Parotid Surgery Complications

  • Knowledge of anatomy allows us to infer probable complications of parotidectomies.
  • Facial nerve motor weakness is a complication inherent to the extent of the operation, the extent of the tumor and technique used (less common in extracapsular dissections and partial parotidectomies, more common in superficial, deep-lobe or total parotidectomies).
  • The rates of transient injury in the literature are highly variable and there are large biases.
  • The lack of sensation or pre auricular and auricular paraesthesia will depend on the preservation of the posterior branch of the greater auricular nerve (at 24 months: 31% vs. 71%, with and without preservation respectively).
  • Frey’s syndrome (also called “gustatory sweating” syndrome) and First Bite Syndrome are more common in parotidectomies that include the deep lobe of the gland.
  • Frey’s has been linked to disruption of the secretagogue [parasympathetic] innervation of the gland (mediated through the auriculotemporal nerve).
  • The First Bite Syndrome occurs more frequently after surgeries for tumors located in the retromandibular prolongation of the gland, or in the pre-styloid space (parapharyngeal), which sometimes force to ligate the external carotid artery causing disruption of the sympathetic innervation.

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