Facial Nerve Palsy following Parotidectomy

Abstract

Objective: To determine the incidence of temporary and permanent facial nerve dysfunction in patients following parotidectomy in a UK teaching hospital.

Method: All parotidectomies performed between January 1, 2009, and January 1, 2012, were analyzed using patients’ clinical and operative records. The grade of the surgeon, the operation, and the presence of a facial nerve monitor were recorded. House-Brackmann scores were recorded preoperatively and postoperatively. The length of time until recovery of facial nerve function was recorded.

Results: Sixty-five parotidectomies were performed. The indications for surgery included pleomorphic adenoma 31%, warthin 23%, malignant disease 34%, and other 15%. Overall postoperative palsy rate was 43% (28/65). The most commonly affected branch was the marginal mandibular, 25% (16/65 %). Six were permanent and 22 temporary. The rate of facial nerve palsy was 44% for benign disease and 41% for malignant. Of the 6 permanent facial nerve palsies, 4 (67%) facial nerves were sacrificed because of preoperative disease involvement. MM was the branch commonly involved in these cases often due to Level 1 nodal clearance. In patients with temporary facial nerve palsy, mean recovery time was 4.3 months (range, 24 hours-12 months).

Conclusion: Facial nerve palsy is a distressing and debilitating complication of parotidectomy, not only functionally but also emotionally and socially. Informed consent is an important part of preoperative assessment and accurate facial nerve palsies incidence rates should be discussed with patients.