Review Question - QID 214938

The most likely complication in this scenario is Facial nerve palsy. The facial nerve traverses the parotid gland, and its branches are at risk of injury during parotid gland surgery, such as parotidectomy, which could lead to facial nerve palsy.

Parotid gland carcinoma is a rare but serious condition that often necessitates surgical intervention. A parotidectomy, which involves the removal of the parotid gland, is a common surgical treatment but carries the risk of facial nerve palsy due to the anatomical relationship between the parotid gland and the facial nerve. The facial nerve (Cranial Nerve VII) has a complex course through the parotid gland, and its branches supply the muscles of facial expression. Any surgical intervention in the parotid region carries a risk of injuring the facial nerve, which can result in facial nerve palsy. This palsy can manifest as an inability to close the eye, loss of the nasolabial fold, and drooping of the mouth on the same side as the surgery. Early identification and careful dissection during surgery are crucial to avoid this complication. However, despite meticulous surgical techniques, the risk of facial nerve injury remains. This case underscores the importance of understanding the anatomical relationships and potential complications associated with surgical interventions in the head and neck region.

The study conducted at by Huang et al from the National Taiwan University Hospital aimed to evaluate the risk factors for postoperative facial palsy in patients with parotid carcinoma who underwent parotidectomy, highlighting the critical interplay between the disease, surgical intervention, and potential for facial nerve palsy​. In another study, the objective was to delineate the complications post-parotidectomy concerning facial nerve dysfunction, emphasizing the vital nature of the facial nerve in parotid surgeries​​. The anatomy of the facial nerve in relation to the parotid gland is intricate, with nerve branches running between the deep and superficial lobes of the gland, posing a risk for facial nerve palsy post-parotidectomy​​. Lesion of the facial nerve is considered one of the most severe complications post-parotid gland surgery, with certain predictive factors related to the occurrence of peripheral facial paralysis post-superficial parotidectomy​​.

Incorrect Answers:
Answer 1: Bone marrow suppression is a side effect associated with chemotherapy agents like methotrexate, not with surgical intervention on the parotid gland.

Answer 3: Hoarseness is often associated with recurrent laryngeal nerve injury, which may occur during thyroid surgery or other neck surgeries, but not typically with parotidectomy.

Answer 4: Ipsilateral deviation of the tongue is indicative of a hypoglossal nerve (Cranial Nerve XII) lesion, which would not be a common complication of parotid gland surgery.

Answer 5: Severe, lancinating pain in the distribution of the trigeminal nerve is characteristic of trigeminal neuralgia, a chronic pain condition, and is not a typical complication of parotidectomy."

Bullet Summary:
Understanding the anatomical relationship between the parotid gland and the facial nerve is crucial to anticipate, prevent, and manage potential complications such as facial nerve palsy during parotidectomy for parotid gland carcinoma.