scholarly journals POSTERIOR AURICULAR NERVE – A NOVEL LANDMARK FOR IDENTIFICATION OF THE FACIAL NERVE IN SUPERFICIAL PAROTIDECTOMY

2021 ◽  
Vol Volume 9 (upjohns/volume9/Issue2) ◽  
pp. 10-14
Author(s):  
Arulalan Mathialagan
Keyword(s):  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Nerve Trunk ◽  
Target Area ◽  
Superficial Parotidectomy ◽  
Tertiary Referral Center ◽  
Individual Variations ◽  
Parotid Surgery ◽  
Auricular Branch ◽  
Nerve Identification

ABSTRACT Background-Facial nerve identification and preservation is the most critical step in parotid surgery. Though there are described landmarks to locate the facial nerve trunk, they have individual variations. The posterior auricular nerve (PAN) is a branch of the facial nerve and is always present, it can be followed to reach the facial nerve trunk. MATERIALS AND METHODS A retrospective cohort study in which analysis of parotidectomy performed from January 2017 to November 2018 at our tertiary referral center was done. RESULTS A total of 23 parotidectomies were performed, of which 18 cases were pleomorphic adenoma. In four cases of pleomorphic adenoma we could clearly identify and preserve the PAN. Using PAN as the landmark the facial nerve trunk was located, all its peripheral branches were dissected and preserved. PAN identification narrows down the target area of dissection to identify the facial nerve trunk. CONCLUSION The posterior auricular branch of the facial nerve can be used as a standard landmark in parotid surgeries, that almost always leads to the facial nerve trunk. CLINICAL SIGNIFICANCE Though identification of PAN may be difficult in all cases, effort must be made to identify it under magnification. If done meticulously PAN can be an ideal landmark to identify facial nerve in parotid surgery. KEYWORDS Parotid surgery, Superficial Parotidectomy, Posterior auricular nerve, Facial nerve.

scholarly journals Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

2019 ◽  
Vol 6 (1) ◽  
pp. 60
Author(s):  
Dheer S. Kalwaniya ◽  
Goutam Kothathi Chowdegowda ◽  
Monish Raj ◽  
Jaspreet S. Bajwa ◽  
Satya V. Arya ◽  
...  
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Surgical Approaches ◽  
Depth Of Invasion ◽  
Tumor Depth ◽  
Facial Paresis ◽  
Superficial Parotidectomy ◽  
Parotid Surgery ◽  
Nerve Paresis

<p class="abstract"><strong>Background:</strong> The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system.  </p><p class="abstract"><strong>Results:</strong> Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size &lt;4 cm), 2 suffered facial paresis and out of 11 patients (size &gt;4 cm), 5 suffered same. Out of 59 patients with depth of tumor &lt;2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth &gt;2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).</p><p class="abstract"><strong>Conclusions:</strong> Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.</p>

IDENTIFICATION OF THE FACIAL NERVE TRUNK DURING SUPERFICIAL PAROTIDECTOMY BY TRIDENT LANDMARK

2019 ◽  
Vol 2 (1) ◽  
pp. 17-26
Author(s):  
Yasser Hatata ◽  
Mohamed Ibrahim ◽  
Reda Fawzy ◽  
Hazem Elgohary
Keyword(s):  
Facial Nerve ◽  
Nerve Trunk ◽  
Superficial Parotidectomy

Long-term recurrence rate of pleomorphic adenoma and postoperative facial nerve paresis (in parotid surgery)

2007 ◽  
Vol 35 (3) ◽  
pp. 189-192 ◽  
Author(s):  
Oliver Zernial ◽  
Ingo N. Springer ◽  
Patrick Warnke ◽  
Franz Härle ◽  
Christian Risick ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Recurrence Rate ◽  
Parotid Surgery ◽  
Nerve Paresis ◽  
Long Term Recurrence Rate

scholarly journals Easy and Safe Method for Facial Nerve Identification in Parotid Surgery

2015 ◽  
Vol 76 (06) ◽  
pp. 426-431 ◽  
Author(s):  
Shetty Sharankumar ◽  
C.J. Sandya ◽  
Vidhyadharan Sivakumar ◽  
Peter Sherry ◽  
Thankappan Krishnakumar ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Safe Method ◽  
Parotid Surgery ◽  
Nerve Identification

Feasibility of Using Posterior Auricular Artery as Landmark for Identification of Facial Nerve Trunk in Parotid Surgery

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Gontu Gopi Satya Sai Reddy ◽  
Roshan K. Verma ◽  
Naga Surya Prakash Devarapalli ◽  
Daisy Sahni ◽  
Jaimanti Bakshi ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Nerve Trunk ◽  
Posterior Auricular Artery ◽  
Parotid Surgery

Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland

2021 ◽  
Vol 14 (6) ◽  
pp. e238759
Author(s):  
Auric Bhattacharya ◽  
Madhumati Singh ◽  
Anjan Shah ◽  
Lynn Lilly Varghese
Keyword(s):  
Salivary Gland ◽  
Parotid Gland ◽  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Needle Aspiration ◽  
Superficial Parotidectomy ◽  
Salivary Gland Tumours ◽  
Patient Reported ◽  
The Face ◽  
Needle Aspiration Cytology

Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair’s incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.

scholarly journals Minimally Invasive Surgery for Parotid Pleomorphic Adenoma

2005 ◽  
Vol 84 (5) ◽  
pp. 308-311 ◽  
Author(s):  
Robert L. Witt
Keyword(s):  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Operating Time ◽  
Frey’S Syndrome ◽  
Superficial Parotidectomy ◽  
Facial Contour ◽  
Great Auricular Nerve ◽  
Objective Reduction ◽  
Frey's Syndrome ◽  
Nerve Dysfunction

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve—defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve—is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved. To test this hypothesis, the author conducted a retrospective study of 30 patients—15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms of morbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.

scholarly journals Post parotidectomy facial nerve palsy: A retrospective analysis

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Dr. Atif Hafeez Siddiqui ◽  
Saad Shakil ◽  
Danish ur Rahim ◽  
Irfan Ahmed Shaikh
Keyword(s):  
Facial Nerve ◽  
Retrospective Analysis ◽  
Pleomorphic Adenoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Sampling Technique ◽  
Female Ratio ◽  
Creative Commons ◽  
Parotid Surgery ◽  
Nerve Dysfunction

Background & Objectives: Transient paralysis of facial nerve is seen to vary from 15 % to 66 % in post-parotid surgery. The objective of this study was to find out the complications in post-parotidectomy with regards to facial nerve dysfunction since it is a vital structure encountered in parotid surgeries. Methods: This was a retrospective study through non probability convenient sampling technique carried from September 2010 to January 2019 in the Department of Otorhinolaryngology, Dow University of Health Sciences, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. Clinical data were recorded from 75 patients and out of them 70 patients had undergone surgery with parotid gland tumours and were reported on the morphology, age, sex, surgical procedure and complications, particularly facial nerve dysfunctions. In most cases ante-grade technique was performed to identify the facial nerve, whereas retrograde technique was used in recurring tumours, and in difficult cases. The stimulator of the nerve has not been used. The nature or severity of Facial nerve dysfunction was assessed in terms of either it is, permanent or temporary, total or incomplete in respect to its branches. Results: Among total 75 patients; the mean age was 38.75 ± 9.26 years with male to female ratio of 1:1. Majority of the patients were diagnosed as pleomorphic adenoma, i.e. 78.6% after which 12% were diagnosed as mucoepidermoid carcinoma. 88.6% of patients had superficial parotidectomy and 11.4% of patients had total parotidectomy. About 75% of patients had no complications. 5(7.1%) patients had complete facial nerve palsy. Damage to the mandibular, buccal and temporozygomatic branch was observed in 10(14%), 2(3%) and 1(1.4%) patients respectively. Conclusion: The most prevalent benign parotid tumour in this study was pleomorphic adenoma. After performing parotid surgery, it was predicted that the rate of complications related to the facial nerve injury was reduced as compared to the previous studies. doi: https://doi.org/10.12669/pjms.36.2.1706 How to cite this:Siddiqui AH, Shakil S, Danish-ur-Rahim, Shaikh IA. Post parotidectomy facial nerve palsy: A retrospective analysis. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1706 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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