Management of Facial Nerve Paresis After Nerve-Preserving Parotidectomy: A Review

Background/Objectives: Postoperative facial nerve paresis remains clinically relevant after nerve-preserving parotidectomy. This scoping review aimed to identify, map, and characterize reported therapeutic strategies and summarize clinical recovery outcomes. Methods: Following Joanna Briggs Institute guidance and PRISMA-ScR, the protocol was deposited on Figshare before data extraction. PubMed, Embase, and Scopus were searched through 24 August 2026. English-language original studies of treatments initiated after the recognition of paresis were eligible. Two reviewers independently selected and appraised studies; one reviewer charted the data and another verified the extraction. Results: Eight studies involving 211 patients were included; reported ages were 17–86 years. Procedures included partial, superficial, subtotal, total, and revision parotidectomy, as well as parotid lobectomy for benign or malignant disease. Immediate or early weakness predominated; two reports described delayed-onset palsy. Evidence comprised two randomized trials, one case–control study, one multicenter cohort, and four case reports. Interventions included corticosteroids, corticosteroid–antiviral therapy, home or supervised exercises, Kabat rehabilitation, neuromuscular retraining, Matrix Rhythm Therapy (MRT), and proprioceptive neuromuscular facilitation with electrical stimulation. The trials found no benefit of prednisolone over placebo and no statistically significant difference between supervised rehabilitation and home exercises; equivalence was not established. Observational findings could not be separated from spontaneous recovery or co-treatment. Conclusions: No intervention has established superiority. Standardized protocols, validated outcomes, and adequately powered comparative studies are needed.