Meet Dr. Larian
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Out Of Town Patients
- Do Salivary Stones Require Surgery?
Salivary gland stones, or sialolithiasis, are small calcium deposits that block the flow of saliva, which if not removed can lead to swelling of the salivary gland, inflammation, infection, Read more >
- Why a Parotid Tumor Requires Immediate Medical Attention
Many people have experienced swollen glands at some point in their lives. However, if you have a lump close to your ear that lingers for more than a couple weeks, Read more >
- How Expert Surgeons Perform Parotid Reconstruction
If your parotid gland function has been impaired for any reason, such as a parotid tumor, you may need surgery. Read more >
Micro-Parotidectomy (MiPa) is a minimally invasive parotid surgery procedure pioneered by Dr. Larian. The surgery, which removes a portion or all of the parotid gland, is done through a small well hidden incision. Micro-parotidectomy minimizes the extent of surgery making the scarring both on the surface and internally be much less, thereby it reduces the pain and the recovery time.
Dr. Larian, who is nationally and internationally renowned due to his expertise in minimally invasive surgery techniques, takes great pride in being able to minimize the resulting surgical scar by using the most advanced and minimally invasive surgery techniques available. He also teams up with Dr. Azizzadeh, who is a leading facial nerve surgeon; together, they help find the facial nerve and all it’s branches, and in cancer cases where the nerve is damaged by the cancer, facial nerve reconstruction is done at the same time. This approach is not only beneficial to patients because it’s comprehensive, but also because it speeds the recovery time, minimizes scarring, and most of the procedures can be done as outpatient procedures, eliminating the need for hospitalization. Along with his team of experts, Dr. Larian is able to bring his patients optimal results while being as minimally invasive as possible.
Dr. Larian is one of the few surgeons in the world who has the expertise to perform minimally invasive parotid surgery (or micro-parotidectomy), and the approach has come about after many years of experience using traditional facelift incisions to access a very delicate area. His surgical technique allows him to access the parotid gland through a very small incision. This approach is combined with facial nerve monitoring which significantly reduces the risk of surgical complications, and leaves an almost invisible scar. But this unique approach does not only minimize the scar and trauma to the tissue, but also is combined with facial reconstruction by Dr. Azizzadeh to immediately fix the hollowness left behind by removing the parotid gland, and create evenness and harmony of the face .
Parotid Tumor: Treatment Overview
The Evolution of the Parotidectomy/Parotid Surgery
The traditional parotidectomy was performed through a Modified Blair Incision in which an incision was made from the top of the ear down toward the jaw and was several inches in length. The entire side of the face is then pulled back to allow for visualization of the entire area, including the facial nerve. This procedure allowed for visibility, and it still is very useful when a neck dissection (removal of lymph nodes in the neck) needs to be also done. Unfortunately, in most cases, facial reconstruction is not done, leaving patients with a hollowness and a long scar alongside the face and neck.
The facelift incision was the next steop in evolution of parotid surgery. Once parotid surgeons began using a facelift incision for parotidectomy procedures, there was also a movement towards facial reconstruction at the same time. The use of a facelift incision results in less scarring than the traditional Modified Blair Incision and a better aesthetic outcome. This incision allows for good access to the facial nerve, greater auricular nerve and the SCM muscle to be used for reconstruction. The incision hides well in the hairline. We still use this incision when the tumor is in a position that does not allow us to see the facial nerve safely from a micro-parotidectomy incision.
The micro-parotidectomy procedure, pioneered by Dr. Larian, is a minimally invasive parotid surgery technique that minimizes scarring and recovery time. Performing this procedure alongside one of the best facial plastic and reconstructive surgeons in the nation, Dr. Larian’s micro-parotidectomy is an effective minimally invasive technique that always involves facial reconstruction for an optimal aesthetic outcome. The small incision reduces scarring under the surface and therefore long term complications and provides patients with a shorter recovery time.
As advances in parotid surgery have been made, Dr. Larian has been able to perfect the micro-parotidectomy technique and he performs this minimally invasive procedure whenever possible. The traditional parotidectomy and facelift incision do still have a place in parotid surgery today and are sometimes required depending on the size, location, and severity of the parotid tumor.
Benefits of a Micro Parotidectomy & Reconstruction:
- Smaller scar
- Less pain
- Less tissue trauma
- Less blood loss
- Faster recovery
- Even facial contour
- Less chance of Frey’s Syndrome
- Protection of the Facial Nerve
Our team approach for all parotid tumor surgeries ensures the best possible outcome for the patient. During the first portion of surgery, the tumor is removed with Dr. Larian in the lead, and with Dr. Azizzadeh assisting. Once the tumor is removed, our experienced reconstructive team will perform a corrective procedure to fill in the defect left behind by removing part of the parotid gland, avoiding a hollowness on the face. Reconstructing the area over the nerve during the same procedure puts an extra layer of protective tissue on top of the nerve, which helps prevent Frey’s syndrome. The two sides of the face are also compared during surgery to create harmony and symmetry. This second portion of the procedure, where the face and neck are reconstructed, is headed by facial plastic surgical expert Dr. Azizzadeh, and assisted by Dr. Larian. Dr. Azizzadeh has extensive experience using flaps, graphs, and other methods to ensure that there is minimal to no scarring. When minimally invasive parotid surgery is performed by an expert surgeon in Los Angeles, the face is left looking perfectly even.
RISKS – Every safety measure and precaution is taken before, during, and after surgery by the best parotid surgeon to assure the facial nerve functions properly. Thus, the incidence of permanent facial nerve paralysis when removing a benign parotid tumor is extremely low (less than 0.1%). In every case we try to preserve the greater auricular nerve (in charge of sensation to the ear lobe); this nerve is only sacrificed if it interferes with finding the facial nerve which is a much more important nerve. Our success rate with this has been greater then 95%. Due to the fact that we reconstruct the area immediately and cover the facial nerve, the incidence of Frey’s syndrome at the CENTER has been less then 1%. Due to our technique and post-operative management, the incidence of seroma (fluid accumulation under the skin) has been similarly low.
Minimally invasive surgery has revolutionized the treatments for parotid disease, and our team of experts performs these types of surgeries on a routine basis.
Watch Dr. Larian Perform A Micro Parotidectomy
Next, learn about saving the facial nerve & parotid surgery.