Distal Facial Nerve Exposure: A Key to Partial Parotidectomy

Abstract

Objective 1) Learn techniques and outcomes of distal facial nerve identification compared with antegrade exposure in partial parotidectomy. 2) Be able to incorporate other modifications of parotidectomy facilitated by distal facial n. isolation including preservation of the greater auricular nerve, superficial musculo-aponeurotic system (SMAS), and parotid duct. Methods 29 parotidectomies done using antegrade facial nerve trunk exposure (Group 1) and 13 consecutive partial parotidectomies done with distal facial nerve branch dissection (Group 2) for benign neoplasms and intraparotid lymph nodes were reviewed from 2001 to 2008. The greater auricular nerve and SMAS were preserved when possible. Branches draining to the main parotid duct from the lesion were incised rather than the main parotid duct whenever feasible. Outcomes examined include postoperative facial nerve function, cutaneous sensation, SMAS preservation, sialocele or salivary fistula. Logistic Regression was used to determine if select variables (age; antegrade vs. retrograde nerve exposure; and size of tumor) significantly affected outcomes. A series of univariate analysis of variance with Bonferroni post hoc tests were subsequently used to confirm findings of the logistic regression. Results No difference in facial nerve function was found between the groups. Group 2 had better cutaneous sensation and SMAS preservation. More salivary fistulas and parotid swelling were associated with parotid duct transection in Group 1. There were no tumor recurrences. Conclusions Partial parotidectomy utilizing distal facial nerve exposure can reduce the extent of surgical dissection, facilitate preservation of the parotid duct and greater auricular nerve, improve contour with primary SMAS closure, and allow greater flexibility in skin incisions.