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Emergency Parotidectomy for Penetrating Zone III Neck Trauma

Luc G. Morris, MD; Maurizio A. Miglietta, DO; Andrew G. Sikora, MD; Monica N. Okun, MD; J. Thomas Roland Jr, MD
Arch Surg. 2007;142(12):1206-1208. doi:10.1001/archsurg.142.12.1206.
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Penetrating trauma to the face and upper zone III of the neck may present unique challenges when the parotid gland and associated neurovascular structures are involved. We report a case of massive hemorrhage from penetrating neck trauma that necessitated emergency parotidectomy for vascular exposure. Facial nerve repair was also necessary, underscoring the importance of this approach not only for successful vascular control but also for preservation of nearby vital structures. The management of penetrating trauma to the parotid region,and relevant anatomy, are discussed.

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Figure 1.

Left parotid region after carotid exploratory surgery.

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Figure 2.

Nerve graft repair of transected upper division of the facial nerve.

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Figure 3.

Vascular anatomy of the left parotid region. Dotted line outlines the parotid gland. STV and STA indicate the superficial temporal vein and artery, respectively (portions intraparotid); EAC, external auditory canal; TFV and TFA, transverse facial vein and artery, respectively (intraparotid); CN7, facial nerve (travels within gland; incompletely illustrated); PD, parotid duct; RMV, retromandibular vein (portions intraparotid); IMAX, internal maxillary artery and vein (deep to mandible); PAV and PAA, posterior auricular vein and artery, respectively; FV and FA, facial vein and artery, respectively; EJV, external jugular vein; IJV, internal jugular vein; and ECA, external carotid artery.

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