Eur Arch Otorhinolaryngol (2010) 267:793–800 DOI 10.1007/s00405-009-1148-8 123 HEAD AND NECK Further anatomical approaches to parotid surgery Tahwinder Upile · Waseem K. Jerjes · Seyed Ahmad Reza Nouraei · William Grant · Sandeep Singh · Holger SudhoV · Colin Hopper Received: 22 August 2009 / Accepted: 22 October 2009 / Published online: 1 December 2009  Springer-Verlag 2009 Abstract The rhytidectomy incision has recently been used to approach the parotid gland and has gained increas- ing popularity, particularly amongst facial-plastic surgeons. However, as the skin incision is placed further back with this approach than with the traditional incision, many sur- geons remain concerned with reference to the adequacy of exposure. We report a further anatomical study to compare the surgical access provided by the two incisions that helps address these concerns. We also discuss our modiWcations to the incision should it become oncologically necessary. Dissections were performed on formaldehyde-Wxed cadav- ers. A standard cervico-mastoid-facial incision was per- formed on one side and a rhytidectomy approach on the other. The border of the parotid gland was deWned in all cases and the distances from the border of the gland to the edge of the Xaps, retracted with two standard Langenbeck retractors were measured and compared between the two incisions. The comparison of the exposure gained with tra- ditional incision and the rhytidectomy approach for paroti- dectomy showed that the Wilcoxon-signed rank test paired nonparametric t test, P value was 0.3749. This suggests that there was no signiWcant diVerence in exposure for the two surgical approaches. In conclusion, we would advocate its more widespread consideration for patients undergoing parotid surgery. However, we do not suggest the approach would be appropriate for all patients or pathological entities and the choice of incision should be dependent on circum- stances. However, we do advocate a Xexibility of surgical thinking in the light of developing anatomicopathological knowledge. Keywords Anatomical approaches · Parotid · Surgery Introduction Parotidectomy for the removal of lesional tissue is not with- out consequence and can at best be tricky and at worst ruin- ous. Apart from obvious oncological considerations, the functional preservation of cosmesis is important; this can be aided by proper identiWcation and preservation of the nerve at surgery that can be especially diYcult in a bloody operative Weld or by an incision that limits exposure; hence, anatomical landmarks and adequate operative exposure can aid in such identiWcation and preservation. This is achieved T. Upile · W. K. Jerjes · C. Hopper UCLH Head and Neck Centre, London, UK W. K. Jerjes e-mail: waseem_wk1@yahoo.co.uk T. Upile · S. A. R. Nouraei · S. Singh The Ear Institute, University College London, London, UK T. Upile · H. SudhoV Department of Otorhinolaryngology/Head and Neck Surgery, University of Bielefeld, Bielefeld, Germany W. K. Jerjes · C. Hopper Department of Surgery, University College London Medical School, London, UK W. K. Jerjes · C. Hopper Unit of Oral and Maxillofacial Surgery, CUL Eastman Dental Institute, London, UK S. A. R. Nouraei · W. Grant ENT Department, Charing Cross Hospital, London, UK T. Upile (&) The Royal National Throat, Nose and Ear Hospital, 330/332 Gray’s Inn Road, London WC1X 8EE, UK e-mail: mrtupile@yahoo.com