Saving the Facial Nerve

The facial nerve, which is extremely delicate, passes through the parotid gland. As a result, there is often a chance of damage to the facial nerve with any parotid tumor surgery. That is why it is important that patients are aware of the risks involved with the procedure, particularly risks involving the facial nerve.

Where the parotid cancer or benign tumor is located relative to the facial nerve determines how extensive the parotid tumor surgery will be, but there is actually a risk of damaging the facial nerve regardless of where the mass is located. Damaging this nerve is the absolute biggest risk and concern for individuals who need parotid gland surgery, as one accidental mistake by a surgeon can have serious repercussions.

Damage to the facial nerve can leave a patient without the ability to smile, or eat and talk normally for the rest of their life. That is exactly why it is important to turn to experienced and renowned physicians, like Dr. Larian and Dr. Azizzadeh. During every parotid surgery performed at the CENTER, Dr. Larian uses a team of specialists to assist in the procedure, making sure the patient always receives the best care possible to result in optimal outcomes.

As the director of the Facial Paralysis Institute, Dr. Babak Azizzadeh is a leading expert on facial nerve diseases and repair, and his understanding of the facial nerve and how it functions is unparalleled. That’s why his presence during surgery improves the safety and outcome of the procedure.

Understanding the Anatomy of the Facial Nerve

To save the facial nerve we have to make sure it is unharmed during the removal of the tumor. To do this, we first have to understand the anatomy of the facial nerve and the parotid gland.

The facial nerve, or the 7th cranial nerve, supplies the muscles of facial expression. Theses muscles (as seen in the diagram on the right) control the movement of the entire face from closing the eye and moving the brow, to smiling and controlling the lips, and even moving and wiggling the nose and ears. The muscles around the nose help keep the nostrils open. The muscles in the cheek help control the food inside the mouth and prevent it from accumulating in the cheeks.

The facial nerve, which is one of twelve cranial nerves, first leaves the brain, and enters the temporal bone. It then travels through the longest bony canal in the skull and passes through the ear, and comes down through bone. It then exits through the stylomastoid foramen which is an opening at the bottom of the skull just underneath the ear.

After exiting the stylomastoid foramen, the facial nerve enters the parotid gland; the anatomy of the nerve as it goes through the parotid gland is very variable. The facial nerve divides the parotid gland into a small, deep lobe, and a large, superficial lobe. The nerve at first, usually, divides into 2 branches: the superior & inferior divisions. Then goes to make further subdivisions, usually into 5 branches, which then go on to make further branches to reach the more then 20 muscles on each side of the face. It is this complex branching and entanglement of the facial nerve with the parotid gland that makes the surgery so complex.

Saving the Facial Nerve during Parotid Tumor Surgery

Before the surgery starts, the surgical team at the CENTER will make sure that the incision is marked out carefully to hide the scar, and also the facial nerve monitoring system is working appropriately. Once this is done, the incision is created along natural skin creases. The next step is to locate the main trunk of the facial nerve as it exits out of the skull. After having identified the main trunk, Dr. Larian uses a Nerve Integrity Monitor to monitor and protect the facial nerve and all it’s branches during surgery. This, in turn, allows Dr. Larian and his team to safely remove the parotid tumor without damaging the facial nerve.

Confirming Nerve Integrity

Once the operation is completed and the parotid tumor or cancer has been removed, we have to confirm the facial nerve is functioning properly. To do this, we stimulate the facial nerve branches and the main trunk to make sure the muscles are moving appropriately. Once the parotid tumor is removed and nerve integrity has been confirmed, we prepare for reconstructing the area to make sure the two sides of the face look even. Learn more about parotid reconstruction.

Repairing a Compromised Facial Nerve

Our team of experts is committed to saving the facial nerve during parotid gland surgery and takes an ultra careful and mindful approach. Even in advanced cancer cases, every effort is made to preserve the facial nerve and all it’s branches, while keeping in mind the main objective which is to get rid of the cancer. It takes considerable experience to make decisions during surgery regarding the facial nerve, especially because each type of cancer behaves differently and attaches or eats through the nerve differently.

At the CENTER, we discuss the risks of surgery with our patients in detail, especially as it relates to the facial nerve in patient’s who have parotid cancer . If there is a risk of injury which is greater then normal, we discuss it in great detail and take every step to avoid injury, but also remain prepared if the cancer does not allow us to save the nerve to reconstruct the nerve immediately. Dr. Azizzadeh can often repair the damage right then and there with a nerve graft or other techniques, if needed. That is exactly why having parotid surgery done by a parotid expert (Dr. Larian) and a facial paralysis expert (Dr. Azizzadeh) offers patients the very best chance of a successful surgery and outcome.

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Next, learn more about minimally invasive parotidectomy.