From the Research
The most common complication after parotidectomy is facial nerve palsy, which occurs in a significant percentage of patients undergoing this surgery. This complication is a major concern due to the facial nerve's proximity to the parotid gland, making it vulnerable to injury during surgical procedures. According to the most recent and highest quality study available, 1, the incidence of facial nerve paralysis after parotidectomy was observed in 51.2% of cases, with transient paralysis in 62.5% and persistent paralysis in 37.5%.
Key Points to Consider
- The facial nerve (cranial nerve VII) runs directly through the parotid gland, dividing it into superficial and deep lobes, making it susceptible to damage during surgery despite careful dissection techniques.
- Surgeons typically use nerve monitoring during the procedure to minimize this risk, but the incidence of facial nerve palsy remains significant.
- Patients experiencing this complication may notice drooping of the mouth, inability to close the eye completely, or asymmetry when smiling.
- Management includes eye protection with artificial tears and lubricating ointment for those unable to close their eye completely, along with possible physical therapy.
Comparison with Other Complications
Other potential complications of parotidectomy, such as Frey's syndrome (gustatory sweating), hematoma, infection, salivary fistula, and permanent numbness around the ear, occur less frequently than facial nerve dysfunction. The study by 2 found a 3.75% incidence of facial nerve palsy with no total paralysis post-parotidectomy for benign disease, highlighting the variability in incidence rates across different studies.
Clinical Implications
Understanding the incidence and factors contributing to facial nerve palsy is crucial for optimizing patient care and surgical outcomes. A tumor size larger than 4 cm was associated with a higher incidence of facial nerve palsy, as noted in 1. This information can guide preoperative planning and surgical techniques to minimize the risk of this complication.