Facial Nerve Preservation in total Parotidectomy for Parotid Tumors: A Review of 27 Cases

Abstract BackgroundPrimary squamous cell carcinoma rarely occurs in parotid gland. Partial, superficial or total parotidectomy as well as radical resection is performed based on patients’ conditions. For patients with symptoms of facial nerve weakness or dysfunction, facial nerve preservation is considered justifiably, whereas groundlessly if the malignancy is asymptomatic. We hereby reported a case of symptomatic primary parotid squamous cell carcinoma performed with total parotidectomy and facial nerve preservation.Case summaryWith the complaint of an asymptomatic mass in right parotid gland for five years and it grew aggressively and pricked recent months, a 46-year-old man visited the local hospital two week ago. A biopsy was performed and squamous cell carcinoma in right parotid gland was diagnosed. He was subsequently referred to Tongji hospital in Wuhan, China. Physical exam revealed a scar in the right parotid gland and impaired function of right facial nerves. An immoveable mass was touched in lower and posterior pole of right parotid gland. The mass was about 2.1*3.1 cm without clear boundary, and moderate pain was observed. No obvious enlarged lymph node was touched in right submandibular region and neck. Magnetic resonance imaging revealed a 1.6*2.4 cm nodular located in a diffuse suspicious mass in right parotid gland. Radical resection of the malignancy was rejected due to the inevitable facioplegia. Considering the short history of tumor aggressive behaviors, unique anatomical structure of parotid gland and absent sign of lymph node metastasis, total parotidectomy with facial nerve preservation and elective right neck dissection were performed. Finial pathological examination confirmed squamous cell carcinoma of right parotid gland. Post-operation radiotherapy was scheduled in the following month. Restoration of facial nerve function was observed in two months later, absent local recurrence and distant metastasis was observed in the three years’ follow-up.Conclusion Primary parotid squamous cell carcinoma is rarely observed in clinical and facial nerve sacrifice requires great attention in treatment. Based on carefully evaluation of patients’ conditions before treatment, individualized treatment is crucial for improvement of patients’ quality of life while completely dissection of the malignancy.

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S18.2 Facial nerve preservation in malignant parotid tumors

Oral Oncology Supplement ◽

10.1016/s1744-7895(05)80123-3 ◽

2005 ◽

Vol 1 (1) ◽

pp. 64

Author(s):

M. Piemonte

Keyword(s):

Facial Nerve ◽

Nerve Preservation ◽

Facial Nerve Preservation ◽

Parotid Tumors ◽

Malignant Parotid Tumors

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Facial Nerve Involvement During Temporal Bone Resection: Overall Survival And Locoregional Recurrence Outcomes.

10.21203/rs.3.rs-1246945/v1 ◽

2022 ◽

Author(s):

Adrien Gendre ◽

Holly Jones ◽

Alison McHugh ◽

Justin Hintze ◽

Fiachra Martin ◽

...

Keyword(s):

Overall Survival ◽

Facial Nerve ◽

Temporal Bone ◽

Locoregional Recurrence ◽

Bone Resection ◽

Nerve Preservation ◽

Facial Nerve Preservation ◽

Temporal Bone Resection ◽

Lateral Temporal Bone Resection ◽

Mean Time

Abstract Purpose: Facial nerve resection is often required in lateral temporal bone resection for tumors extending to the lateral skull base. Limited data exists to guide facial nerve reanimation strategies. Methods: This is a retrospective cohort study. Patients undergoing lateral temporal bone resection in a national referral center were included and divided into two groups: facial nerve preservation or resection. Survival and locoregional recurrence outcomes were analyzed by Kaplan-Meier survival analysis. Prognostic factors were identified using univariate and multivariate analysis. Facial nerve reconstructive methods were collected.Results: 39 patients were included with 20 having facial nerve resection at surgery. Squamous cell carcinoma (SCC) was the most common pathology. 48% of patients died during follow-up. Mean overall survival (OS) was 27 months and mean time to locoregional recurrence (LRR) 23 months in the facial nerve preservation group. Mean OS was 16 months and mean time to LRR was 13 months in the facial nerve resection groups (logrank OS p=0.330 and LRR p=0.445). 75% of patients in the facial nerve resection group had static facial nerve reanimation using tarsorrhaphy, gold-weight eyelid implant and fascia lata sling. Middle ear cavity extension was a negative predictor of OS and LRR.Conclusion: Facial nerve resection during lateral temporal bone surgery is associated with poor overall survival and locoregional control outcomes. Multidisciplinary surgical management and static facial reanimation should be offered to maintain function and quality of life in this group of patients.

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The Offprint of an Abnormal Pre-Parotidectomy Electrodiagnostic Finding in a Normally Functioning Facial Nerve: Correlation with Intraoperative Findings, Histology and Postoperative Facial Nerve Function

Journal of Clinical Medicine ◽

10.3390/jcm11010248 ◽

2022 ◽

Vol 11 (1) ◽

pp. 248

Author(s):

Verena Katheder ◽

Matti Sievert ◽

Sarina Katrin Müller ◽

Vivian Thimsen ◽

Antoniu-Oreste Gostian ◽

...

Keyword(s):

Facial Nerve ◽

Malignant Tumor ◽

Facial Palsy ◽

Benign Lesion ◽

Nerve Function ◽

Facial Nerve Function ◽

Nerve Preservation ◽

Clinically Normal ◽

Parotid Tumors ◽

Supramaximal Stimulation

The aim of this study was to search for associations between an electrodiagnostically abnormal but clinically normal facial nerve before parotidectomy and the intraoperative findings, as well as the postoperative facial nerve function. The records of all patients treated for parotid tumors between 2002 and 2021 with a preoperative House–Brackmann score of grade I but an abnormal electrophysiologic finding were studied retrospectively. A total of 285 patients were included in this study, and 222 patients had a benign lesion (77.9%), whereas 63 cases had a malignant tumor (22.1%). Electroneurographic facial nerve involvement was associated with nerve displacement in 185 cases (64.9%) and infiltration in 17 cases (6%). In 83 cases (29.1%), no tumor–nerve interface could be detected intraoperatively. An electroneurographic signal was absent despite supramaximal stimulation in 6/17 cases with nerve infiltration and in 17/268 cases without nerve infiltration (p < 0.001). The electrophysiologic involvement of a normal facial nerve is not pathognomonic for a malignancy (22%), but it presents a rather rare (~6%) sign of a “true” nerve infiltration and could also appear in tumors without any contact with the facial nerve (~29%). Of our cases, two thirds of those with an anatomic nerve preservation and facial palsy had already directly and postoperatively recovered to a major extent in the midterm.

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