Surgical Dissection of the Facial nerve in Parotidectomy: Our Personal Experience

Salivary gland tumors are relatively rare and constitute 3-4% of all head and neck neoplasms. The majority (70%) of salivary gland tumors arise in the parotid gland. Recommended treatment for a parotid mass is surgical excision with a surrounding cuff of normal tissue to prevent recurrence.

This is a retrospective study of 300 patients who were operated by a single surgeon for parotidectomy over a 20-year period in Ghaem Hospital, Mashhad, Iran. The patients'' age, sex, operation findings, pathology report and type of surgery (parotidectomy or mastoidectomy) were analyzed.

In 25 cases we had to find the nerve in a retrograde fashion by finding the distal branches and dissecting backwards to reach the mass, whereas in 275 patients the trunk of the facial nerve was approached in a conventional antegrade fashion. Twelve cases needed some sort of repair on the nerve due to a trauma in the surgical field, either grafting or anastomosis was done. Interestingly mastoidectomy was required in 5 of our cases. The aim of these mastoidectomies was to eradicate the malignancy in cases where a perineural invasion was present. It also gave us a chance to find a normal proximal nerve ending in order to perform a safe nerve reconstruction (grafting or anastomosis).

Mastoidectomy and facial nerve anastomosis may be required in parotid surgery