The influence of facial-nerve sacrifice in surgery of malignant parotid tumors.

Malignant parotid tumors in 224 patients were dealth with surgically at the Mayo Clinic between 1940 and 1969. The clinical histories, including follow-up of 5 years or more in every case, were reviewed with particular attention to sacrifice of the facial nerve in conjunction with the excision of tumor. This was done in 65 cases. High-grade malignancy necessitated nerve sacrifice; other frequent indications were preoperative facial-nerve paralysis, pain, and rapid growth of the tumor. Over the 30-year review period, the trend was toward more radical surgery, often including nerve sacrifice, and away from local excision and radiotherapy. Nerve grafting or anastomosis of a sacrificed nerve was seldom performed in an attempt to lessen the cosmetic defect of facial paralysis. Later reconstructive procedures are favored.