A parotid malignancy surrounds but does not clinically or radiologically invade a normally functioning facial nerve. What principle should guide nerve management at resection?
UK multidisciplinary guidance supports preserving a functioning facial nerve when it is not infiltrated. Direct invasion may require sacrifice with immediate reconstruction planning where feasible.
A. Sacrifice the nerve routinely for every high-grade tumour: Histological grade alone does not mandate nerve sacrifice when an oncologically sound dissection plane exists.
B. Shell the tumour out to protect all nerve branches: Enucleation risks tumour violation and inadequate margins.
C. Avoid discussing facial function before surgery: Potential weakness, sacrifice and reconstructive options are material risks requiring preoperative discussion.
D. Preserve the facial nerve if oncologically separable, sacrificing only when directly involved: UK multidisciplinary guidance supports preserving a functioning facial nerve when it is not infiltrated. Direct invasion may require sacrifice with immediate reconstruction planning where feasible.
E. Perform nerve grafting while leaving gross tumour on the nerve: Functional reconstruction cannot justify knowingly inadequate oncological clearance.
If preoperative complete palsy and imaging showed neural invasion, planned sacrifice and immediate reanimation would become more likely.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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