This procedure is performed
to decrease salivary flow by interrupting parasympathetic fibers of
Jacobson's nerve. It was first performed by Golding Wood hence goes
by the term “Golding Wood operation”.
Indication:
- In excessive drooling caused by neurological disorders
- Frey syndrome following parotid surgery
- Recurrent inflammation of parotid gland if conventional medical management fails
Procedure:
Can be performed both under
local / General anesthesia.
Postero superior
tympanomeatal flap is created and carried down up to the level of
annulus. The incision should be fashioned in such a way that if need
arises it can be extended anteriorly along the inferior canal wall to
about 5 o clock position. This extension of incision helps in the
evaluation of the inferior most portion of the nerve as it enters
through the floor of hypotympanum.
The annulus is
dissected off its groove and is pushed forwards to 5 o clock position
anteriorly and superiorly up to the short process of malleus. After
elevation of the tympanic membrane the jacobson's nerve is identified
at the promontory as it crosses from inferior to superior direction.
This nerve may be completely exposed or partially covered by bone.
The hypotympanic portion of this nerve is searched for its antero
inferior branch which should be sought and avulsed. This nerve
identified at the promontory should be cleared off its bony covering
if present and avulsed completely.
Eventhough majority of
parasympathetic nerve supply to the parotid is via the tympanic
nerve, it has been demonstrated that chorda tympani nerve also
carries a few parasympathetic fibers.
The decision to avulse
chorda tympanic nerve along with Jacobson's nerve is highly
controversial as it can lead to troublesome xerostomia.
Complications:
- Residual perforation of ear drum
- Damage to middle ear structures
- Rarely troublesome xerostomia
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