Management of Malignant Parotid Tumors With Complete Facial Paralysis

OBJECTIVES: Facial paralysis in the setting of a parotid gland malignancy requires a complex, multidisciplinary approach in surgical oncologic management. This article reviews current treatment considerations to assist clinicians in decision-making when managing cases with facial nerve involvement. DATA SOURCES: The PubMed database in the last 10 years. REVIEW METHODS: This review examines the spectrum of facial nerve reanimation treatments in parotid gland malignancy by analyzing literature using search terms including "parotid gland malignancy", "radical parotidectomy", "complete facial nerve palsy", "facial nerve reanimation", and "facial nerve reconstruction". RESULTS: Recent literature on facial reanimation in parotid gland malignancies highlights a tailored approach using both static and dynamic techniques after nerve sacrifice in radical parotidectomy. Key intraoperative strategies include temporal bone dissection, partial or complete nerve resection, nerve grafting with sural or great auricular nerves, cross-face nerve grafts, temporalis myoplasty, and cranial nerve substitution techniques such as masseteric (5-7) and hypoglossal (12-7), alongside static procedures like oral commissure slings, eyelid weights, canthoplasty, and brow lifts. Emerging methods, including vascularized nerve grafts and stem cell-based therapies, show potential for enhancing nerve regeneration and recovery. CONCLUSIONS: When planning for a total parotidectomy with nerve resection, a thorough understanding of the multitude of facial reanimation techniques, both intraoperatively and longitudinally, is essential to optimize patients' quality of life.