Comparison of antegrade versus retrograde facial nerve dissection in cases of superficial parotidectomy for pleomorphic adenoma of parotid gland

Mundada Ashishkumar B., Pradeep P. S.


Background: Pleomorphic adenoma being the most common benign tumor of the major salivary gland, parotid in particular, attracts attention. Facial nerve anatomically separates the superficial lobe from deeper lobe. Superficial Parotidectomy, commonly practiced surgical technique carries high risk of nerve injury causing long term functional and esthetic deficits. This prospective study was to designed to compare required time of  surgery and facial nerve injury in antegrade versus retrograde dissection.

Methods: Total of 32 patients who underwent superficial parotidectomy between June 2010 to June 2013 included in this study in which 18 patients were in retrograde dissection group and 14 subjects were in antegrade facial nerve dissection group. Time from the incision till closure is noted along with post operative facial nerve palsy for statistical analysis.

Results: This study shows that retrograde facial nerve dissection in superficial parotidectomy requires statistically significant lesser time duration with no difference in facial nerve injury when compared to antegrade nerve dissection.

Conclusions: This study approves retrograde facial nerve dissection over antegrade nerve dissection in cases of superficial parotidectomy for betterment of the patient.


Antegrade facial nerve dissection, Facial nerve injury, Pleomorphic adenoma, Retrograde facial nerve dissection, Superficial parotidectomy

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Lopes MA, Kowalski LP, Da Cunha Santos G, Paes De Almaeida O. A clinicopathologic study of 196 intra oral minor salivary gland tumors. J Oral Pathol Med. 1999:28:264-7.

Loyola AM, De Araujo Vc, De Souza SOM, De Araujo NS. Minor salivary gland tumors: a retrospective study of 164 cases in Brazilian population. Eur J Cancer B Oral Oncol. 1995:31:197-201.

Rajendran S, Sivapathasundram S. Shafers Textbook of oral Pathology. 6th Ed. New Delhi, Elsevier;2009:219-24.

Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 3rd ed. St. Louis, Saunders Elsevier;2009:477-9.

Frazell EL. Clinical aspects of tumors of the major salivary glands. Cancer. 1954;7(4):637-59.

Mra Z, Komisar A, Blaugrund SM. Functional facial nerve weakness after surgery for benign parotid tumors: A multivariate statistical analysis. Head Neck. 1993;15:147-52.

Boahene D, Olsen K, Lewis J, Pinheiro AD, Pankratz VS, Bagniewski SM. Mucoepidermoid carcinoma of the parotid gland. Arch Otolaryngol Head Neck Surg. 2004;130:849-56.

Yu G. Superficial parotidectomy through retrograde facial nerve dissection. J R Coll Surg Edinb. 2001;46:104-7.

Vieira M, Maia A, Ribeiro J. Randomized prospective study of the validity of the great auricular nerve preservation in parotidectomy. Arch Otolaryngol Head Neck Surg. 2002;128:1191-5.

Ussmueller J, Jaehne M, Neumann B. The use of diathermy scissors in parotid gland surgery. Arch otolaryngol Head Neck Surg. 2004;130:187-9.

Bailey H. Treatment of tumors of parotid gland with special reference to total parotidectomy. BMJ. 1941;228:336-49.

Woods JE, Weiland LH, Chong GC, Irons GB. Pathology and surgery of primary tumors of parotid. Surg Clin North Am. 1997;57:565-73.

Chan S, Gunn A. conservation parotidectomy by the peripheral approach. Br J Surg. 1981;68:405-7.

Bhattacharyya N, Richardson ME, Gugino LD. An objective assessment of the advantages of retrograde parotidectomy. Otolaryngol Head Neck Surg. 2004;131(4):392-6.