The underappreciated role of auriculotemporal nerve involvement in local failure following parotidectomy for cancer

Background Locoregional recurrence rates following parotidectomy for cancer remain as high as 20‐30%. The auriculotemporal nerve (ATN) may allow parotid cancers to spread from the facial nerve (FN) toward the skull base, causing local recurrence. Methods Retrospective review of 173 parotidectomies for malignancy. Preoperative and post‐recurrence imaging were reviewed by a neuroradiologist for signs of tumor adjacent to the ATN. Results Clinical and imaging signs of possible ATN involvement correlated with FN weakness and sacrifice. Eight patients had pathologically confirmed tumor from the ATN or V3. Forty‐four percent of local recurrences had post‐recurrence imaging showing tumor along the course of the ATN. Locoregional failure along the ATN was also associated with preoperative FN weakness, intraoperative FN sacrifice, and failure to complete recommended adjuvant therapy. Conclusions Parotid cancers may invade the FN and spread to the skull base via the ATN. If not appropriately managed, this may lead to local recurrence.