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Postoperative facial nerve function in pediatric parotidectomy: a 12-year review
James A Owusu1, Noah P Parker, Frank L Rimell
1Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN 55455, USA. usuja@gmail.com
Insights
Postparotidectomy facial nerve paresis is common in children, with most recovering function within months. Patient factors did not predict nerve dysfunction after parotid surgery.
Area of Science:
- Pediatric Otolaryngology
- Facial Nerve Surgery
- Oncology
Background:
- Parotidectomy is a complex procedure in pediatric patients.
- Facial nerve dysfunction is a known complication of parotidectomy.
Purpose of the Study:
- To determine the incidence of postparotidectomy facial nerve dysfunction in pediatric patients.
- To assess the relationship between patient demographics, pathology, and functional outcomes.
Main Methods:
- Retrospective case series of pediatric patients (<18 years) undergoing parotidectomy.
- Chart review to analyze facial nerve dysfunction and recovery.
- Statistical analysis (chi-square, t-test) to identify predictive factors.
Main Results:
- 21% incidence of immediate facial nerve paresis (9/43 patients).
- Most common dysfunction involved the marginal mandibular nerve.
- Full recovery occurred within 10 months for most affected patients.
Conclusions:
- Distal facial nerve paresis is a frequent outcome post-pediatric parotidectomy.
- Preoperative counseling should include the risk of nerve dysfunction.
- Age, gender, and pathology did not predict nerve dysfunction.
Objective:
To analyze the incidence of postparotidectomy facial nerve dysfunction in pediatric patients and to evaluate the association between patient demographics or underlying pathology and functional outcomes.
Study Design:
Case series with chart review.
Setting:
Tertiary-care pediatric hospital.
Subjects And Methods:
We reviewed charts of patients younger than 18 years who underwent parotidectomy performed by a pediatric otolaryngologist between 1999 and 2011 at a tertiary pediatric center. Distributions of postoperative facial nerve dysfunction and timing of recovery were noted. Chi-square and t-test analyses were conducted to determine the association between demographics or pathology and functional outcomes.
Results:
Forty-three patients met inclusion criteria: 41 underwent superficial parotidectomy, and 2 underwent total parotidectomy. Leading indications for surgery were atypical mycobacterial infection (16/43 [37.2%]) and first branchial cleft anomaly (8/43 [18.6]). The facial nerve was sacrificed in 1 (2%) patient with Ewing's sarcoma involving the nerve. The incidence of immediate facial nerve paresis was 21% (9/43), involving the marginal mandibular nerve (n = 7), buccal branch (n = 1), and both marginal mandibular and frontal branches (n = 1). Full recovery of nerve function in patients with paresis occurred within 1 month (n = 2), 2 months (n = 1), 6 months (n = 3), or 10 months (n = 2).
Conclusion:
Postparotidectomy paresis of distal branches of the facial nerve is a common occurrence in the pediatric population and should be discussed during preoperative evaluation. The risk is comparable to that of the adult population. Age, gender, and pathologic diagnosis were not predictive of postoperative nerve dysfunction.
