Facial Nerve Dysfunction After Parotidectomy: The Role of Local Factors

Gaillard, C.; Périé, Sophie; Susini, B.; Guily, Jean Lacau St

doi:10.1097/01.mlg.0000154735.61775.cd

Cited by 139 publications

(122 citation statements)

References 14 publications

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“…The branch of the facial nerve most at risk for injury during parotidectomy is the marginal mandibular branch. 12 In our study, we found five (45.46%) patients had marginal mandibular injury. So the result is comparable with the above study.…”

Section: Discussionmentioning

confidence: 48%

Study of the Nerve Injury in Parotid Gland Surgery

Rahman

Joarder

2012

Nepalese J ENT Head Neck Surg

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Tumors of the parotid glands are believed to represent approximately 2% of tumors of the head and neck. Parotid gland tumors also accounts for 70% to 80% of all tumors of the salivary glands. 1 Approximately, 80% of parotid tumors are benign and 80% of benign tumours are pleomorphic adenomas and 80% arise from the superficial lobe of the parotid gland. 2 Less commonly, tumours may arise from the accessory lobe of the gland and present as a persistent swelling in the cheek. Rarely, tumours may arise from the deep lobe of the parotid gland and present as parapharyngeal masses. 3 The facial nerve is a very important nerve which exits through the skull base, below the ear lobule and travels through the parotid gland, separating the gland into superficial and deep lobes. 4 The hazardous course of the facial nerve through the parotid has evoked considerable risk of nerve injury. 2 The incidence of facial nerve paralysis is higher in total than in superficial parotidectomy, which may be related to stretch injury or as a result of surgical interference with the vasa nervosum. Among the branches of facial nerve which is the most at risk for injury during parotidectomy, is the marginal mandibular branch. 5 Parotid duct ligation increases the risk of nerve palsy in the distribution of zygomatic and buccal branches. Operations for Warthins tumour were associated with the increased risk of dysfunction of the cervical branch of the facial nerve. 6 Advanced age, longer operation time and larger specimen will have the significant risk for transient facial palsy after conservative parotidectomy. 7 There are two basic techniques for the identification and dissection of the facial nerve. One is the forward or antegrade dissection, where the approach to the main trunk is taken as an early step of tracing it to the bifurcation and peripheral branches. Retrograde dissection of the facial nerve is more popular in china with encouraging results. 1 Function preserving parotid surgery has relatively low complication rate like the use of a modified facelift incision, preservation of the great auricular nerve and normal parotid parenchyma. Ear sensation returned more rapidly and more completely in patients in whom the posterior branch of the great auricular nerve is preserved than in those in whom the nerve is sacrificed. 8 The auriculotemporal nerve provides both parasympathetic innervations to the parotid gland and sympathetic innervations to sweat glands and subcutaneous blood vessels. Freys syndrome is due to regrowth of the secretomotor parasympathetic fibers into the distal cut ends of the sympathetic fibers into the skin. 9 The objective of this study is to find out the frequency of nerve injuries after parotid surgery. O b j e c t i v e :To find out the frequency of nerve injuries after parotid surgery M a t e r i a l a n d m e t h o d s :A Cross sectional study was done from January 2008 to December 2009, in the Department of Otolaryngology and Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) & Dhaka Medical ...

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Section: Discussionmentioning

confidence: 48%

Study of the Nerve Injury in Parotid Gland Surgery

Rahman

Joarder

2012

Nepalese J ENT Head Neck Surg

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“…Although a large percentage of these recover, the short-term and unfortunately some longterm palsies can have profound impacts on a patient's quality of life especially in the setting of an apparent small and innocuous lesion [6,7].…”

Section: Introductionmentioning

confidence: 99%

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Riffat

Mahrous

Buchanan

et al. 2012

J. Maxillofac. Oral Surg.

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Introduction The current practice for removal of clinically benign superficial parotid lesions is an appropriate superficial parotidectomy with a cuff of normal parotid tissue for complete pathological clearance. This technique requires the identification of the facial nerve at the main trunk and dissection of the segment of the facial nerve deep to the lesion. The reported major complications of this procedure include temporary or permanent facial nerve weakness, Frey's syndrome and salivary leaks. In order to avoid these complications, a local extracapsular dissection technique can be utilised in the management of small inferiorly located benign lesions of the parotid gland. Methods A retrospective case note review was performed for all parotidectomies between 2004 and 2009 in Addenbrooke's Hospital, Cambridge by the senior authors. Results A total of 172 cases were identified out which 46 underwent an extracapsular dissection. The average size of these lesions was 1.9 cm (0.9-2.4 cm) with all universally located inferior or posterior to the angle of the mandible. The pathologies were 14 pleomorphic adenomas, 24 Warthin's tumours, 6 lymphangiomas and 2 simple cysts. There were no post-operative facial nerve weaknesses, Frey's syndrome or salivary leaks within the extracapsular dissection group. The median follow-up of these patients were 4.6 years (2-6 years) with 6 patients lost to followup. No recurrences have been noted in the cohort at followup.

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“…The marginal mandibular branch was reported as the single most affected nerve branch following parotidectomy (48.2 %). Facial nerve dysfunction after total parotidectomy was found to be significantly higher (P \ 0.001) than that in superficial parotidectomy (18.2 % at day 1 and 10.9 % at month 1) [3].…”

Section: Discussionmentioning

confidence: 83%

Identification of Facial Nerve During Parotidectomy: A Combined Anatomical & Surgical Study

Pal

Sengupta

Chowdhury

et al. 2013

Indian J Otolaryngol Head Neck Surg

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To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Cadaveric dissection was performed in the Department of Anatomy and the surgeries were done in the Department of ENT and Head and Neck surgery of R. G. Kar Medical College of Kolkata. The distance of the facial nerve trunk from three most commonly used landmarks (viz., tympanomastoid suture, tragal pointer and posterior belly of digastric muscle) was measured in both cadaver and live patients. The ease of identification of the nerve trunk using each of the landmarks, particularly during live surgery was also assessed. The mean distance of the tympanomastoid suture from the facial nerve trunk was 3.5 mm (cadaver) and 3.87 mm (live surgery), the tragal pointer was found to be at a mean distance of 16.61 mm (cadaver) and 16.36 mm (live surgery) and in case of the posterior belly of digastric muscle it was 7.41 mm (cadaver) and 8.03 mm (live surgery). During live surgery the posterior belly of digastric was found to be the most easily identifiable landmark with a consistent anatomical relationship with the nerve trunk. The posterior belly of digastric muscle is the most easily identifiable and a very consistent landmark for facial nerve dissection during parotidectomy. When supplemented with the tragal pointer, accuracy in identifying the facial nerve trunk is very high, thereby avoiding inadvertent injury to the nerve trunk.

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Facial Nerve Dysfunction After Parotidectomy: The Role of Local Factors

Cited by 139 publications

References 14 publications

Study of the Nerve Injury in Parotid Gland Surgery

Study of the Nerve Injury in Parotid Gland Surgery

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Identification of Facial Nerve During Parotidectomy: A Combined Anatomical & Surgical Study

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