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Facial Paralysis caused by
Parotid Tumors

Facial weakness before parotid surgery
When facial weakness develops in the setting of a parotid gland mass, it suggests that the mass is impeding the function of the nerve. Tumors which impede neural function tend to be malignant cancers, rather than benign growths. Benign tumors can slightly push upon, but do not invade nerves. One exception is a facial schwannoma, which is a benign tumor that grows directly from the nerve, and can affect facial movements even though it is not a cancerous lesion.

For complete malignant tumor removal with pre-operative facial nerve weakness, it is very common for a portion of the facial nerve to be intentionally cut (sacrificed) to remove all the malignant cells. When this is the case, the nerve is often reconstructed using a donor piece of nerve from elsewhere in the body (neck, arm, or leg).

Facial weakness after parotid surgery
When facial nerve function is abnormal following parotid surgery, it is important to distinguish the cause of the weakness. The most common scenario is that the nerve is stretched during tumor removal, and in those situations complete recovery is likely. The degree of nerve dysfunction dictates the time frame of recovery. Complete facial paralysis takes longer to recover from than mild facial weakness, though when the nerve is anatomically intact, full recovery is the expected outcome.

In cases where the facial nerve must be cut in order to remove the entire mass with adequate margins, patients experience either partial or complete facial paralysis. Sometimes it is possible to perform a nerve graft at the time of surgery, in order to promote regeneration from the native facial nerve stump. In situations where the tumor extends deeply along the nerve or extensively into the facial musculature, grafting is not feasible, and other methods of facial paralysis management are employed.

Click on image to enlarge

Parotid Gland and Facial Nerve Illustration by Robert J. Galla

Parotid Gland and Facial Nerve
Illustration by Robert J. Galla