From the Research
The most common complication after parotidectomy is facial nerve palsy, which occurs in approximately 51.2% of patients undergoing parotidectomy, with the majority being transient paralysis. This is based on the most recent and highest quality study available, which analyzed 78 patients who underwent parotidectomy at a tertiary care institution 1. The facial nerve (cranial nerve VII) runs directly through the parotid gland, dividing it into superficial and deep lobes, making it vulnerable during surgery despite careful dissection and nerve monitoring techniques.
Key Points
- The incidence of facial nerve palsy after parotidectomy can range from 10 to 68%, with long-term dysfunction ranging from 0 to 19% 2.
- Tumor size larger than 4 cm was associated with a higher incidence of facial nerve palsy (57.5%) 1.
- The majority of facial nerve palsy cases were classified as grade II and III according to the House-Brackmann grading system 1.
- Management of facial nerve palsy includes eye protection with artificial tears and lubricating ointment, facial physical therapy exercises, and in some cases, corticosteroids to reduce inflammation around the nerve.
Complications and Management
Other less common complications include Frey's syndrome (gustatory sweating), hematoma, infection, salivary fistula, and numbness around the ear lobe due to greater auricular nerve injury. Patients should be counseled about these potential complications before surgery and reassured about the typically temporary nature of facial weakness. The study by 3 also found that partial superficial parotidectomy and extracapsular dissection are low-risk treatments for benign parotid tumors, with a 3.75% incidence of facial nerve palsy.
Prevention and Treatment
Prevention of facial nerve palsy is crucial, and this can be achieved through extensive preoperative planning and better surgical practices, as emphasized by the study 2. The use of intra-operative facial nerve monitoring and meticulous surgical technique can also help reduce the risk of facial nerve injury. Overall, facial nerve palsy is a significant complication of parotidectomy, but with proper management and prevention, the risk can be minimized.