Immediately after parotidectomy for a benign tumour, the patient has complete ipsilateral facial paralysis. The operative note says the nerve was anatomically intact, but stimulation was lost near the end of dissection. What is the best next principle?
Complete immediate palsy requires documentation by branch, corneal protection and review of operative events. When continuity is uncertain or a reversible mechanical cause is plausible, early exploration may permit decompression or repair before delay compromises outcome.
A. Reassure and review in one year: Complete immediate paralysis risks corneal injury and may represent a repairable lesion.
B. Perform contralateral facial-nerve sacrifice for symmetry: This is harmful and has no therapeutic basis.
C. Start radiotherapy to the nerve: The tumour was benign and radiation does not treat operative neuropraxia or transection.
D. Suture the eyelids permanently without assessing recovery potential: Temporary eye protection may be necessary, but definitive irreversible measures require a broader recovery and reanimation plan.
E. Urgent senior reassessment, eye protection and consideration of early exploration if transection or compression is plausible: Complete immediate palsy requires documentation by branch, corneal protection and review of operative events. When continuity is uncertain or a reversible mechanical cause is plausible, early exploration may permit decompression or repair before delay compromises outcome.
If weakness were mild, delayed and improving with confirmed intraoperative continuity, observation with eye care and serial facial grading would be more appropriate.
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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