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

Joshua D Smith; Owen A F Darr; Catherine T Haring; Andrew J Rosko; Matthew E Spector; Molly E Heft-Neal

doi:10.1016/j.amjoto.2024.104582

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

Am J Otolaryngol. 2024 Dec 21;46(1):104582. doi: 10.1016/j.amjoto.2024.104582. Online ahead of print.

Authors

Joshua D Smith¹, Owen A F Darr², Catherine T Haring³, Andrew J Rosko¹, Matthew E Spector⁴, Molly E Heft-Neal⁵

Affiliations

¹ Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
² Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
³ Department of Otolaryngology - Head & Neck Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
⁴ Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, USA.
⁵ Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA. Electronic address: mheftnea@med.umich.edu.

PMID: 39731964
DOI: 10.1016/j.amjoto.2024.104582

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Anterograde; Benign; Dissection; Facial nerve; Parotidectomy; Retrograde.