Indication and operative technique for reservation of facial nerve of parotid gland cancer

• Published in: jibi to rinsho Vol. 49; no. 4Supplement3; pp. S213 - S217
• Main Authors: HAYASAKI, Katsutake, TAKEUCHI, Yohsuke, SASAKI, Keita, SHIMAMOTO, Hiroaki
• Format: Journal Article
• Language: Japanese
• Published: JIBI TO RINSHO KAI 20.11.2003
• ISSN: 0447-7227; 2185-1034
• DOI: 10.11334/jibi1954.49.4Supplement3_S213

We here report about the indication for preservation of facial nerve in the surgery of parotid gland cancer from the points of histopathology and clinical diagnostics including inspection and palpation. The preoperative diagnosis of histopathology is usually performed by FNA, which determines that the facial nerve is preserved in the case of low grade malignancy, whereas it is resected and replaced by nerve transplantation in that of high grade malignancy. However, the preservation of facial nerve in the case of intermediate grade of malignancy can be decided by the observations during surgery. In terms of clinical symptom, presence or absence of facial nerve palsy as well as size and movability of the tumor may give an important information. Furthermore, sialography, CT, MRI, and ultrasonography may also be useful. However, they are just instructive. In this paper, we describe about the surgical techniques how to reserve facial nerve during the operation of parotid gland cancer mainly by Kitamura's procedure. These include how to expose facial nerve, how to dissect it, and how to keep it intact. It is our surgical policy that nerve resection and its transplantation should be performed if the facial nerve is adhered with the tumor even a little bit.