial parotidectomy [J]. Journal of Oncology, 2001, 7(3):132-135. [2] Nikolaos Papadogeorgakis, Chris A. Skouteris, Anastassios I. Mylonas, Angelos P. Angelopoulos. 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