Facial reanimation in radical parotidectomy: The Milan proposal

Surgery for advanced stage or recurrent parotid tumors often involves VII nerve sacrifice. Facial reanimation techniques aim to restore corneal protection and both static and dynamic facial symmetry, without compromising resection. Surgical strategies were based on tumor histology and intraoperative frozen section analysis. Masseteric to facial nerve branch (for the ZMM) neurorrhaphy was done in patients without perineural invasion, while temporalis muscle tendon lengthening was used when that nerve was resected. Facial symmetry and function were objectively assessed using the eFACE system preoperatively and in follow-up. Postoperative eFACE analysis demonstrated good results in both static and dynamic facial symmetry. Masseteric to facial neurorrhaphy achieved satisfactory smile excursion (81 ± 14), while static symmetry parameters, including nasolabial fold orientation (90 ± 4), were high across both surgical groups. Gentle and full eye closure scored lower (79 ± 3 and 85 ± 4), reflecting the limited impact of reanimation techniques on voluntary eyelid closure. The multimodal facial reanimation protocol adopted effectively addressed recovery of facial symmetry and function. Masseteric to ZMM branch neurorrhaphy combined with cross face nerve graft offers excellent dynamic results with minimal morbidity, while additional static techniques ensure immediate ocular protection and aesthetic outcomes.