Lobectomy for parotid gland tumor by retrograde approach from peripheral branches of the facial nerve

Dissection and preservation of the facial nerve plays an important part in lobectomy for parotid gland tumor. So far, normal grade approach has been generally used in an approach to the facial nerve in lobectomy. However, when the parotid gland is thick, it is sometimes difficult to dissect the facial nerve from the gland. In that case, it is useful to approach the main trunk retrogradely from the peripheral branch. Among peripheral branches, the temporal branch is situated in the anterior and superficial part of the parotid gland, so it is comparatively easy to identify the temporal branch. The crucial point for identifying the peripheral branch is, (1) to get wide and bright field, (2) to dissect just above the myofacia of the protid gland, (3) to use magnifying glass in an identification of the facial nerve branches. Clinically, we should deal with the situation on a case-by-case basis without regard for the choice between normal grade and retro grade approach.