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MR-Neurography of the facial nerve in parotid tumors: intra-parotid nerve visualization and surgical correlation

  • Head-Neck-ENT Radiology
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Abstract

Purpose

One of the most severe complications in surgery of parotid tumors is facial palsy. Imaging of the intra-parotid facial nerve is challenging due to small dimensions. Our aim was to assess, in patients with parotid tumors, the ability of high-resolution 3D double-echo steady-state sequence with water excitation (DE3D-WE) (1) to visualize the extracranial facial nerve and its tracts, (2) to evaluate their relationship to the parotid lesion and (3) to compare MRI and surgical findings.

Methods

A retrospective study was conducted including all patients with parotid tumors, who underwent MRI from April 2022 to December 2023. Two radiologists independently reviewed DE3D-WE images, assessing quality of visualization of the facial nerve bilaterally and localizing the nerve’s divisions in relation to the tumor. MRI data were compared with surgical findings.

Results

Forty consecutive patients were included (M:F = 22:18; mean age 56.3 ± 17.4 years). DE3D-WE could excellently visualize the nerve main trunk and the temporofacial division in all cases. The cervicofacial branch was visible in 99% of cases and visibility was good. Distal divisions were displayed in 34% of cases with a higher visibility on the tumor side (p < 0.05). Interrater agreement was high (weighted kappa 0.94 ± 0.01 [95% CI 0.92–0.97]).

Compared to surgery accuracy of MRI in localizing the nerve was 100% for the main trunk, 96% for the temporofacial and 89% for the cervicofacial branches.

Conclusions

Facial nerve MR-neurography represents a reliable tool. DE3D-WE can play an important role in surgical planning of patients with parotid tumors, reducing the risk of nerve injury.

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Chiara Gaudino and Andrea Cassoni contributed equally to the study and share first authorship.

Authors and Affiliations

  1. Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161, -Rome, Italy

    Chiara Gaudino & Patrizia Pantano

  2. Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Via Caserta 6, 00161, Rome, Italy

    Andrea Cassoni, Angela Palma & Valentino Valentini

  3. Department of Maxillo-Facial Surgery, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy

    Andrea Cassoni & Valentino Valentini

  4. Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00180, Rome, Italy

    Martina Lucia Pisciotti & Nicoletta Fantoni

  5. Department of Maxillo-Facial Surgery, Azienda Ospedaliera San Camillo Forlanini, Circonvallazione Gianicolense 87, 00152, Rome, Italy

    Resi Pucci

  6. Department of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università 30, 00185, -Rome, Italy

    Patrizia Pantano

  7. IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy

    Patrizia Pantano

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  1. Chiara Gaudino
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Correspondence to Chiara Gaudino.

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Gaudino, C., Cassoni, A., Pisciotti, M.L. et al. MR-Neurography of the facial nerve in parotid tumors: intra-parotid nerve visualization and surgical correlation. Neuroradiology (2024). https://doi.org/10.1007/s00234-024-03372-5

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