Aim: Classically, parotidectomy is performed by the antegrade facial nerve dissection technique. However, a significant amount of normal parotid parenchyma is mobilized and killed needlessly, without enhancing the oncological outcome, as most tumours do not reside in the proximity of the facial nerve trunk. We investigate whether retrograde facial nerve dissection (the facial nerve branches were identified and dissected proximally) is a safe or better alternative. Patients and Methods: Patients who underwent parotidectomy for clinically-benign parotid tumours from September 2000 to December 2009 were enrolled. From 2007, we adopted retrograde parotidectomy as the form of surgery for treating parotid masses. A comparison was made between the antegrade and retrograde facial nerve dissection groups regarding the operation time, hospital stay and surgical complications. Results: The patient and tumour characteristics were comparable between the two groups. The mean operation time was shorter in the retrograde group: 144 min versus 176.2 min (P = 0.002). The postoperative stay was also shorter for the retrograde group: 3.3 days versus 4.1 days (P = 0.037). There was no tumour relapse in either group. More great auricular nerves were divided in the antegrade group: 59 per cent versus 10.3 per cent (P = 0.009). A consistent trend of a lower rate of transient facial palsy, pinna numbness, sialocele/salivary fistula and Frey's syndrome was seen in the retrograde group, although they were statistically insignificant. Conclusion: Retrograde parotidectomy can be performed safely without compromising the oncological outcome.
