Parotid tumours: clinical and oncologic outcomes after microscope-assisted parotidectomy with intraoperative nerve monitoring

摘要

Temporary and permanent facial nerve dysfunctions can be observed after parotidectomy for benign and malignant lesions. Intraoperativenerve monitoring is a recognised tool for the preservation of the nerve, while the efficacy of the operative microscope has been rarely stated.The authors report their experience on 198 consecutive parotidectomies performed on 196 patients with the aid of the operative microscopeand intraoperative nerve monitoring. 145 parotidectomies were performed for benign lesions and 53 for malignancies. Thirteen patientstreated for benign tumours experienced temporary (11 cases) or permanent facial palsy (2 cases, both of House-Brackmann grade II). Tenpatients with malignant tumour presented with preoperative facial nerve weakness that did not improve after treatment. Five and 6 patientswith malignant lesion without preoperative facial nerve deficit experienced postoperative temporary and permanent weakness respectively(the sacrifice of a branch of the nerve was decided intraoperatively in 2 cases). Long-term facial nerve weakness after parotidectomy forlesions not directly involving or originating from the facial nerve (n = 185) was 2.7%. Patients treated for benign tumours of the extra facialportion of the gland without inflammatory behaviour (n = 91) had 4.4% facial nerve temporary weakness rate and no permanent palsy.The combined use of the operative microscope and intraoperative nerve monitoring seems to guarantee facial nerve preservation duringparotidectomy.