Major structures at risk include the facial nerve, parotid duct, and parenchymal damage. Facial nerve injury is detected by careful clinical assessment of the branches of the nerve, as compared with the normal side. Early repair is preferable and will entail the use of a nerve stimulator to identify the severed branches. Ductal injury should be suspected when saliva is present in the wound. Confirmation of ductal injury is obtained via intraoral cannulation.
Direct repair involves suturing the duct over a polyethylene catheter.
More complex procedures may be required if the duct cannot be anastomosed. Malignancy arising in a minor salivary gland tends to be more aggressive in nature. Surgical resection often includes subtotal-total parotidectomy, with efforts to preserve the facial nerve. The most common malignant tumor of the parotid gland is the mucoepidermoid carcinoma, which can be classified as low grade or high grade based on histological analysis. Signs and symptoms of parotid malignancy include facial nerve paralysis, pain, or facial paresis.