Primary parotid malignoma surgery in patients with normal preoperative facial nerve function: outcome and long-term postoperative facial nerve function.

Objectives/hypothesis: Most patients with primary parotid cancer present with normal facial nerve function. The common surgical strategy for these patients is to perform a parotidectomy with facial nerve preservation. Nevertheless, the functional outcome for the facial nerve and oncological outcome is unclear.

Study Design: Medical records of 211 patients treated from 1986 to 2000 in an university hospital were reviewed. One hundred seven patients with primary surgery for primary parotid cancer and long-term follow-up were analyzed retrospectively.

Methods: The characteristics, treatment, and oncological outcome were evaluated using hospital chart data. All patients with postoperative facial paresis were had follow-up with electromyography until recovery or permanent paresis became apparent.

Results: Ninety-one patients had a normal preoperative function. Facial nerve preservation during surgery by total parotidectomy was possible in 79 patients, whereas in 28 patients a radical parotidectomy was necessary. Otherwise, the oncological characteristics of both groups were not different. Directly after total parotidectomy, half of the patients presented a facial paresis but only two patients (2%) developed a permanent partial paresis. The 5-year disease-free rate and the 5- and 10-year survival rates were 65%, 83%, and 54%, respectively. After radical parotidectomy, the results were not significantly different. The 5-year disease-free rate and the overall 5- and the 10-year survival rates were 56%, 62%, and 42%, respectively.

Conclusion: Treatment of primary parotid cancer with preoperatively normal facial nerve function by standardized parotidectomy and precise microsurgical preservation of the facial nerve is often possible. This approach demonstrates favorable oncological results with a low level of long-term facial nerve morbidity.