Vol. 3, Issue 4, Part I (2019)

Introduction and Background: The most common surgical procedure for parotid gland tumors and associated diseases is parotidectomy. Facial nerve paralysis, paresis, and synkinesis are serious postoperative problems that can occur due to the facial nerve's close proximity to the parotid gland, making this treatment extremely complicated. The purpose of this research is to determine whether a thorough familiarity with the anatomy of the face's nerves helps reduce the risk of intraoperative nerve injury and postoperative problems after parotidectomy.

Materials and Methods: In a tertiary care hospital, 150 patients who had parotidectomy were the subjects of a retrospective and prospective study. This study was conducted at the Department of Anatomy, I- Care Institute of Medical Sciences and Research, Haldia, West Bengal, India from March 2018 to February 2019. Two groups were formed from the patients: Patients in Group A (n = 75) had surgeries performed using standard anatomical knowledge, whereas patients in Group B (n = 75) had surgeries performed using high-resolution magnetic resonance imaging (MRI) and nerve mapping before surgery, as well as intraoperative nerve monitoring (IONM). The House-Brackman (HB) face grading scale was used to assess nerve state before surgery, and results were examined 1, 3, and 6 months after the procedure. Operating time, tumor resection extent, intraoperative nerve identification success rate, and postoperative facial nerve dysfunction were among the critical surgical characteristics that were documented and evaluated.

Results: The rates of facial nerve identification and preservation were greatly enhanced by the combination of intraoperative nerve monitoring and preoperative imaging. The mean time for nerve identification in Group A was 21.3 ± 4.2 minutes, while in Group B it was 13.8 ± 2.9 minutes (p = 0.001). Group B had a considerably lower incidence of transitory facial nerve paresis (9.3% vs. 26.7%, p = 0.005) and a significantly lower incidence of persistent facial nerve paralysis (1.3% vs. 6.0%, p = 0.07). Compared to Group A, Group B had a substantially higher mean HB face grading score at 6 months (1.1 ± 0.4) with a p-value of 0.002.

Conclusion: A thorough familiarity with the anatomy of the facial nerves, along with state-of-the-art preoperative imaging and intraoperative nerve monitoring, considerably lessens the likelihood of nerve damage, surgical duration, and postoperative problems after parotidectomy. To improve the safety and effectiveness of parotid procedures, it is recommended to incorporate nerve monitoring and advanced imaging tools into standard treatment.