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6.3.8: 8. Facial Nerve in Parotidectomy

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  • Always attempt to preserve the nerve: If functioning preoperatively, one should aim to have a functioning nerve postoperatively

    Intraoperative facial nerve monitoring

    Benign salivary tumours

    • Displace, but do not invade nerve
    • Nerve can always be dissected / peeled off tumours

    Malignant tumours

    • Functioning, normal looking nerve may be peeled off tumour, and microscopic residuum treated with postoperative radiotherapy
    • If nerve is invaded/encased by tumour
    • Confirm malignancy on frozen section
    • Resect involved segment until free margins on frozen section (perineural spread can extend many centimetres beyond normal looking nerve)
    • Be prepared to dissect the mastoid segment of the nerve if positive margin at stylomastoid foramen
    • Immediately graft resected nerve, unless a small midface branch (cross-innervation in midfacial branches)

    No postoperative radiotherapy or frozen section with known malignancy adherent to, or invading nerve

    • May need to be surgically more aggressive
    • Reservations about peeling nerve off tumour – but resect nerve only when the remainder of the operation is likely to achieve clear margins
    • Resect nerve at least 1cm beyond obvious tumour