Nerve dissection technique for excision of parotid tumors: Outcomes controlling for tumor size and location

We examined operative efficiency, rate of facial nerve paresis, and post-operative outcomes in patients undergoing retrograde (RGD) vs anterograde dissection (AGD) of the facial nerve controlling for tumor location.

Single-institution, retrospective analysis of patients with benign parotid tumors undergoing superficial parotidectomy with facial nerve dissection over a six-year period. Operative and pathology reports were reviewed to classify tumor size, location in relation to facial nerve branches, and technique for facial nerve dissection. Chi-square and Student's t-test were used to compare operative time, rates of facial nerve paresis, and post-operative outcomes between groups.

Our cohort included 35 patients who underwent RGD and 70 who underwent AGD of the facial nerve. Pleomorphic adenoma was most common in both the RGD (n = 25, 71.4 %) and AGD (n = 69, 98.6 %) groups. Both groups were balanced for demographics, tumor size and location in relation to facial nerve branches. Operative times, rate of surgical drain use, and frequency of post-operative admission were significantly reduced in the RGD group. The rate of temporary facial nerve paresis was significantly reduced (n = 3, 8.6 % vs n = 30, 42.9 % in the RGD vs AGD groups, respectively, p < 0.001) and more frequently limited to single nerve distributions in the RGD group.

RGD of the facial nerve during superficial parotidectomy for benign parotid tumors is associated with reduced operative times, post-operative admission rates, and rates of facial nerve paresis compared to AGD even when controlling for tumor location.