Dr. Babak Larian, Dr. Babak Azizzadeh and Dr. William Slattery
at the CENTER have earned international acclaim for their successful outcomes in facial nerve preservation during parotid surgery.
Facial Nerve Preservation Overview
The facial nerve – which controls the full scope of facial expression and movement – passes directly through the parotid gland. This delicate structure enables verbal and non-verbal communication, as well as the ability to speak, close ones eyes and breathe properly. Given its critical functions and close location with the parotid gland, the preservation of the facial nerve is one of the most important aspects of a successful parotid surgery. As such, the parotid tumor needs to be removed very carefully by a team of surgeons with a high level of expertise and experience.
Facial Nerve & all the branches connecting to the muscles of the face.
Facial Nerve & all the branches are identified & preserved during surge (The nerves are seen as white lines in this image which is made into an animatio from an actual Micro Parotidectom
At the CENTER, Doctors Larian, Azizzadeh, & Slattery have combined their efforts and experience to deliver the very best in treatment of diseases of the parotid gland and the facial nerve. Dr. Larian takes extra time identifying the facial nerve branches & protecting them before removing the tumor and the necessary portions of the parotid gland. Dr. Azizzadeh & Dr. Slattery’s skills are required in more complex cases. Dr. Azizzadeh is world renowned for his innovations in the field of facial nerve repair & research. Similarly Dr. Slattery is in the forefront of skull base surgery and various treatments of facial nerve disorders. The combined talents, knowledge & different skill sets of these doctors creates a “dream team” of unrivaled facial nerve & parotid specialists to tackle all parotid maladies. This unique partnership delivers the best in surgical outcome because it assures the safety of the facial nerve, thus preserving the patient’s facial function.
MONITORING & PRESERVING THE FACIAL NERVE
Although the anatomy of facial can vary widely between people, there are three factors that are almost always the same: (1) the facial nerve comes out of the skull in the same area just under the ear (2) it then divides into two main branches, the UPPER & LOWER DIVISIONS, and (3) the ultimate destination of the nerves is always the same, and that is the muscles of the face which are in front of the face. This fact allows us to monitor the health & functioning of the facial nerve during surgery by place monitoring probes in the muscles of the face that will be stimulated every time the nerve has any kind of activity, including being touched or moved.
In the 3 illustrations one can see 3 different variations of the facial nerve, but despite these differences the RED Probes are able to monitor the activity of the UPPER & LOWER DIVISIONS of the facial nerve.
This provides the parotid surgeon at the CENTER additional information to make the surgery even safer. The expertise of the parotid surgeon is of utmost importance, to know how and where to find the facial nerve and branches. More importantly how to handle the parotid tissue with patience, gentleness and extreme care as to minimize the chance of causing swelling or bruising of the facial nerve which would cause temporary weakness. Sacrificing the facial nerve branches is not an option, especially when dealing with benign tumors, this is where the experience, patience and dexterity of the surgeon makes a huge difference.
There are many different ways to find the facial nerve and its branches, the surgeons at the CENTER are well versed and have great expertise in all the techniques to identify the facial nerve. The reason for this expertise is not only that they do a very large number of parotid surgeries but also that they deal with a large variety and sizes of tumors; these tumors may be located anywhere in the parotid and may obstruct the view from certain angles, as such the surgeons at the CENTER will have to be able to approach the facial nerve from different angels, find and protect it. During the course of the surgery we often use physiologic nerve stimulators to check the location and health of the facial nerve as you can see in the video.
Furthermore, once the tumor is removed the facial nerve is stimulated to
confirm all the branches are functioning and healthy. So before completing the surgery, our surgeons will confirm that the nerve is working & healthy, as shown in the video below (live surgery made into animation).
Facial Nerve monitored during surgery & stimulated at the end of the procedure to make sure all branches are fully functioning
This is the animated version of a micro-parotidectomy after a large parotid tumor has been removed It shows the preserved Greater Auricular Nerve. It also shows the Facial Nerve & how it is stimulated to confirm it is functioning
Repairing a Compromised Facial Nerve
Dr. Larian and his team of specialists are committed to preserving the facial nerve and all its branches during every single parotid gland surgery performed at the CENTER. Every effort is made to preserve the nerve and all of its branches, while keep the main surgical objective in mind – removing the tumor. However, in very rare and advanced cancer cases, the location and scope of the disease may prohibit the preservation of the facial nerve. During these surgeries, Dr. Larian and Dr. Azizzadeh have the expertise to reconstruct the facial nerve immediately, repairing the damage with a nerve graft and other advanced techniques.
At the CENTER, we make it a priority to discuss the importance of protecting the facial nerve during parotid tumor removal surgery with all of our patients. It is such an integral part of the surgery and we want to make sure that all of our patients understand the risks. Although these risks can be very critical, you can trust that our team of parotid surgeons are some of the most experienced in the world and have among the lowest rates of complications. We do everything possible to successfully remove the parotid tumor and save the patient’s smile.
Saving the Facial Nerve During A Parotidectomy | The Doctors | Dr. Larian & Dr. Azizzadeh
Parotid Gland Tumor Removal | The Doctors | Dr. Babak Larian
Parotid Gland Tumor Removal | The Doctors | Dr. Babak Larian
Facial Paralysis Surgery
Facial paralysis is a loss of facial movement due to nerve damage. It can occur due to a variety of reasons including infection, brain tumors, parotid tumors, or surgery. It typically occurs on just one side of the face and can cause a number of complications, including difficulty eating or drinking, an inability to have facial expressions, asymmetrical appearance, and facial pain. In addition, facial paralysis can cause eye damage due to an inability to fully close the eyelids.
Dr. Azizzadeh and Dr. Larian are two of only a handful of specialists in the country capable of performing surgery to treat facial paralysis and restore facial function. They employ a multi-disciplinary approach, and call on the expertise of respected experts from various specialties that are singularly focused on facial nerve disorders – including ophthalmic plastic surgeons, neuro-otologists, physical therapists, radiologists, neurosurgeons and psychologists. This strategy has resulted in one of the highest levels of patient outcomes in the country and delivered successful surgical results for countless patients.
FREQUENTLY ASKED QUESTIONS
Is every parotidectomy done with facial nerve monitoring?
Yes, at the CENTER all parotidectomy procedures are done with a facial nerve
monitor as an additional measure of safety to protect and preserve the facial nerve.
How do the facial nerves monitors work?
The probes of the facial nerve monitor have two very thin needles that are placed through the skin into the muscles of the face that are controlled by the facial nerve. If the nerve is in anyway stimulated, which includes touching or pushing the nerve, then the nerve will send a signal into the muscle that creates electrical activity in the muscles that is picked up by the probes. This nerve monitoring machine will show the level of activity as well as sounding an alert so the surgeons can hear immediately when they are getting close to the nerve.
Does the stimulation of the facial nerve damage the nerve?
In the past the nerve stimulators were too powerful and would cause the nerve to fatigue which would resolve over time. However the newer generation of the nerve stimulators produce electrical energy that is more like normal nerve activity. As such they are much less likely to tire the nerve out. None of these nerve stimulators damage the nerve itself.
Is there a scenario where the nerve monitoring equipment
is not used?
Not in the US. The nerve monitoring equipment is very expensive and not available in all hospitals, as such parotid surgery should not be done at facilities that don’t have this equipment.
On our medical missions to other countries unfortunately we don’t have the nerve monitoring equipment, and are often forced to do parotid tumor surgery in rural areas without it. In these situations we do the surgery without a monitor but do use nerve stimulators to help identify nerve branches. Despite this limitation our outcomes have been fantastic on our missions.
Meet The Team
Led by board-certified parotid surgeon, Dr. Babak Larian, our team of specialists has decades of experience successfully diagnosing and treating diseases of the parotid glands with minimally invasive procedures. Distinguished by our compassionate care and cutting-edge techniques, the CENTER has developed a reputation for delivering the best parotid tumor surgery available.
