Preoperative Visualization of the Intraparotid Facial Nerve-Tumor Relationship in Parotidectomy

Preoperative visualization of the intraparotid facial nerve remains challenging with conventional imaging. This retrospective case series evaluated the feasibility of three-dimensional double-echo steady-state with water excitation magnetic resonance imaging for identifying the intraparotid facial nerve and its relationship to parotid tumors. Fifteen lesions in 14 patients who underwent parotidectomy with preoperative imaging using this sequence were analyzed. The main trunk and major divisions were identified in 14 of 15 lesions (93%). Three-dimensional reconstructions demonstrated the tumor-main trunk relationship, and findings were concordant with intraoperative observations in all evaluable cases, including in the setting of distorted anatomy. Visualization of distal branches was limited. These findings suggest that this imaging technique enables preoperative assessment of the intraparotid facial nerve and may support surgical planning in anatomically complex cases.