STUDY OF THE NERVE INJURY IN PAROTID GLAND SURGERY

Abstract

Objective:

To find out the frequency of nerve injuries after parotid surgery

Material and methods:

A Cross sectional study was done from January 2008 to December 2009, in the Department of Otolaryngology and Head Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) & Dhaka Medical College Hospital (DMCH), Dhaka. Thirty patients with parotid gland diseases underwent surgical treatment were selected for this study by convenient, purposive, none randomize sampling. The patients were followed up for one year after surgery and evaluated the status of the nerve injury (temporary or permanent).

Results:

Out of 30 cases, superficial parotidectomy was done in 23 (76.67%) patients and total conservative parotidectomy was done in 7 (23.33%) patients. In this study, 23 (76.67%) patients had benign tumours, 5 (16.67%) patients had malignant tumours and 2 patients had inflammatory disease. Most of the benign parotid tumours were pleomorphic adenoma (73.33%). Majority of the pleomorphic adenomas involved the superficial lobe (90.91%) of the gland. Immediately after operation we observed facial nerve injuries in 11 patients and great auricular nerve injuries in four patients. In this series, 26.67% developed temporary facial paresis, whereas 10% developed permanent facial palsy. Marginal mandibular branch of the facial nerve was the most commonly injured (16.33%) nerve. Temporary great auricular nerve palsy was observed in 10% where as permanent paralysis was observed in 3.33%. Frey’s syndrome was  found in 4.34%.

Conclusion:

Most patient regained normal facial nerve functions between one and six months after surgery. This observation has important implications for the management of post parotidectomy facial nerve palsy. Temporary facial nerve paresis is the cosmetic problem and patients should be assured that their appearance would return to normal.

Keywords: facial paresis, parotidectomy, pleomorphic adenoma