Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

Dheer S. Kalwaniya, Goutam Kothathi Chowdegowda, Monish Raj, Jaspreet S. Bajwa, Satya V. Arya, Ranjith Mahadevan, Rohit Choudhary, Ashok Kumar, Nipun Singla


Background: The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.

Methods: This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system.  

Results: Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size <4 cm), 2 suffered facial paresis and out of 11 patients (size >4 cm), 5 suffered same. Out of 59 patients with depth of tumor <2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth >2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).

Conclusions: Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.


Pleiomorphic adenoma, Superficial parotidectomy, Facial nerve injury

Full Text:



Foresta E, Torroni A, Di Nardo F, de Waure C, Poscia A, GaspariniG, et al. Pleomorphic Adenoma and benign parotid tumors:extracapsular dissection vs superficial parotidectomy - review of literature and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117:663-76.

Loyola AM, Araújo VC, de Sousa SOM, de Araújo NS. Minor salivary gland tumors. A retrospective study of 164 cases in a Brazilian population. Oral Oncol Eur J Cancer. 1995;31:197-201.

Nanda KDP, Mehta A, Nanda J. Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions. J Oral Pathol Med. 2012;41:106-12.

Long-Jiang L, Yi L, Yu-Ming W, Hong-Wei Z. Clinical analysis of salivary gland tumor cases in West China in past 50 years. Oral Oncol. 2008;44:187-92.

Lima SS, Soares AF, de Amorim RF, Freitas R, de A. Epidemiologic profile of salivary gland neoplasms: analysis of 245 cases. Braz J Otorhinolaryngol. 2005;71:335-40.

Zbären P, Vander Poorten V, Witt RL, Woolgar JA, Shaha AR, Tri-antafyllou A, et al. Pleomorphic adenoma of the parotid: formal parotidectomy or limited surgery? Am J Surg. 2013;205:109-18.

Lin CC, Tsai MH, Huang CC, Hua CH, Tseng HC, Huang ST. Parotidtumors: a 10 year experience. Am J Otolaryngol. 2008;29:94-100.

Sungur N, Akan IM, Ulusoy MG, Ozdemir R, Kilinc H, Ortak T.Clinicopathological evaluation of parotid gland tumors: a retro-spective study. J Craniofacial Surg. 2002;13:26-30.

Shashinder S, Tang IP, Velayutham P, Prepageran N, Gopala KG, Kuljit S, et al. A review of parotid tumors and their management: a ten-year-experience. Med J Malasia. 2009;64:31-3.

Upton DC, McNamar JP, Connor NP, Harari PM, Hartig GK. Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol Head Neck Surg. 2007;136:788–92.

Guntinas–Lichius O, Klussmann JP, Wittekindt C, Stennert E. Parotidectomy for benign disease at a university teaching hospital: outcome of 963 operations. Laryngoscope. 2006;116:534–40.

Witt RL. The significance of the margin in parotid surgery for pleomorphic adenoma. Laryngoscope. 2002;112:2141-54.

Klintworth N, Zenk J, Koch M, Iro H. Postoperative complications after extracapsular dissection of benign parotid lesions with particular reference to facial nerve function. Laryngoscope. 2010;120:484-90.

Roh JL, Kim HS, Park CI. Randomized clinical trial comparing partial parotidectomy versus superficial or total parotidectomy. Br J Surg. 2007;94:1081-7.

Malard O, Wagner R, Joubert M, Delemazure AS, Rio E, Durand N, et al. Prognostic factors for secondary recurrence of pleo-morphic adenoma: a 20-year, retrospective study. J Laryngol Otol. 2013;127:902-7.

Zhang SS, Ma DQ, Guo CB, Huang MX, Peng X, Yu GY. Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy. Int J Oral Maxillofac Surg. 2013;42:868-73.

Araya J, Martinez R, Niklander S, Marshall M, Esguep A. Incidence and prevalence of salivary gland tumors in Valparaiso, Chile. Med Oral Patol Oral Cir Bucal. 2015;20:532-9.

Mendenhall WM, Mendenhall CM, Werning JW, Malyapa S, Mendenhall NP. Salivary gland pleomorphic adenoma. Am J Clin Oncol. 2008;31:95-9.

Marshall AH, Quraishi SM, Bradley PJ. Patients’ perspectives on the short- and long-term outcomes following surgery for benign parotid neoplasms. J Laryngol Otol. 2003;117:624–9.

McGurk M, Thomas BL, Renehan AG. Extracapsular dissection for clinically benign parotid lumps: reduced morbidity without oncological compromise. Br J Cancer. 2003;89:1610–3.

Al Salamah SM, Khalid K, Khan IA, Gul R. Outcome of surgery for parotid tumors: 5-year experience of a general surgical unit in a teaching hospital. ANZ J Surg. 2005;75:948–52.

Guntinas–Lichius O, Gabriel B, Klussmann JP. Risk of facial palsy and severe Frey’s syndrome after conservative parotidectomy for benign disease: analysis of 610 operations. Acta Otolaryngol. 2006;126:1104–9.

O’Brien CJ. Current management of benign parotid tumors—the role of limited superficial parotidectomy. Head Neck. 2003;25:946–52.

Dulguerov P, Marchal F, Lehmann W. Post parotidectomy facial nerve paralysis: possible etiologic factors and results with routine facial nerve monitoring. Laryngoscope. 1999;109:754–62.

Deneuve S, Quesnel S, Depondt J, Albert S, Panajotopoulos A, Gehanno P, et al. Management of parotid gland surgery in a university teaching hospital. Eur Arch Otorhinolaryngol. 2010;267:601–5.

Ochoa J, Fowler TJ, Gilliatt RW. Anatomical changes in peripheral nerves compressed by a pneumatic tourniquet. J Anat. 1972;113(3):433–55.

Laccourreye H, Laccourreye O, Cauchois R, Jouffre V, Ménard M, Brasnu D. Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients. Laryngoscope. 1994;104:1487-94.

Witt RL. Facial nerve function after partial superficial parotidectomy: an 11-year review (1987-1997). Otolaryngol Head Neck Surg. 1999;121:210-3.

Koch M, Zenk J, Iro H. Long-term results of morbidity after parotid gland surgery in benign disease. Laryngoscope. 2010;120:724-30.

Guntinas-Lichius O, Klussmann JP, Wittekindt C, Stennert E. Parotidectomy for benign parotid disease at a universityteaching hospital: outcome of 963 operations. Laryngoscope. 2006;116:534-40.

Gaillard C, Périé S, Susini B, St Guily JL. Facial nerve dysfunction after parotidectomy: the role of local factors. Laryngoscope. 2005;115:287-91.

Dulguerov P, Marchal F, Lehmann W. Post-parotidectomy facial nerve paralysis: possible etiologic factors and results with routine facial nerve monitoring. Laryngoscope. 1999;109:754-62.

O’Brien CJ, Malka VB, Mijailovic M. Evaluation of 242 con-secutive parotidectomies performed for benign and malignant disease. Aust N Z J Surg. 1993;63:870-7.

Johnson JT, Ferlito A, Fagan JJ, Bradley PJ, Rinaldo A. Roleof limited parotidectomy in management of pleomorphic ade-noma. J Laryngol Otol. 2007;121:1126-8.

Ellingson TW, Cohen JI, Andersen P. The impact of malignantdisease on facial nerve function after parotidectomy. Laryngoscope. 2003;113:1299-303.