Water-jet dissection in parotid gland surgery.

Introduction: The most frequent complication following parotidectomies is postoperative facial nerve dysfunction. In animal experiment we successfully studied the technique of water-jet-dissection for safe and functional preservation in facial nerve dissection in parotid gland surgery. The aim of the present study was to evaluate our animal experiments clinically. Methods: Until November '99 ten patients with benign parotid gland tumors (4 female, 6 male, age 32-77 years) underwent lateral or latero-segmental parotidectomies using water-jet-dissection ("Hydro-Jet", Andreas Pein Medizintechnik GmbH, Schwerin, Germany). All operations were performed under permanent intraoperative facial nerve monitoring ("Neurosign 100", Fa. Inomed, Tenningen, Germany). The postoperative facial nerve function was measured daily by the House-Brackmann and Stennert-Paresis-Index for at least one week. Results: A quick parotid gland and safe facial nerve dissection could be performed in all operations using the 120 mum-nozzle with effective working pressures from 30-50 bar. In addition strong connective tissue fibers were transected with scissors. Intraoperative facial nerve lesions did not occur and cardiopulmonary complications due to eventual cutting-fluid-resorption were not seen. After surgery all patients had a normal facial nerve function. Discussion: The results of our studies showed that the technique of water-jet-dissection provides safe facial nerve dissection and preservation during parotid gland surgery. Conclusions: The tissue selective cutting qualities of the new surgical method are an excellent alternative compared to standard dissection methods in parotid surgery.