Parotid gland surgery is a common procedure in oral and maxillofacial surgery. According to data statistics from 296 cases of various types of surgeries in this area at the Oral Hospital of Sichuan Medical College, the success rate can reach 84.6%. Most patients can eat on the same day, and the systemic and local reactions after surgery are mild, with little need for painkillers. However, there are still some failed cases, and the reasons for these failures are almost always related to severe lesion adhesions and prolonged surgical time.

Case Selection

Adult patients requiring parotid tumor removal, parotidectomy, or parotid duct transplantation due to parotid tumors, chronic parotiditis, or parotid cysts can be selected. Patients with severe adhesions, extensive lesion areas, or extreme nervousness are not suitable for this procedure.

Acupuncture Anesthesia Method

I. Acupoint Prescription

Currently, there are many acupoint formulas used in various regions. The following groups are more commonly used:

(1) Affected side Fenglong (ST40), Taichong (LR3), Hegu (LI4), Gongsun (SP4) (retaining needle).

(2) Affected side Fenglong (ST40), Houxi (SI3), Hegu (LI4), Waiguan (TE5) penetrating Neiguan (PC6) (electroacupuncture); affected side ear point Shenmen (HT7), subcortex.

II. Acupoint Injection

Select the affected side Xiaguan (ST7) (insert into the foramen ovale) and inject 5ml of 0.25% promethazine. Select the affected side auriculotemporal (insert from the upper helix along the skin to the tragus) and inject 5-10ml of 0.25% promethazine. Inject 2-3ml of 0.25% promethazine at the affected side Yifeng (TE17) acupoint.

III. Auxiliary Medication:

(2) Intravenous injection of pethidine 1-1.5mg/kg body weight or a mixture of haloperidol 5mg and fentanyl 0.1mg at 1/2 dose 10 minutes before surgery. If the surgery time exceeds 2 hours, an additional 1/2 or 2/3 of the initial dose can be administered.

IV. Stimulation Method:

(1) For the retaining needle group, after obtaining the needling sensation, manually twist and stimulate Fenglong (ST40), Taichong (LR3), Hegu (LI4), and Gongsun (SP4) alternately for 3-5 minutes, then retain the needle. During the surgery, appropriate twisting is performed to maintain the stimulation.

(2) For the electroacupuncture group, use a frequency of 3-80Hz, with the intensity adjusted to the patient's tolerance.

V. Induction Time:

15-30 minutes is appropriate.

Methods to Improve Acupuncture Anesthesia Effect

The parotid region is rich in blood vessels and has a network of nerves. The sensory nerves are the great auricular nerve and the auriculotemporal nerve. The main trunk of the facial nerve exits through the stylomastoid foramen and enters the parotid gland, dividing into five branches on its superficial surface, which requires special attention during surgery. During the surgical process, when flipping the anterior flap, the incision site can be infiltrated with a 1/500,000 adrenaline saline solution and sharply dissected. When flipping the posterior flap, 1-2ml of 0.25% procaine can be injected around the great auricular nerve, then the great auricular nerve is cut, and the external auditory canal cartilage is exposed. When dissecting the facial nerve, it is advisable to first inject 3-5ml of 1% procaine at the main trunk to block it. When dealing with the deep part of the upper pole of the parotid gland, if the patient experiences pain, 5-10ml of 0.25% procaine can be used for local infiltration.