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Antegrade Versus Retrograde Facial Nerve Dissection in Benign Parotid Surgery: A Systematic Review and Meta-Analysis
Do Hyun Kim1, David W Jang2, Se Hwan Hwang3
1Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Head & Neck
|June 22, 2026
Summary
Retrograde dissection (RD) for parotidectomy reduces transient facial nerve palsy compared to anterograde dissection (AD). RD also offers shorter operative times and less blood loss, especially in superficial parotidectomies.
Area of Science:
- Otolaryngology
- Neurosurgery
- Surgical Oncology
Background:
- Parotidectomy is crucial for benign parotid tumors.
- Facial nerve preservation is a key surgical challenge.
- The optimal dissection technique (anterograde vs. retrograde) is debated.
Purpose of the Study:
- To compare anterograde dissection (AD) and retrograde dissection (RD) for parotidectomy.
- To evaluate operative parameters, complications, and facial nerve recovery.
- To provide an updated meta-analysis of existing evidence.
Main Methods:
- Systematic review and meta-analysis of 21 studies.
- Inclusion of 1632 patients undergoing parotidectomy.
- Pooled analysis of operative parameters, complications, and nerve recovery using ORs and CIs.
Main Results:
- Retrograde dissection (RD) significantly reduced transient facial nerve palsy versus AD (OR, 0.73; 95% CI, 0.54-0.98).
- No significant difference in permanent facial nerve palsy or long-term recovery (1, 6, 12 months).
- RD was associated with shorter operative time, less blood loss, and smaller resected tissue volume, particularly in superficial parotidectomy.
Conclusions:
- Retrograde dissection (RD) presents advantages over anterograde dissection (AD) for parotidectomy.
- RD is particularly beneficial in superficial parotidectomy cases.
- Further randomized controlled trials are recommended to confirm findings.
