CPT® Code 42420

Total excision of the parotid gland or a parotid tumor involves a surgical procedure where the entire parotid gland or a tumor located within it is removed. This procedure is characterized by the dissection and preservation of the facial nerve, which is crucial for maintaining facial function. The parotid gland is the largest of the three major paired salivary glands, situated below and in front of the ear, playing a significant role in saliva production. The surgical approach typically begins with an incision made just in front of the auricle of the ear, which is then extended around the ear lobe and along the mandible. This incision allows for the elevation of a skin flap to expose the parotid gland. The surgeon carefully dissects the inferior aspect of the gland from the sternocleidomastoid muscle and continues the dissection towards the digastric muscle. Special attention is given to the area anterior to the tip and superior to the tragus, where the trunk of the facial nerve is located. A nerve stimulator is utilized to identify the branches of the facial nerve, ensuring they are preserved during the procedure. The parotid gland is then divided and retracted to provide a clear view of the nerve branches. In the case of CPT® Code 42420, the entire parotid gland or tumor is meticulously dissected away from the facial nerve and its branches, allowing for their preservation. This contrasts with CPT® Code 42425, where the tumor has invaded the facial nerve, necessitating an en bloc removal of both the parotid gland and the tumor, resulting in the sacrifice of the facial nerve. Throughout the procedure, bleeding is managed using electrocautery, and a drain is placed through a separate incision behind the ear to facilitate fluid drainage. Finally, the platysma muscle, subcutaneous tissue, and skin are closed in layers to complete the surgical process.