Relationship of Postoperative Temporary Facial Nerve Dysfunction With Tumor Location in Parotid Surgery

Introduction Postoperative temporary facial nerve dysfunction (TFND) is a common complication after parotidectomy, and the tumor location is believed to influence its risk. This study aimed to evaluate the relationship between tumor location and postoperative TFND, as well as to assess the effects of lobe involvement and surgical approach. Methods This prospective observational study was conducted at Bangladesh Medical University, Dhaka, between June 2022 and December 2023, and 35 patients with parotid neoplasms who underwent surgery were enrolled in this study. Preoperative magnetic resonance imaging was used to determine the tumor location (anterior/posterior, superior/inferior, superficial/deep), and lobe involvement was confirmed intraoperatively. Facial nerve function was assessed via the House-Brackmann grading system on postoperative day 2 and at one and three months. Univariate and multivariate logistic regression were performed to analyze the TFND risk factors. Results The participants had a mean age of 48.80 ± 11.92 years, with a female predominance. Pleomorphic adenoma was the most common tumor type (60%). TFND occurred in 54.3% of patients on postoperative day 2, 51.4% at one month, and 45.7% at three months, most commonly involving the marginal mandibular branch. On multivariate analysis, anterior tumor location (OR: 25.05; 95% CI: 1.29-484.05; p = 0.033), bilobar involvement (OR: 21.84; 95% CI: 1.13-421.84; p = 0.041), and total conservative parotidectomy (OR: 20.89; 95% CI: 1.05-413.72; p = 0.046) were significantly associated with increased risk of TFND on postoperative day 2. At one month, anterior tumor location remained a significant predictor (OR: 31.75; 95% CI: 2.02-497.19; p = 0.014). At three months, anterior tumor location (OR: 13.59; 95% CI: 1.72-107.22; p = 0.013) and bilobar involvement (OR: 10.14; 95% CI: 1.39-73.92; p = 0.022) remained independently associated with persistent TFND. No significant association was observed between TFND and age, sex, tumor size, or histopathology. Conclusion Anterior tumor location, bilobar involvement, and extensive surgery significantly increase TFND risk and persistence. These findings suggest that careful preoperative imaging-based localization and meticulous surgical planning may help reduce the risk of TFND in parotid surgery.