Intraoperative Facial Nerve Involvement in Parotid Tumours - A Retrospective Analysis in a Tertiary Care Centre

Pooja Pal; Ankur Mohan; Rupinder Kaur; Gurkiran Kaur; Bikramjit Singh

doi:10.1007/s12070-024-04478-1

Intraoperative Facial Nerve Involvement in Parotid Tumours - A Retrospective Analysis in a Tertiary Care Centre

Indian J Otolaryngol Head Neck Surg. 2024 Apr;76(2):1972-1978. doi: 10.1007/s12070-024-04478-1. Epub 2024 Jan 11.

Authors

Pooja Pal¹, Ankur Mohan², Rupinder Kaur³, Gurkiran Kaur⁴, Bikramjit Singh⁵

Affiliations

¹ Otolaryngology & Head Neck Surgery, Sri Guru Ram Das Institute of Medical Sciences, Amritsar, India.
² Otolaryngology & Head Neck Surgery, AIIMS Bathinda, Bathinda, India.
³ Surgical Oncology, Government Medical College Amritsar, Amritsar, India.
⁴ Otolaryngology & Head Neck Surgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sangrur, India.
⁵ Professor & Head of Department, Surgical Oncology, Government Medical College Amritsar, Amritsar, India.

PMID: 38566689
PMCID: PMC10982282 (available on 2025-04-01)
DOI: 10.1007/s12070-024-04478-1

Abstract

Purpose: The study aims to provide a comprehensive overview of the various malignant and benign parotid tumours and evaluate the predictive factors for intraoperative nerve involvement leading to facial palsy (FP).

Methods: It is a single-centre retrospective analysis for reviewing the involvement of facial nerve in post- parotidectomy patients. The clinical database from January 2012 to December 2020 was included in the study with a follow-up period of a minimum of 2 years. To maintain homogeneity, all squamous cell carcinomas of level 2 nodes involving parotid or residual/recurrent disease of the oral cavity requiring parotid dissection were excluded.

Results: A total of 248 patients (171 benign; 77 malignant) were evaluated with a mean age of 46.48 ± 10.76 years. The presence of malignancy increases the risk of FP (p = 0.027). 37 (14.92%) patients with FP were detected which included 34 with partial [32.35% in malignant; 62.16% in recurrent pleomorphic adenoma (RPA)] and 3 with total paralysis (66.67% in malignant; 33.33% in RPA). The recurrence of pleomorphic adenoma increases FP. While old age, larger size, hard fixed swelling with masseteric space (MS) infiltration appeared as risk factors for FP in malignant tumours (p = 0.047; p = 0.004; p < 0.00001 respectively).

Conclusion: Tumour size, malignancy, hard fixed mass, masseteric space infiltration, recurrence, and age > 45yrs have been statistically significant predictive factors for intraoperative facial nerve involvement leading to FP. The study also revealed that FP occurred more commonly when there was concurrent involvement of both superficial and deep lobes but was not statistically significant.

Keywords: Facial nerve; Facial palsy; Parotid tumours; post-parotidectomy.

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