Abstract

We conducted a study to evaluate the success of facial nerve preservation in 27 adults with a parotid tumor who underwent total parotidectomy. Of this group, 11 patients had a malignant tumor, 10 had a recurrent benign tumor, and 6 had a primary benign tumor. Preoperatively, 7 patients had facial nerve paresis. Postoperatively, facial nerve preservation was achieved in all but 1 case; in the exception, the nerve was sacrificed and grafting was necessary. In conclusion, facial nerve preservation can be achieved in almost all cases of total parotidectomy.

Introduction

Salivary gland tumors account for less than 4% of all neoplasms of the head and neck; of these, benign tumors are much more common than malignant tumors.1 The overall incidence of salivary gland tumors is roughly the same throughout the world, and there is no significant predilection for either sex. In Egypt, malignant salivary gland tumors represent 0.49% of all malignant tumors, and parotid gland tumors represent 70.83% of all salivary gland tumors.2 Important factors in the prognosis of malignant salivary gland tumors include tumor size, histopathologic type, differentiation, and stage.3

The principal treatment of parotid gland tumors is surgical excision, either alone or in conjunction with radiotherapy.4 The goal of surgery is complete excision with minimal morbidity, but again, success depends on tumor size, location, and histologic type. Almost all benign tumors and most malignant tumors can be treated by surgical excision with facial nerve preservation.

mplications of surgery in the area of the parotid gland. As a result, surgeons with little experience prefer more conservative local surgery.5 However, the possibility of facial nerve injury should be weighed against the possibility of local recurrence, which carries a higher risk of nerve injury during a second operation.

Treatment of local recurrences remains controversial; some authors advocate a second resection, while others advocate more aggressive radical surgery.6 Also, some authors recommend postoperative radiotherapy while others do not.6

The facial nerve emerges from the stylomastoid foramen to enter the substance of the parotid gland at its posteromedial surface. As the nerve exits from the stylomastoid foramen, it is surrounded by a thick layer of fascia, which is continuous with the periosteum of the skull base. During parotidectomy, every effort should be made to preserve facial nerve function if the nerve is directly invaded

We conducted a study to evaluate the success of facial nerve preservation in patients who underwent total parotidectomy

Patients and methods

We retrospectively reviewed the records of 27 adults—15 men and 12 women, aged 22 to 67 years (mean: 39.6)— who had undergone a total parotidectomy at Menofiya University Hospital in Egypt between March 1, 2002, and December 31, 2008. All patients had been treated for a palpable or visible lump in the parotid area in the Department of Otorhinolaryngology and the Department of General Surgery. Of this group, 11 patients (40.7%) had a malignant tumor, 10 (37.0%) had a benign recurrent tumor, and 6 (22.2%) had a benign primary tumor. Patients were operated on with either an anterograde technique or retrograde technique.