Abstract
OBJECTIVE: To compare facial nerve function and perioperative outcomes among antegrade, retrograde, and extracapsular parotidectomy approaches in benign and malignant tumors. STUDY DESIGN: Retrospective review. SETTING: Tertiary academic center. METHODS: Adults undergoing parotidectomy with facial nerve preservation between 2018 and 2023 were included. Demographic, surgical, and outcome variables were analyzed using bivariate and multivariable regression. RESULTS: A total of 740 tumors were analyzed (353 benign, 387 malignant). Antegrade dissection was performed in 288 cases (194 malignant), retrograde in 334 (167 malignant), and extracapsular in 118 (26 malignant). Transient and permanent facial weakness occurred in 20% and 5% of cases. After adjustment, extracapsular dissection (odds ratio [OR] = 0.2, 95% confidence interval [CI] 0.1-0.7, P = .0058) significantly reduced transient weakness compared with antegrade dissection. Retrograde dissection (OR = 0.5, 95% CI 0.3-1.1, P = .11) demonstrated a trend toward lower rates of transient weakness relative to antegrade dissection. In malignant tumors, outcomes were similar across approaches. Extracapsular dissection was rarely used in malignant disease and reserved for selected cases. Antegrade dissection had longer operative times in benign and malignant tumors (P < .001). Perioperative complication rates, unplanned visits, recurrence, re-operations, ED visits, and readmissions were low and not significantly different across techniques. CONCLUSION: In benign parotidectomy, extracapsular dissection significantly reduced transient facial weakness, while retrograde dissection demonstrated a trend toward reduced transient weakness compared with antegrade. In malignant disease, outcomes were similar across approaches. Selective application of extracapsular and retrograde techniques may optimize facial nerve outcomes and operative efficiency.