Most Common Complication After Parotid Surgery or Parotidectomy
The most common complication after parotid surgery or parotidectomy is temporary facial nerve weakness, which occurs in approximately 27% of cases, while permanent facial weakness occurs in about 2.5% of patients with normal preoperative function. 1
Analysis of Complications by Frequency
Facial Nerve Palsy (Answer B)
- Temporary facial weakness occurs in approximately 27% of cases 1
- Permanent facial weakness occurs in about 2.5% of patients 1
- An older study reported temporary facial nerve palsy in 38% and permanent palsy in 9% of cases 2
- This complication directly impacts facial function and quality of life
Frey Syndrome (Answer A)
- Occurs in a significant percentage of patients following parotidectomy
- Reported in 11% of patients in one study 2
- Another study found that 62% of patients suffered from gustatory sweating following superficial parotidectomy 3
- However, many cases are subclinical - 85% of patients who did not notice symptoms actually had subclinical manifestation when tested 3
- While common, it typically develops later (average 12 months post-surgery) 4
- Only 44% of patients with Frey syndrome are symptomatic 4
Skin Flap Anesthesia (Answer C)
- Often related to greater auricular nerve injury
- Listed as a potential complication in guidelines 1
- Complaints of local hypoaesthesia were reported as common after parotid surgery 5
- However, it is not documented as the most frequent complication in the available evidence
Other Notable Complications
- Hematoma formation
- Salivary fistula
- Seroma
- Keloid formation
- Recurrent tumor
Prevention and Management
- Meticulous surgical technique with careful facial nerve handling is essential to reduce the risk of facial nerve injury 1
- Maintaining thick skin flaps when oncologically appropriate may reduce the risk of complications such as Frey syndrome 1
- For established Frey syndrome, intracutaneous injection of botulinum toxin A is an effective treatment 1, 3, 5
- Early detection and management of complications are critical to preventing long-term sequelae 1
Clinical Pearls
- Facial nerve function should be carefully documented before and after surgery
- Patients should be counseled about the high likelihood of temporary facial weakness
- Many complications may develop months after surgery, necessitating long-term follow-up
- While Frey syndrome is common, many cases are subclinical or asymptomatic
- The risk of complications must be balanced against the need for adequate tumor removal
Based on the most recent and highest quality evidence from the 2025 Praxis Medical Insights guideline, facial nerve palsy (temporary or permanent) is the most common complication after parotid surgery.