The Effect of a Single Dose of Intravenous Dexamethasone Administered before Parotid Surgery on Facial Nerve Paralysis; Randomized Controlled Clinical Trial

Document Type : Original Article (s)

Authors

1 Professor, Department of Ear, Nose, and Throat, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Assistant Professor, Department of Ear, Nose, and Throat, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

3 Otolaryngologists, Department of Ear, Nose, and Throat, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: Facial nerve weakness is the major complication of parotid tumors. The aim of this study was to evaluate the effect of a single dose of intravenous dexamethasone before superficial parotidectomy on postoperative facial nerve dysfunction.Methods: This randomized clinical trial study was performed on 40 patients with benign parotid lesions and normal function of the facial nerve. Patients were randomly assigned to two groups of 20 patients under medication and placebo; patients in both groups underwent superficial parotidectomy. Early postoperative function, and rate of function return and its relationship to size, type, and position of the mass, as well as age, and sex were compared among the groups.Findings: Incidence of postoperative facial nerve dysfunction was significantly lower in patient received dexamethasone (5% in drug group versus 35% in placebo group) on the first postoperative day (P = 0.018). There was no statistically significant difference between the nerve dysfunction based on the mass location (P = 0.749) and size (P = 0.505), and the nerve dysfunction rate between the two groups in terms of age (P = 0.490) and gender (P = 0.429).Conclusion: This study shows that using intravenous dexamethasone 4 hours before the superficial parotidectomy has a good result in reduction of facial nerve dysfunction.

Keywords

References

  1. Day TA, Deveikis J, Gillespie MB, Joe JK, Ogretmen B, Osguthorpe JD, et al. Salivary gland neoplasms. Curr Treat Options Oncol 2004; 5(1): 11-26.
  2. Upton DC, McNamar JP, Connor NP, Harari PM, Hartig GK. Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol Head Neck Surg 2007; 136(5): 788-92.
  3. Jianjun Y, Tong T, Wenzhu S, Shanzhen S, Jianguo T, Fengcai W, et al. Use of a parotid fascia flap to prevent postoperative fistula. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87(6): 673-5.
  4. Marchese-Ragona R, De FC, Marioni G, Staffieri A. Treatment of complications of parotid gland surgery. Acta Otorhinolaryngol Ital 2005; 25(3): 174-8.
  5. Witt RL. Facial nerve function after partial superficial parotidectomy: An 11-year review (1987-1997). Otolaryngol Head Neck Surg 1999; 121(3): 210-3.
  6. Guntinas-Lichius O, Klussmann JP, Wittekindt C, Stennert E. Parotidectomy for benign parotid disease at a university teaching hospital: Outcome of 963 operations. Laryngoscope 2006; 116(4): 534-40.
  7. Nouraei SA, Ismail Y, Ferguson MS, McLean NR, Milner RH, Thomson PJ, et al. Analysis of complications following surgical treatment of benign parotid disease. ANZ J Surg 2008; 78(3): 134-8.
  8. Gaillard C, Perie S, Susini B, St Guily JL. Facial nerve dysfunction after parotidectomy: the role of local factors. Laryngoscope 2005; 115(2): 287-91.
  9. Meier JD, Wenig BL, Manders EC, Nenonene EK. Continuous intraoperative facial nerve monitoring in predicting postoperative injury during parotidectomy. Laryngoscope 2006; 116(9): 1569-72.
  10. Eisele DW, Wang SJ, Orloff LA. Electrophysiologic facial nerve monitoring during parotidectomy. Head Neck 2010; 32(3): 399-405.
  11. Yildirim MA, Karlidag T, Akpolat N, Kaygusuz I, Keles E, Yalcin S, et al. The effect of methylprednisolone on facial nerve paralysis with different etiologies. J Craniofac Surg 2015; 26(3): 810-5.
  12. Bayrak AF, Olgun Y, Ozbakan A, Aktas S, Kulan CA, Kamaci G, et al. The Effect of Insulin Like Growth Factor-1 on Recovery of Facial Nerve Crush Injury. Clin Exp Otorhinolaryngol 2017; 10(4): 296-302.
  13. Varadharajan K, Beegun I, Daly N. Use of steroids for facial nerve paralysis after parotidectomy: A systematic review. World J Clin Cases 2015; 3(2): 180-5.
  14. Ou XR, Su HB. Facial nerve dysfunction after various surgical managements for benign parotid tumor. Hunan Yi Ke Da Xue Xue Bao 2001; 26(4): 371-3. [In Chinese].
  15. Stodulski D, Skorek A, Mikaszewski B, Wisniewski P, Stankiewicz C. Facial nerve grading after parotidectomy. Eur Arch Otorhinolaryngol 2015; 272(9): 2445-50.
  16. Hall ED. The effects of glucocorticoid and nonglucocorticoid steroids on acute neuronal degeneration. Adv Neurol 1993; 59: 241-8.
  17. Lee HM, Weinstein JN, Meller ST, Hayashi N, Spratt KF, Gebhart GF. The role of steroids and their effects on phospholipase A2. An animal model of radiculopathy. Spine (Phila Pa 1976 ) 1998; 23(11): 1191-6.
  18. Kartush JM, Brackmann DE. Acoustic neuroma update. Otolaryngol Clin North Am 1996; 29(3): 377-92.
  19. Higgins JP, Altman DG. Assessing risk of bias in included studies. cochrane handbook for systematic reviews of interventions. Hoboken, NJ: John Wiley and Sons; 2008. p. 187-241.
  20. Lee KJ, Fee WE, Jr., Terris DJ. The efficacy of corticosteroids in postparotidectomy facial nerve paresis. Laryngoscope 2002; 112(11): 1958-63.
  21. Roh JL, Park CI. A prospective, randomized trial for use of prednisolone in patients with facial nerve paralysis after parotidectomy. Am J Surg 2008; 196(5): 746-50.
  22. Laccourreye H, Laccourreye O, Cauchois R, Jouffre V, Menard M, Brasnu D. Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: A 25-year experience with 229 patients. Laryngoscope 1994; 104(12): 1487-94.
  23. Bron LP, O'Brien CJ. Facial nerve function after parotidectomy. Arch Otolaryngol Head Neck Surg 1997; 123(10): 1091-6.
  24. Tung BK, Chu PY, Tai SK, Wang YF, Tsai TL, Lee TL, et al. Predictors and timing of recovery in patients with immediate facial nerve dysfunction after parotidectomy. Head Neck 2014; 36(2): 247-51.
  25. Mra Z, Komisar A, Blaugrund SM. Functional facial nerve weakness after surgery for benign parotid tumors: a multivariate statistical analysis. Head Neck 1993; 15(2): 147-52.
Journal of Isfahan Medical School
Volume 35, Issue 455 - Serial Number 455
September and October 2018
Pages 1599-1604

Files

History

  • Receive Date: 21 October 2017
  • Revise Date: 29 April 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics