Postparotidectomy facial nerve paralysis: peripheral versus proximal identification.

Facial nerve palsy is a distressing complication of parotid surgery. We determined to analyse parotid surgery outcomes in a district general hospital in order to identify our own risk factors leading to increased incidence of facial nerve palsy. Primarily, we aimed to determine the efficacy of peripheral versus proximal facial nerve identification in preventing facial nerve damage.This was a retrospective study of hospital records. The records of sixty-four patients aged between 32 and 84 years who had attended our Otolaryngology department over a six-year period were analysed, with notes made of operative procedure, identification of the facial nerve and post-operative facial nerve palsy. The Neurosign400 facial nerve monitor was used and the degree of facial nerve paralysis was assessed using the House Brackmann (HB) classification of facial nerve paralysis.Sixty-four patients underwent parotidectomy. Thirty-two patients had the peripheral branch of the facial nerve identified while another thirty-two patients had proximal nerve identification. Six patients had HB 2 facial nerve palsy, but all completely recovered within six months. Four out of the six patients had peripheral identification of the facial nerve.Although peripheral versus proximal identification of the facial nerve was associated with greater incidence of temporary facial nerve paralysis, all the patients recovered within six months. This study may indicate that exposing a peripheral branch of the facial nerve with the help of Neurosign400 is a useful way of performing parotidectomy where proximal identification of a nerve is not possible.