CPT® Code 42426

The procedure described by CPT® Code 42426 involves the excision of a tumor from the parotid gland, which is the largest of the three major paired salivary glands located beneath and in front of the ear. This surgical intervention is comprehensive, as it includes a total removal of the parotid gland along with a unilateral radical neck dissection. The approach begins with an incision made just anterior to 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, providing access to the parotid gland. During the procedure, careful dissection is performed to separate the inferior aspect of the parotid gland from the sternocleidomastoid muscle, continuing until the digastric muscle is reached. The surgical team meticulously dissects the tissue located anterior to the tip and superior to the tragus to expose the trunk of the facial nerve. To ensure the preservation of nerve function, a nerve stimulator is utilized to identify the branches of the facial nerve. In cases where the tumor has invaded the facial nerve, an en bloc removal of both the parotid gland and the tumor is conducted, which may necessitate sacrificing the facial nerve. Hemostasis is achieved using electrocautery, and a drain is placed through a separate incision behind the ear to manage any postoperative fluid accumulation. Following the parotid gland excision, a radical neck dissection is performed, which involves the meticulous removal of lymph node groups from levels I to V, along with surrounding tissues. This extensive dissection may also include the removal of the sternocleidomastoid muscle, internal jugular vein, submandibular gland on the affected side, and potentially the anterior belly of the digastric muscle, as well as the sternohyoid and sternothyroid muscles. The surgical wounds are then repaired, and suction drains are placed as necessary to facilitate recovery.