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Parotid Malignancy with Facial Weakness: Should the Facial Nerve Be Sacrificed?

  • Luiz Paulo Kowalski
  • Alvaro Sanabria
  • Joel Arevalo
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Carcinoma of the parotid gland accounts for 14–25% of all parotid lesions. 14–30% patients present with no clinical indications of an advanced tumor until discovery of FN weakness/paresis during the preoperative exam or a nerve invasion during surgery.

It is commonly accepted that patients with preoperative total paralysis of the FN are not candidates for preservation. Additionally, in cases of weakness or selectively compromised FN branches, attempts should be made to preserve the trunk and the non-compromised branches. In at least a third of patients without preoperative FN paralysis, an intraoperative finding obligated the sacrifice of the FN. The belief that postoperative radiotherapy can control positive microscopic margins in cases of FN preservation is not supported by evidence.

Approximately 25–33% patients have moderately functional sequelae even after FN sacrifice. An immediate reconstruction with nerve free graft improves functional recovery and should be attempted.

Keywords

Parotid gland Facial nerve Paralysis Survival Recurrence Reconstruction Quality of life 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luiz Paulo Kowalski
    • 1
  • Alvaro Sanabria
    • 2
    • 3
  • Joel Arevalo
    • 2
  1. 1.Head and Neck Service Surgery and Otorhinolaryngology DepartmentAC Camargo Cancer CenterSao PauloBrazil
  2. 2.Head and Neck ServiceFundación Colombiana de Cancerología—Clínica VidaMedellinColombia
  3. 3.Department of SurgeryUniversidad de AntioquiaMedellinColombia

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