Modern approaches to surgical treatment of tumors of the parotid salivary gland with preservation of the branches of the facial nerve

Abstract

Relevance. Tumors of the parotid salivary gland (PSG) occupy a significant place in the structure of neoplasms of the head and neck, and pleomorphic adenoma is the most common benign form. Surgical removal with preservation of the branches of the facial nerve requires high technical training and is aimed at preventing relapses and reducing the risk of functional disorders. Objective of the study. To evaluate the effectiveness of surgical treatment of PSG tumors with preservation of the branches of the facial nerve, to analyze the clinical features and results of operations. Materials and methods. An analysis of 61 medical histories of patients with tumors and chronic inflammatory diseases of the PSG, who were treated in different periods (2012-2022), was carried out. Diagnostics included cytological examination, ultrasound, MRI, and, if necessary, express biopsy. Partial, subtotal and complete parotidectomy with dissection and preservation of the main branches of the facial nerve were used. During extirpation of the TSJ, the nerve was necessarily covered with a flap on a pedicle from the masseter muscle. Results and discussion. The highest recurrence rate was observed in patients previously operated in non-specialized institutions. The use of complete extirpation of the TSJ with preservation of the branches of the facial nerve made it possible to reduce the recurrence of pleomorphic adenoma to 6.7%. Mild paresis of the facial muscles was detected in 75% of patients and regressed on its own, severe paresis - in 25% (with relapses and deep location of the tumor). The use of modified surgical approaches ensured good visual control and minimization of aesthetic defects. Conclusion. Surgical removal of TSJ tumors with preservation of the branches of the facial nerve and their obligatory cover with muscle flaps is an effective method that allows to reduce the recurrence rate and provide satisfactory functional and aesthetic results.

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