[Results of a national survey on the treatment of the facial nerve in malignant tumors of the parotid gland].

The rare diagnosis of parotid malignant tumors, the different clinico-biological behavior of each histological type and the lack of agreement concerning surgical procedures to be followed in treating the facial nerve led the Authors to carry out a national survey on malignant parotid tumors and their treatment. A questionnaire concerning problems inherent to facial nerve treatment in malignant tumors of the parotid gland was sent to 69 ENT Departments. Data on 139 patients (69 females and 70 males, mean age--59.9 years) were collected for this study. Facial nerve function deficits occurred in 25.9% of the patients, primarily in cases of adenoid cystic carcinoma, adenocarcinoma and undifferentiated carcinoma. Clinical findings were not a good guide in choosing the best surgical procedure to be used with the VII nerve. In fact, in 17% of the cases with no facial deficit, a neural infiltration was found intraoperatively. Total parotidectomy with facial nerve sacrifice (PTST or PTSP) was performed in 87.6% of the patients with complete facial deficit and in 80% of the patients with partial deficit. A more conservative approach was followed when the facial nerve was compressed but not infiltrated. Only 71.7% of the patients with facial nerve infiltration underwent post-operative radiotherapy, a fact which is probably explained by the few departments of radiotherapy in existence. While the functional results reported in Literature are good, facial nerve repairs were carried out in this study in only 9% of the cases. The present study, which supplies interesting data on the treatment of the facial nerve in parotid gland malignant tumors, confirms the need of a multidisciplinary approach and a more frequent use of neural repair techniques in order to preserve the aesthetic and functional aspects of the facial nerve.