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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.
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