Post parotidectomy facial nerve palsy: A retrospective analysis

Atif Hafeez Siddiqui, Saad Shakil, Danish Ur Rahim, Irfan Ahmed Shaikh, Atif Hafeez Siddiqui, Saad Shakil, Danish Ur Rahim, Irfan Ahmed Shaikh

Abstract

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.

Keywords: Parotid gland tumour; facial nerve dysfunction; parotidectomy.

Copyright: © Pakistan Journal of Medical Sciences.

References

    1. Musani MA, Sohail Z, Zafar A, Malik S. Morphological pattern of parotid gland tumours. J Coll Physician Surg Pak. 2008;18(5):274–277. doi:05.2008/JCPSP.274277.
    1. Ghosh S, Chowdhury MK, Haque E, Sarkar S, Sarkar A, Haque M. Clinical Presentation and Surgical Outcome of Parotid Gland Tumors-Experience in ENT Department of Rajshahi Medical College Hospital. J Teach Assoc. 2018;31(2):21–26. doi:10.3329/taj.v31i2.41592.
    1. Ruohoalho J, Makitie AA, Aro K, Atula T, Haapaniemi A, Keski–Santti H, et al. Complications after surgery for benign parotid gland neoplasms:A prospective cohort study. Head and Neck. 2017;39(1):170–176. doi:10.1002/hed.24496.
    1. El-Shakhs S, Khalil Y, Abdou AG. Facial nerve preservation in total parotidectomy for parotid tumors:a review of 27 cases. Ear Nose Throat J. 2013;92(6):1–5. doi:10.1177/014556131309200611.
    1. Nepal A, Chettri ST, Joshi RR, Bhattarai M, Ghimire A, Karki S. Primary salivary gland tumors in eastern Nepal tertiary care hospital. J Nepal Health Res Counc. 2010;8(1):31–34. doi:10.33314/jnhrc.v0i0.220.
    1. Castro MA, Dedivitis RA, Guimaraes AV, Cernea CR, Brandao LG. The surgical management of parotid gland tumours. S Afr J Surg. 2015;53(4):45–47.
    1. Jaafari-Ashkavandi Z, Ashraf MJ, Moshaverinia M. Salivary gland tumors:a clinicopathologic study of 366 cases in southern Iran. AsianPac J CancerPrev. 2013;14(1):27–30. doi:10.7314/APJCP.2013.14.1.27.
    1. Iro H, Zenk J, Koch M, Klintworth N. Follow-up of parotid pleomorphic adenomas treated by extracapsular dissection. Head &neck. 2013;35(6):788–793. doi:10.1002/hed.23032.
    1. Wong WK, Shetty S. The extent of surgery for benign parotid pathology and its influence on complications:A prospective cohort analysis. Am J Otolaryngol. 2018;39(2):162–166. doi:10.1016/j.amjoto.2017.11.015.
    1. Borumandi F, George KS, Cascarini L. Parotid surgery for benign tumours. J Oral Maxillofac Surg. 2012;16(3):285–290. doi:10.1007/s10006-012-0352-7.
    1. Thahim K, Udaipurwala IH, Kaleem M. Clinical manifestations, treatment outcome and post-operative complications of parotid gland tumours-an experience of 20 cases. J Pak Med Assoc. 2013;63(12):1472–1475.
    1. Wierzbicka M, Kopeć T, Szyfter W, Kereiakes T, Bem G. The presence of facial nerve weakness on diagnosis of a parotid gland malignant process. Eur Arch Oto Rhino Laryngol. 2012;269(4):1177–1182. doi:10.1007/s00405-011-1882-6.
    1. Shashinder S, Tang IP, Velayutham P, Prepageran N, Gopala KG, Kuljit S, et al. A review of parotid tumours and their management:a ten-year-experience. Med J Malaysia. 2009;64(1):31–33.
    1. Rahman MA, Alam MM, Joarder AH. Study of the Nerve Injury in Parotid Gland Surgery. NepaleseJ ENT Head NeckSurg. 2011;2(1):17–19. doi:10.3126/njenthns.v2i1.6779.
    1. Ramadan MM. Facial nerve morbidity following parotid surgery. Suez Canal Univ Med J. 2003;6:29–34.
    1. Adeyemo WL, Taiwo OA, Somefun OA, Olasoji HO, Ndukwe KC, Fashina AA, et al. A survey of facial nerve dissection techniques in benign parotid surgery among maxillofacial and ear, nose, and throat surgeons in Nigeria. Niger. J Clin Pract. 2011;14(1):83–87. doi:10.4103/1119-3077.79272.
    1. Klintworth N, Zenk J, Koch M, Iro H. Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve function. Laryngoscope. 2010;120(3):484–490. doi:10.1002/lary.20801.
    1. Dulguerov P, Marchal F, Lehmann W. Postparotidectomy facial nerve paralysis:possible etiologic factors and results with routine facial nerve monitoring. The Laryngoscope. 1999;109(5):754–762. doi:10.1097/00005537-199905000-00014.
    1. Mahmood K, Williams GS, Morgan N. Postparotidectomy facial nerve paralysis:peripheral versus proximal identification. B-ENT. 2010;6(2):117–121.
    1. Huang G, Yan G, Wei X, He X. Superficial parotidectomy versus partial superficial parotidectomy in treating benign parotid tumors. Oncol Lett. 2015;9(2):887–90. doi:10.3892/ol.2014.2743.
    1. Musani MA, Zafar A, Suhail Z, Malik S, Mirza D. Facial nerve morbidity following surgery for benign parotid tumours. J Coll Physicians Surg Pak. 2014;24(8):569–572.
    1. Tung BK, Chu PY, Tai SK, Wang YF, Tsai TL, Lee TL, et al. Predictors and timing of recovery in patients with immediate facial nerve dysfunction after parotidectomy. Head and Neck. 2014;36(2):247–251. doi:10.1002/hed.23287.

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