Factors associated with facial weakness following surgery for benign parotid disease: a retrospective multicenter study

Abstract

BACKGROUND: Facial nerve weakness is the most common and most concerning complication after parotidectomy. Risk factors for this complication following surgery for benign diseases remain controversial. OBJECTIVE: Review the frequency and prognosis of facial nerve weakness after parotidectomy and analyze potential risk factors. DESIGN: Retrospective review of medical records. SETTINGS: Two tertiary care centers. PATIENTS AND METHODS: We included all parotidectomies performed for benign diseases from January 2006 to December 2018. Details about the development and recovery of postoperative facial weakness were recorded. Patient, disease and surgery-related variables were analyzed using bivariate and multivariate analyses to identify risk factors. MAIN OUTCOME MEASURES: Frequency, recovery rates and risk factors for facial nerve weakness SAMPLE SIZE: 191 parotidectomies, 183 patients, 61 patients with facial weakness. RESULTS: The frequency of postoperative facial weakness was 31.9% (61/191 parotidectomies). Among patients with temporary weakness, 90% regained normal facial movement within 6 months. Steroid therapy was not associated with a faster recovery. Postoperative weakness was not associated with age, diabetes, smoking, disease location, use of an intraoperative facial nerve monitor or direction of facial nerve dissection. Risk factors for temporary weakness were total parotidectomy and surgical specimens larger than 60 cubic centimeters. Revision surgery was the only identified risk factor for permanent weakness. CONCLUSION: Larger parotid resections increase the risk of temporary facial nerve weakness while permanent weakness is mainly influenced by previous surgeries. LIMITATIONS: Retrospective nature, underpowered sample size, selection bias associated with tertiary care cases. CONFLICT OF INTEREST: None.

Indications and Outcomes of Parotidectomy in Saudi Children: Experience From Two Tertiary Centers

“…Some authors suggested a possible higher rate of facial weakness in children [ 2 ]. Contrarily, in a previous study by the primary author of the present study, age was not a risk factor for temporary or permanent facial weakness [ 14 ]. Similarly, Owusu et al concluded that age was not predictive of facial weakness in their review of 43 pediatric parotidectomies [ 13 ].…”

“…The rate of temporary facial weakness in our study was 33%. Previous studies on both adult and pediatric parotidectomies reported similar rates ranging from 9.3% to 64.6% [3,[12][13][14]. Some authors suggested a possible higher rate of facial weakness in children [2].…”

Patient safety and quality improvements in parotid surgery

“…Dexamethasone‐treated patients also regained facial function slower than controls (median recovery time: 60 vs. 150 days). Retrospective studies have also concluded that steroids may not play a role in the recovery of facial weakness 38,41 …”

“…Rates of transient paralysis after parotidectomy range from 10% to over 50% whereas permanent paralysis is less common at 0%–8% 31,38 . Paralysis rates may vary by tumor size and the indications for surgery, only some of which are modifiable.…”

“…Retrospective studies have also concluded that steroids may not play a role in the recovery of facial weakness. 38,41 Current literature suggests parotidectomy-related facial function and recovery is likely not influenced by perioperative steroids.…”