Retrograde Facial Nerve Dissection Using Zygomatic Branch as Landmark in Parotid Gland Surgery for Pleomorphic Adenoma: A 4 Year Prospective Study of 40 Cases

Abstract

Background: The retrograde dissection for doing parotidectomy is technically easier and surgeon can limit the dissection to 1 or 2 branches of facial nerve if required and hence avoids injury to the trunk or other branches of facial nerve, aiming at removal of only the parotid parenchymal area that bears the tumour. Objectives: To compare our results with those of similar studies in the recent literature. To compare nerve recovery rates when zygomatic branch is used as landmark with that of other techniques from literature. Methods: In this study 40 patients with pleomorphic adenoma of parotid gland underwent superficial parotidectomy at V.S.S Medical College hospital Burla and S.C.B medical college Cuttack in a 4 year period between 2013 and 2016. All 40 patients underwent retrograde superficial parotidectomy. We compared our results with results of similar studies in the recent literature. Results: Although all 40 patients experienced paresis immediately after surgery, 25% patients completely recovered and 75% patients had facial nerve weakness at the end of first week. Among this 60% patients were having H.B-2 weakness, 7.5% had H.B-3 weakness, 5% had H.B-4 and 2.5% had H.B-5 weakness. Any injury equal to or more than H.B-3 was considered serious. 15% patients were having serious injury. None of the patients had H.B-6 (severe) facial nerve weakness. Conclusion: Transient nerve weakness after retrograde parotidectomy is common but recovery will be faster than that of ante grade technique and within 6 months to 1 year all patients should recover nerve function completely.