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CC BY-NC-ND 4.0 · International Journal of Practical Otolaryngology 2025; 08(01): e33-e42
DOI: 10.1055/s-0045-1814082
Original Article

Factors Affecting Facial Nerve Exposure during Extracapsular Dissection of Benign Parotid Tumors

Autor*innen

  • Ryo Kawata

    1   Department of Otolaryngology–Head and Neck Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
    2   Department of Otolaryngology–Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

  • Ichita Kinoshita

    1   Department of Otolaryngology–Head and Neck Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
    2   Department of Otolaryngology–Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

  • Hiromi Nishimura

    1   Department of Otolaryngology–Head and Neck Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan
    2   Department of Otolaryngology–Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

  • Tsuyoshi Jinnin

    2   Department of Otolaryngology–Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

  • Masaaki Higashino

    2   Department of Otolaryngology–Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

  • Tetsuya Terada

    2   Department of Otolaryngology–Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan

  • Shin-Ichi Haginomori

    2   Department of Otolaryngology–Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Abstract

Extracapsular dissection (ECD) is typically indicated for small, benign parotid tumors. The surgical procedure for ECD does not involve the identification of the main trunk of the facial nerve. Although the nerve branches may become exposed during surgery, it is considered safer if they are not exposed. Therefore, we investigated the relationship between tumor location and size and intraoperative exposure of nerve branches in cases of ECD. The study included 61 cases that underwent ECD, with tumors meeting all of the following criteria preoperatively: tumor diameter ≤25 mm, superficial tumor, good mobility, and benign tumor. The tumor location was determined via magnetic resonance imaging, with the anterior–posterior axis classified into anterior, middle, and posterior regions, and the superior–inferior axis classified into superior, middle, and inferior regions. We compared 29 cases in which the nerve branches were identified (identified group) with 32 cases in which the nerve branches were not identified (nonidentified group). All three cases that developed transient facial nerve paralysis after surgery were included in the identified group. Excluding anterior tumors, nerve exposure was significantly more frequent in cases with a tumor diameter of ≥16 mm. The diameter of posterior tumors was significantly larger than that of anterior tumors; however, the nerve identification rate was significantly lower. Anterior tumors were significantly smaller in diameter than posterior tumors; however, no significant difference was observed in the nerve identification rate. These findings are likely influenced by tumor location and the course of the facial nerve. When the nerve is exposed or identified during ECD, there is an associated risk of postoperative transient facial nerve paralysis. Therefore, it is important to assess the likelihood of nerve identification based on tumor size and location before surgery.

Keywords

parotid tumor - extracapsular dissection - facial nerve - facial nerve exposure


Publikationsverlauf

Eingereicht: 15. April 2025

Angenommen: 06. August 2025

Artikel online veröffentlicht:
11. Dezember 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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