Facial paralysis after superficial parotidectomy: analysis of possible predictors of this complication

Renato Fortes Bittar, Homero Penha Ferraro, Marcelo Haddad Ribas, Carlos Neutzling Lehn, Renato Fortes Bittar, Homero Penha Ferraro, Marcelo Haddad Ribas, Carlos Neutzling Lehn

Abstract

Introduction: Salivary gland tumors represent 3-10% of all head and neck neoplasms. These tumors occur predominantly in major salivary glands. The parotid gland is affected most often, ranging from 36.6% to 83%. The pleomorphic adenoma comprises 45-60% of all salivary gland tumors. Several surgical approaches have been described to treat this tumor. Lesion of the facial nerve is one of the most serious complications that can occur after parotid gland surgery.

Objectives: To determine possible predictive factors related to the occurrence of peripheral facial paralysis (PFP) after superficial parotidectomy in the surgical treatment of the pleomorphic adenomas of the parotid gland.

Methods: This was a primary, observational, case-control study performed through the revision of patients' charts and histopathological reports. Data was obtained from 1995 to 2014. The analyzed events were: tumor's length and depth; duration of the disease referred by the patient (more than 1, 5 or 10 years); primary or secondary surgical approach.

Results: The analysis showed that tumor lengths equal or superior to 3.0cm were a risk factor of PFP with an odds ratio of 3.98 (p=0.0310). Tumor depths equal or superior to 2.0cm were also a risk factor with an odds ratio of 9.5556 (p=0.0049). When the tested event was secondary surgery to recurrent tumors we have found an odds ratio of 6.7778 (p=0.0029).

Conclusion: Tumors with 3.0cm or more in length and/or 2.0cm or more in depth have a significant higher risk of facial nerve injury. Secondary surgery to recurrent tumors also has a much higher risk of evolving with facial palsy after superficial parotidectomy.

Keywords: Facial nerve; Facial paralysis; Neoplasias de glândulas salivares; Nervo facial; Paralisia facial; Parotidectomia; Parotidectomia superficial; Parotidectomy; Salivary gland neoplasms; Superficial parotidectomy.

Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Facial paralysis grade versus elapsed time until complete recovery.

References

    1. Foresta E., Torroni A., Di Nardo F., de Waure C., Poscia A., Gasparini G., et al. Pleomorphic adenoma and benign parotid tumors: extracapsular dissection vs superficial parotidectomy – review of literature and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117:663–676.
    1. Loyola A.M., Araújo V.C., de Sousa S.O.M., de Araújo N.S. Minor salivary gland tumors. A retrospective study of 164 cases in a Brazilian population. Oral Oncol Eur J Cancer. 1995;31:197–201.
    1. Nanda K.D.P., Mehta A., Nanda J. Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions. J Oral Pathol Med. 2012;41:106–112.
    1. Kayembe M.K., Kalengayi M.M. Salivary gland tumors in Congo (Zaire) Odontostomatol Trop. 2002;25:19–22.
    1. Satko I., Stanko P., Longauerova I. Salivary gland tumors treated in the stomatological clinics in Bratislava. J Craniomaxillofac Surg. 2000;28:56–61.
    1. Long-Jiang L., Yi L., Yu-ming W., Hong-wei Z. Clinical analysis of salivary gland tumor cases in West China in past 50 years. Oral Oncol. 2008;44:187–192.
    1. Lima S.S., Soares A.F., de Amorim R.F., Freitas R., de A. Epidemiologic profile of salivary gland neoplasms: analysis of 245 cases. Braz J Otorhinolaryngol. 2005;71:335–340.
    1. Zbären P., Vander Poorten V., Witt R.L., Woolgar J.A., Shaha A.R., Triantafyllou A., et al. Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Am J Surg. 2013;205:109–118.
    1. Senn N. W.B. Saunders; Philadelphia, PA: 1895. The pathology and surgical treatment of tumors.
    1. Witt R.L. The significance of the margin in parotid surgery for pleomorphic adenoma. Laryngoscope. 2002;112:2141–2154.
    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;120:484–490.
    1. Roh J.L., Kim H.S., Park C.I. Randomized clinical trial comparing partial parotidectomy versus superficial or total parotidectomy. Br J Surg. 2007;94:1081–1087.
    1. Malard O., Wagner R., Joubert M., Delemazure A.S., Rio E., Durand N., et al. Prognostic factors for secondary recurrence of pleomorphic adenoma: a 20-year, retrospective study. J Laryngol Otol. 2013;127:902–907.
    1. Zhang S.S., Ma D.Q., Guo C.B., Huang M.X., Peng X., Yu G.Y. Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy. Int J Oral Maxillofac Surg. 2013;42:868–873.
    1. Laccourreye H., Laccourreye O., Cauchois R., Jouffre V., Ménard M., Brasnu D. Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients. Laryngoscope. 1994;104:1487–1494.
    1. Witt R.L. Facial nerve function after partial superficial parotidectomy: an 11-year review (1987–1997) Otolaryngol Head Neck Surg. 1999;121:210–213.
    1. Koch M., Zenk J., Iro H. Long-term results of morbidity after parotid gland surgery in benign disease. Laryngoscope. 2010;120:724–730.
    1. Guntinas-Lichius O., Klussmann J.P., Wittekindt C., Stennert E. Parotidectomy for benign parotid disease at a university teaching hospital: outcome of 963 operations. Laryngoscope. 2006;116:534–540.
    1. Gaillard C., Périé S., Susini B., St Guily J.L. Facial nerve dysfunction after parotidectomy: the role of local factors. Laryngoscope. 2005;115:287–291.
    1. Dulguerov P., Marchal F., Lehmann W. Postparotidectomy facial nerve paralysis: possible etiologic factors and results with routine facial nerve monitoring. Laryngoscope. 1999;109:754–762.
    1. O’Brien C.J., Malka V.B., Mijailovic M. Evaluation of 242 consecutive parotidectomies performed for benign and malignant disease. Aust N Z J Surg. 1993;63:870–877.
    1. Johnson J.T., Ferlito A., Fagan J.J., Bradley P.J., Rinaldo A. Role of limited parotidectomy in management of pleomorphic adenoma. J Laryngol Otol. 2007;121:1126–1128.
    1. Ellingson T.W., Cohen J.I., Andersen P. The impact of malignant disease on facial nerve function after parotidectomy. Laryngoscope. 2003;113:1299–1303.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren