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B. Swendseid et al. / Oral Oncology 73 (2017) 43–47

patient with confirmed malignancy and a normal nerve function, but who is experiencing facial pain, should be cautioned that their risk of nerve sacrifice may be as high as 60%, much higher than the 25% of those without pain or nerve dysfunction. Even a patient with abnormal facial nerve function in whom nerve sacrifice is all but guaranteed can be counseled that half of the time, only iso lated branches will need to be removed, and they may retain some facial nerve function. In addition to preoperative counseling for the patient, the abil ity to predict the likelihood of facial nerve sacrifice helps the sur geon in regard to operative planning. Nerve grafting with local or distant donor sites may require additional resources, i.e. a recon structive surgeon and preoperative imaging. Considerations regarding procedures such as gold weight implants, lateral canthus suspension, static slings and/or microvascular work may come into play. This manuscript provides additional data that augments the current literature regarding the need for facial nerve sacrifice in patients with parotid malignancies, and this will hopefully help surgeon’s preoperative planning and patient counseling. Our study illustrates that facial nerve sacrifice in the setting of malignancy may be necessary but can often be avoided in patients without pain or preoperative dysfunction. It also indicates that preopera tive pain (along with deep lobe involvement and preoperative dys function) significantly increases the likelihood of sacrifice. Being able to counsel patients on the likelihood of nerve sacrifice, the potential need for facial nerve grafting or complex reconstructive techniques and the likelihood of some degree of facial nerve dys function will help to give patients a clearer picture of what may be necessary for the treatment of their salivary gland malignancy (primary or secondary). It is our hope that with this predictive model, physicians will be able to provide better perioperative counseling for patients undergoing parotidectomy for malignancy. Conclusion

References

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Conflict of interest

The authors declared that there is no conflict of interest.