Parotidectomy

When a patient presents with a mass at the angle of the mandible, a neoplasm within the parotid gland is a strong consideration. The parotid is the largest of the salivary glands. Terminal branches of the facial nerve are found within the gland. Their functional preservation is an important goal of parotid surgery. Risks of facial nerve injury rise in reoperative procedures and resection of cancers. Surgical principles apply in parotidectomy. In addition to facial nerve injury, a numb earlobe, contour deficit, salivary fistula, and gustatory sweating should be discussed with the patient before an operation. Most lesions can be removed after identification of the main trunk of the facial nerve, but a retrograde approach after finding a peripheral branch may be required. No randomized trials support a benefit from nerve monitoring. An intact facial nerve will usually begin to function, but months of recovery time may be needed. Permanent paralysis is rare. Salivary fistulae are usually self-limited. Many methods to ameliorate the cosmetic changes after parotidectomy have been described. None has gained ascendency. This review contains 6 figures and 61 references. Key words: facial nerve, facial paralysis, Frey syndrome, gustatory sweating, nerve monitoring, parotid gland, parotid neoplasm, parotidectomy, salivary fistula