European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 11, pp 2615–2626 | Cite as

Management of the facial nerve in parotid cancer: preservation or resection and reconstruction

  • Orlando Guntinas-LichiusEmail author
  • Carl E. Silver
  • Jovanna Thielker
  • Manuel Bernal-Sprekelsen
  • Carol R. Bradford
  • Remco De Bree
  • Luis P. Kowalski
  • Kerry D. Olsen
  • Miquel Quer
  • Alessandra Rinaldo
  • Juan R. Rodrigo
  • Alvaro Sanabria
  • Ashok R. Shaha
  • Robert P. Takes
  • Vincent Vander Poorten
  • Peter Zbären
  • Alfio Ferlito
Review Article



Management of the facial nerve is instrumental in the surgical treatment of parotid cancer.


A literature search was conducted using PubMed and ScienceDirect database. A total of 195 articles were finally included into the analysis, based on relevance, scientific evidence and actuality.


In the majority of cases the facial nerve is not involved by tumor. In these cases, identification and preservation of the nerve, in addition to complete tumor removal, are essential for successful surgery. When the nerve is infiltrated by tumor, the affected portion of the nerve must be resected as part of radical parotidectomy. Primary nerve reconstruction or other reanimation techniques give the best long-term functional and cosmetic results. A comprehensive diagnostic evaluation with current imaging and electrophysiological studies will provide the surgeon with the best knowledge of the relationship of the facial nerve to the tumor. Several standardized methods are helpful in finding, dissecting and preserving the nerve during parotid cancer surgery. When radical parotidectomy is indicated, the initial diagnostic work-up can assist in defining the need for adjuvant postoperative therapy and facial reanimation. The aim of rehabilitation is to restore tone, symmetry, and movement to the paralyzed face.


The surgical management of facial paralysis has undergone many improvements in recent years. This review gives an overview of recent advances in the diagnostic work-up, surgical techniques and any necessary rehabilitation of the facial nerve in parotid cancer surgery.


Facial nerve Parotidectomy Parotid tumor Parotid cancer Facial nerve preservation Facial nerve sacrifice Facial nerve reconstruction 


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

405_2018_5154_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 30 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Orlando Guntinas-Lichius
    • 1
    • 2
    • 3
    Email author
  • Carl E. Silver
    • 4
  • Jovanna Thielker
    • 1
    • 2
  • Manuel Bernal-Sprekelsen
    • 5
  • Carol R. Bradford
    • 6
  • Remco De Bree
    • 7
  • Luis P. Kowalski
    • 8
  • Kerry D. Olsen
    • 9
  • Miquel Quer
    • 3
    • 10
  • Alessandra Rinaldo
    • 11
  • Juan R. Rodrigo
    • 12
  • Alvaro Sanabria
    • 13
  • Ashok R. Shaha
    • 14
  • Robert P. Takes
    • 15
  • Vincent Vander Poorten
    • 3
    • 16
  • Peter Zbären
    • 17
  • Alfio Ferlito
    • 18
  1. 1.Department of Otorhinolaryngology, Institute of Phoniatry/PedaudiologyJena University HospitalJenaGermany
  2. 2.Facial Nerve CenterJena University HospitalJenaGermany
  3. 3.European Salivary Gland SocietyGenevaSwitzerland
  4. 4.Department of SurgeryUniversity of Arizona College of MedicinePhoenixUSA
  5. 5.Hospital Clinic, Servicio de ORLUniversity of BarcelonaBarcelonaSpain
  6. 6.Department of OtolaryngologyUniversity of MichiganAnn ArborUSA
  7. 7.Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
  8. 8.Department of Head and Neck Surgery and OtorhinolaryngologyA.C. Camargo Cancer CenterSão PauloBrazil
  9. 9.Department of OtorhinolaryngologyMayo ClinicRochesterUSA
  10. 10.Department of OtolaryngologyHospital Santa Creu i Sant PauBarcelonaSpain
  11. 11.University of Udine School of MedicineUdineItaly
  12. 12.Department of OtolaryngologyHospital Universitario Central de Asturias and Instituto Universitario de Oncología del Principado de Asturias, CIBERONCOviedoSpain
  13. 13.Department of Surgery, School of Medicine, Clinica VidaUniversidad de AntioquiaMedellínColombia
  14. 14.Head and Neck ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  15. 15.Department of Otolaryngology-Head and Neck SurgeryRadboud University Medical CenterNijmegenThe Netherlands
  16. 16.Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, section Head and Neck OncologyUniversity Hospitals LeuvenLeuvenBelgium
  17. 17.Department of Otorhinolaryngology-Head and Neck SurgeryUniversity HospitalBerneSwitzerland
  18. 18.Coordinator of the International Head and Neck Scientific GroupPaduaItaly

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