Facial Nerve Preservation

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.

During each parotid surgery performed at the CENTER, expert parotid surgeon, Dr. Larian, works alongside Dr. Babak Azizzadeh and Dr. Slattery, leading experts in facial nerve disease, repair and preservation. Dr. Azizzadeh is the lead investigator of the Cedars-Sinai facial nerve regeneration project and the author of five best selling medical textbooks. Dr. Slattery is a world-renowned skull base and facial nerve specialist. Additionally, Dr. Slattery and Dr. Azizzadeh are the authors of the preeminent textbook entitled "Facial Nerve." Their knowledge of the facial nerve is unrivaled and truly provides patients with the best care possible. This unique partnership delivers the best possible surgical outcome because it ensures the safety of the facial nerve, thus preserving the patient's facial function.

Preserving The Facial Nerve During Parotid Surgery

To begin the procedure, Dr. Larian will make a small incision along the skin's natural creases to ensure the resulting scar is well hidden. He then lifts the skin off of the underlying parotid gland and separates the gland from the surrounding tissues to get access to the facial nerve. From there, Dr. Larian and Dr. Azizzadeh will locate the main trunk of the facial nerve as it exits the skull. They will then use a cutting-edge Nerve Integrity Monitor to observe and protect the facial nerve and all its branches during surgery.

Once the parotid tumor, cyst or gland has been removed, Dr. Larian will confirm the facial nerve's function by stimulating its branches and main trunk to ensure the associated muscles are moving properly. Once nerve integrity has been confirmed, he and Dr. Azizzadeh will reconstruct the area to ensure both sides of the face are symmetrical, thus achieving an optimal cosmetic effect. If the tumors are large or involve the bones in the skull (which the team would identify prior to surgery), Dr. Slattery will help find the facial nerve inside the skull so that it would be traced out and preserved.

Again, we cannot stress enough how important it is to have a highly skilled and experienced team of surgeons perform parotid surgery. No two patients have the exact same facial nerve anatomy and there is no way to predict the facial nerve anatomy before surgery. It isn't until surgery has begun that the doctors can truly see the facial nerve anatomy. While most patients will have a more "standard" facial nerve anatomy, for those patients who do not, Dr. Larian and Dr. Azizzadeh have the experience necessary to perform a successful parotidectomy, while preserving and saving the patient's ability to smile!

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.

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.