Management of Malignant Parotid Tumors With Complete Facial Paralysis

Area of Science:

• Surgical Oncology
• Neurosurgery
• Plastic and Reconstructive Surgery

Background:

• Parotid gland malignancies often necessitate radical parotidectomy, potentially involving facial nerve sacrifice.
• Facial paralysis secondary to parotid gland cancer presents significant functional and aesthetic challenges for patients.

Purpose of the Study:

• To review current treatment considerations for facial nerve reanimation in the context of parotid gland malignancy.
• To assist clinicians in decision-making for managing facial nerve involvement during oncologic surgery.

Main Methods:

• A comprehensive literature review was conducted using the PubMed database, focusing on the last 10 years.
• Search terms included "parotid gland malignancy," "radical parotidectomy," "complete facial nerve palsy," "facial nerve reanimation," and "facial nerve reconstruction."

Main Results:

• Facial reanimation in parotid gland malignancies involves a tailored approach combining static and dynamic techniques post-nerve sacrifice.
• Key intraoperative strategies include nerve grafting (sural, great auricular), cross-face nerve grafts, temporalis myoplasty, cranial nerve substitution (masseteric, hypoglossal), and static procedures (slings, weights, canthoplasty, brow lifts).
• Emerging techniques like vascularized nerve grafts and stem cell therapies show promise for enhanced nerve regeneration.

Conclusions:

• Optimizing patient quality of life after total parotidectomy with nerve resection requires a deep understanding of various facial reanimation techniques.
• A multidisciplinary approach and longitudinal planning are crucial for successful facial nerve reconstruction and functional recovery.