WHAT IS THE PAROTID GLAND?
The Parotid glands are the largest of the salivary glands. They are located either side of the face, in front of the ears, and produce saliva. Over three quarters (80%) of salivary tumours start in this gland. The facial nerve, which allows movement in the face, runs and branches-out through the Parotid gland. The nerve’s placement in the salivary gland means that it is frequently in very close proximity to tumours - making surgery difficult and increasing the risk of nerve injury.
Traditionally, it is extremely difficult to map out the path of the nerve, or the extent of its involvement in salivary gland tumours except by tracing it by hand at the time of the surgery. The importance of the nerve means that traditional surgery is based on a nerve dissection. This carries with it a 1-2% risk of permanent nerve injury to one or more branches of the nerve and a 27-30% chance of transient injury. These risks are increased with malignant tumours. The nerve damage can result in several different issues, which can take a toll on a patient’s recovery. These include weakness or numbness of the face, problems moving the lower lip or problems closing the eye. The risk of these side effects are a concern to patients and surgeons alike. The situation has now changed with the help of HNCF, we can now trace and visualise the nerve before surgery. This offers the prospect of reduced facial nerve injury.
WHAT IS THE NEW TECHNOLOGY AND HOW DOES IT WORK?
New MRI machines with large 3t scanners allow radiologists to reliably see the nerve and map its pathway as it branches through the Parotid gland. Special software can then be applied to segment the anatomical structures such as the jaw, parotid gland, facial nerve and blood vessels. This creates a three-dimensional model of the Parotid gland and shows precisely where the tumour sits in relation to the major facial nerves. The data can then be uploaded to a Microsoft Hololens, creating a three-dimensional model of the anatomy in augmented reality. This is effectively a ‘real-life’ model of the tumour, gland and nerve.
This 3D model can be studied before treatment so that surgeons can accurately locate the tumour and map its proximity to the nerve. This instils confidence in both patients and surgeons. Patients can be more confident when consenting to surgery, as they are more aware of the risk associated with their own procedure - they can physically see it with their Consultant. Surgeons can also enter the operating theatre with greater confidence - as they can accurately assess the risks associated with each individual and mitigate the anomalies found during surgery. In the future, this 3D holographic model will then we projected on to the patient during their surgery, which means the oncology team can study and continue to analyse the surgical plan throughout, maximising positive patient outcomes.
HNCF helped this research by providing the academic unit at UCL with the HoloLens, this is the first team in the world to produce these three-dimensional models.
HOW IS HNCF DRIVING INNOVATION IN THE TREATMENT OF PAROTID TUMOURS?
No one else is using the software of the Hololens for this purpose. This is a completely new technological process which is hugely beneficial to the outcomes of patients with Parotid gland tumours. However, there are barriers to the universal adoption of the software and use of the Hololens in both costs and training. These factors currently limit the number of radiologists who can utilise this technology.
HNCF is working to help this situation. We plan to roll this technology out to the global oncology community through our education and accessibility programme. We have already ran seminars in the Far East, Europe and United States to explain how to use this technology.
We also aim to make you aware of developments in the treatment of Parotid gland tumours and continue to raise awareness of this new and innovative treatment.
HNCF Patient Story: Parotid Gland
The story of Mrs Williams, who was able to benefit from this innovative technology and achieve optimal outcomes from her surgery.
Treatment Showcase: Parotid Treatment
This video showcases the 3D model used to assist with the surgery of the above patient. This model allowed surgeons to prevent serious nerve injury to the patient.