Temporary facial nerve paralysis after parotidectomy: the mansoura experience, a prospective study

Abstract

Background Parotidectomy was first introduced into the world literature by Berard in 1823 who removed a parotid tumor of 8 years' duration. Since then the procedure has been modified and applied to a variety of benign and malignant conditions affecting the gland; superficial parotidectomy, subtotal parotidectomy, and total parotidectomy are now the options available to the head and neck surgeon. The primary goal of parotid surgery is the complete removal of tumors while preserving facial nerve function. Despite efforts to preserve the anatomic and functional integrity of the facial nerve, facial nerve paralysis continues to be a daunting complication of parotidectomy. Purpose The aim of the study was to evaluate our experience in parotid surgery, aiming to lower the incidence of facial nerve palsy and study postoperative complications. Patients and methods This prospective study was conducted on 30 patients from July 2012 to June 2013 with parotid swelling persistent over 1 year; patients were submitted to careful history taking, complete clinical examination, and examination of facial nerve integrity before surgery. Over a period of 1 year these 30 patients with parotid swelling underwent parotidectomy by means of an antegrade technique of whom 26 underwent superficial conservative parotidectomy (nine men and 17 women) and four underwent total conservative parotidectomy (two men and two women). Results Most patients (26) underwent superficial conservative parotidectomy. Four patients underwent total conservative parotidectomy with excision of the superficial lobe, dissection of facial nerve branches, and excision of the deep lobe of the gland from between the branches of the facial nerve. In our study population (30) 10 patients had temporary facial nerve paralysis (33.3%) of whom five were HB II (16.7%), three were House-brackmann Scale HB III (10%), and two were HB IV (6.6%). Conclusion In our study, we adopted certain precautions to lower the incidence of temporary facial nerve paresis. One of these precautions is vertical retraction to reduce the risk of traction injury. Once the nerve trunk was identified we did not use diathermy at all; hemostasis was performed with surgical ligatures (5/0 polygalactin).