Since in our experience facial paralysis has been a common sequela following the removal of malignant tumors of the parotid, we present herewith a description of our technic in removing the malignant parotid gland with the preservation of the facial nerve. We do not advise this radical procedure for simple encapsulated mixed tumors of the parotid; but we are in accord with Sistrunk in urging early diagnosis and early operation in such cases. However, we believe that there is need for a surgical procedure which will permit the complete removal of the parotid gland when these tumors have broken through their capsules into the parotid tissue. It must also be borne in mind that this radical operation should be performed if there is any doubt concerning metastasis from the encapsulated tumor into the parotid gland.
Preservation of facial nerve functions during vestibular schwannoma surgery: outcome analysis
Facial Nerve Preservation | Dr. Larian
Babak Larian, Dr. Babak Azizzadeh and Dr. William Slattery at the CENTER have earned international acclaim for their successful outcomes in facial nerve preservation during parotid surgery. The facial nerve - which controls the full scope of facial expression and movement - passes directly through the parotid gland.
The classical surgical technique for the resection of vestibular schwannomas VS has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. The extracisternal approach is described in detail.
Tumor size was estimated from computerized tomography CT scans, and its influence on anatomical and functional preservation of the facial nerve was assessed. Six tumors one invading the petrous bone, three medium and two large tumors were not detected on CT scans. The translabyrinthine approach was used in seven instances one small and six medium tumors and the suboccipital transmeatal approach for 28 tumors seven medium and 21 large tumors. A further two patients underwent subtotal removal, but the facial nerve was destroyed. Damage to the facial nerve occurred more frequently in patients with preoperative evidence of facial weakness; however, this factor did not appear to influence functional recovery of the facial nerve, provided that the nerve was intact at the end of the operation.