Benign parotid mass and facial palsy: systematic review

Abstract

Introduction Parotid masses causing facial palsy are highly indicative of malignancy. A significant number of cases describing benign parotid disease causing facial palsy have been reported. Materials and methods We performed a systematic review of the literature to establish the aetiology, clinical features, investigations and management undertaken during these presentations to assess how these factors differed from malignant presentations and to establish an evidence-based algorithm for their management. Results A total of 85 cases were identified from 78 articles. Cystadenolymphomas were the most common histopathological type (p = 0.034). Mean facial palsy recovery duration in neoplastic aetiology was longer than for infective aetiology (p = 0.033). A significant association existed between uncommon infective organisms and development of facial palsy (p = <0.0001). Conclusion Uncommon benign aetiologies are associated with facial palsy. Investigations and management should be guided by patients’ clinical presentations, avoiding excessive treatment. Complete facial palsy recovery rates are high, although not immediate.

"Facial nerve injury following temporomandibular joint reconstruction, parotidectomy and mastoidectomy: a systematic review and meta-analysis"

“…Several maxillofacial surgeries were frequently associated with damage to the FN (Imola & Liddell, 2016;Moin et al, 2018;Stewart et al, 2021;Chen et al, 2009). Iatrogenic facial nerve paralysis has been associated with temporomandibular joint (TMJ) reconstruction surgeries such as autogenous bone graft, alloplastic replacement and distraction osteogenesis (Imola & Liddell, 2016;Moin et al, 2018).…”

“…Iatrogenic facial nerve paralysis has been associated with temporomandibular joint (TMJ) reconstruction surgeries such as autogenous bone graft, alloplastic replacement and distraction osteogenesis (Imola & Liddell, 2016;Moin et al, 2018). Similarly, injury to the FN was found following surgical removal of the parotid gland (parotidectomy), whether it was a superficial (partial) or complete removal due to congenital malformations or tumors (Stewart et al, 2021;Lakkadsha et al, 2022). Furthermore, facial nerve paralysis was reported following surgeries related to the temporal bone, such as mastoidectomy, which involves the unfolding of the post auricular air cells by extracting the thin barrier between them.…”

“…A study conducted by Hohman in 2013 investigating causes of iatrogenic facial nerve injury (IFNI) using Facial Nerve Center patient records reported that injury was most observed with TMJ replacement followed by parotidectomy and mastoidectomy (Hohman et al, 2014). As these selected surgeries are frequently associated with IFNI, several studies reported the incidence proportion of IFNI following TMJ reconstruction, parotidectomy and mastoidectomy (Imola & Liddell, 2016;Moin et al, 2018;Stewart et al, 2021;Chen et al, 2009). We aim to provide a review of the current literature and conduct a meta-analysis to obtain a pooled estimate of the IFNI incidence proportion following each surgical procedure and to identify the affected FN branches.…”

Optimizing Facial Function in Patients With High-Risk Recurrent Pleomorphic Adenoma and a History of Facial Nerve Injury

“…The gradual onset of paralysis, more typical to parotid cancers in presentation, 6 has also been reported in noncancerous PAs involving the facial nerve. [7][8][9][10][11][12] More so, fine-needle aspiration favoring benign PA does not exclude cancer or future malignant transformation. 13,14 Compared with primary PA patients, recurrent PA (rPA) patients represent a subgroup of this population with an even higher risk for facial nerve injury due to considerably greater diagnostic, surgical, and postoperative challenges.…”

Apparent Diffusion Coefficient (ADC) Histogram Analysis in Parotid Gland Tumors: Evaluating a Novel Approach for Differentiation between Benign and Malignant Parotid Lesions Based on Full Histogram Distributions

“…However, less frequently encountered, malignant parotid gland tumors (MT), e.g., adenoid cystic carcinoma or mucoepidermoid carcinoma usually require extensive surgery, often accompanied with the loss of the facial nerve [ 8 , 9 , 10 , 11 ]. Clinically, benign and malignant parotid gland tumors are hard to distinguish from each other and the tumor extension may be underestimated [ 12 , 13 ]. Therefore, a reliable imaging modality is essential for sufficient preoperative assessment [ 14 , 15 ].…”