Facial nerve reconstruction following radical parotidectomy and subtotal petrosectomy for advanced malignant parotid neoplasms

Abstract

Introduction:

To describe the oncological management and functional outcome of patients with advanced parotid malignant tumors undergoing facial nerve reconstruction after radical parotidectomy and subtotal petrosectomy.

Materials and Methods:

A combined approach was used to treat advanced stage parotid malignancies with intrapetrous involvement of the facial nerve main trunk or abutment on the stylomastoid foramen. Patients underwent facial nerve rehabilitation with cable graft reconstruction or with static techniques.

Results:

Six patients were included. All patients had Stage IV disease and underwent surgical treatment using a combined approach. Three patients underwent facial-nerve cable graft technique and three patients underwent static techniques to rehabilitate facial nerve function. Five patients received adjuvant treatment with radiotherapy and/or chemotherapy. The mean follow-up was 27.5 months, with a minimum of 7 months and a maximum of 8 years. Four patients remain disease-free, with an overall survival rate of 66%. Among the patients undergoing dynamic reconstruction, first signs of recovery were established at 6 months of follow-up. All patients achieved a House-Brackmann score of III-IV within the first two postoperative years.

Conclusions:

When possible, facial nerve grafting is the preferred method of facial nerve rehabilitation in an advanced stage parotid tumors. A multidisciplinary approach allows better functional and oncological outcomes.