Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Special scalpel reduces blood loss, facial nerve trauma in salivary surgery

27.06.2005


A harmonic scalpel that uses ultrasound to coagulate as it cuts can reduce blood loss and postoperative facial paralysis in patients who need a portion of their salivary gland removed, surgeons say.



Infection of the sponge-like parotid gland is uncomfortable but temporary, says Dr. Christine G. Gourin, otolaryngologist at the Medical College of Georgia.

But when the gland develops cancerous or benign tumors or stones that interfere with saliva flow, a rather tricky surgery to remove part or all of the gland is needed.


Surgical removal is delicate because the parotid sits between the cheekbone and jawbone and the facial nerve runs right through it, Dr. Gourin says of the gland which contributes a watery fluid to the saliva mix that helps lubricate the mouth and tongue and digest food.

The standard approach is making an incision in a skin fold in front of the ear that runs back into the hairline – the same as for a facelift – then using surgical scissors to remove the gland and surgical ties or electrocautery to stop bleeding.

A small pilot study published in Otolaryngology – Head and Neck Surgery in 2004 described how the harmonic scalpel could reduce operative time and blood loss in patients who had benign disease and needed only a portion of their gland removed.

The new expanded study, published in the June issue of Laryngoscope, compared a larger mix of patients: 41 patients who underwent conventional surgery and 44 who underwent harmonic scalpel parotidectomy for benign or malignant disease and required superficial or total gland removal.

In the superficial group, the harmonic scalpel reduced blood loss during surgery, drainage afterward and facial nerve trauma, says Dr. Gourin, corresponding author on the study.

In the 13 patients who needed total parotidectomy, no significant differences were noted between the four who had conventional surgery and the nine who had harmonic scalpel parotidectomy. Researchers say their findings warrant further study of the scalpel’s potential in patients with malignancies who need their entire gland removed.

“We pooled our data and looked at patients with all kinds of tumors and more extensive surgery and found that the harmonic scalpel was just as effective when it was used for malignant disease,” says Dr. Gourin. “When malignant disease involves the deep lobe of the parotid gland underneath the facial nerve, there is more risk from the surgery but the harmonic scalpel appears to be safe for use in this area.”

While the number of patients with deep lobe disease was small, the evidence showed the harmonic scalpel worked as well as the standard approach and suggested a trend toward some of the same improvements seen with less extensive surgery, Dr. Gourin says.

The facial nerve is the main reason Dr. Gourin sought better surgery options. “Anything we use in the parotid gland to cut tissue or stop bleeding cannot harm the nerve. Standard electrocautery is not a great option because there is a rim of thermal injury around the tip of the cautery blade that can theoretically injure facial nerve branches,” Dr. Gourin says. The harmonic scalpel, which uses ultrasonic vibrations instead of electricity to coagulate tissue, doesn’t have this potential for collateral injury.

Facial nerve injury, resulting in paralysis including a droopy smile and inability to completely close the eye, is the biggest risk of parotidectomy. Another consequence can be a sunken-look where the parotid is removed. Dr. Gourin and her MCG colleagues now use fat from the abdomen to fill the deficit. “We are doing it more and more,” even with cancer because the fat will not interfere with follow-up treatment, she says.

She noted that about 80 percent of parotid tumors are benign but must be removed because they keep growing and risk becoming malignant.

The harmonic scalpel came into use in 1993 and is widely used for other head and neck surgeries, such as thyroid surgery, where it’s been shown to reduce surgery time, and tonsillectomy, where it reduces postoperative pain. Patients included in the parotid gland study were treated at MCG Medical Center and the Veterans Affairs Medical Center in Augusta from 1999-2004.

Toni Baker | EurekAlert!
Further information:
http://www.mcg.edu

More articles from Health and Medicine:

nachricht Hepatitis: liver failure attributable to compromised blood supply
19.12.2018 | Technische Universität München

nachricht Collagen nanofibrils in mammalian tissues get stronger with exercise
14.12.2018 | University of Illinois College of Engineering

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New megalibrary approach proves useful for the rapid discovery of new materials

Northwestern discovery tool is thousands of times faster than conventional screening methods

Different eras of civilization are defined by the discovery of new materials, as new materials drive new capabilities. And yet, identifying the best material...

Im Focus: Data storage using individual molecules

Researchers from the University of Basel have reported a new method that allows the physical state of just a few atoms or molecules within a network to be controlled. It is based on the spontaneous self-organization of molecules into extensive networks with pores about one nanometer in size. In the journal ‘small’, the physicists reported on their investigations, which could be of particular importance for the development of new storage devices.

Around the world, researchers are attempting to shrink data storage devices to achieve as large a storage capacity in as small a space as possible. In almost...

Im Focus: Data use draining your battery? Tiny device to speed up memory while also saving power

The more objects we make "smart," from watches to entire buildings, the greater the need for these devices to store and retrieve massive amounts of data quickly without consuming too much power.

Millions of new memory cells could be part of a computer chip and provide that speed and energy savings, thanks to the discovery of a previously unobserved...

Im Focus: An energy-efficient way to stay warm: Sew high-tech heating patches to your clothes

Personal patches could reduce energy waste in buildings, Rutgers-led study says

What if, instead of turning up the thermostat, you could warm up with high-tech, flexible patches sewn into your clothes - while significantly reducing your...

Im Focus: Lethal combination: Drug cocktail turns off the juice to cancer cells

A widely used diabetes medication combined with an antihypertensive drug specifically inhibits tumor growth – this was discovered by researchers from the University of Basel’s Biozentrum two years ago. In a follow-up study, recently published in “Cell Reports”, the scientists report that this drug cocktail induces cancer cell death by switching off their energy supply.

The widely used anti-diabetes drug metformin not only reduces blood sugar but also has an anti-cancer effect. However, the metformin dose commonly used in the...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

ICTM Conference 2019: Digitization emerges as an engineering trend for turbomachinery construction

12.12.2018 | Event News

New Plastics Economy Investor Forum - Meeting Point for Innovations

10.12.2018 | Event News

EGU 2019 meeting: Media registration now open

06.12.2018 | Event News

 
Latest News

New megalibrary approach proves useful for the rapid discovery of new materials

19.12.2018 | Materials Sciences

Artificial intelligence meets materials science

19.12.2018 | Materials Sciences

Gut microbiome regulates the intestinal immune system, researchers find

19.12.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>