Parotid surgery using Nd:YAG laser contact tips: clinical assessment of perioperative facial nerve function

The objective of this paper is to review 51 consecutive contact Nd:YAG laser parotidectomies to determine perioperative outcomes and complications related to the facial nerve and the use of the laser tips. Parotid surgery is mostly performed with scalpel or scissors, techniques that may put the facial nerve at risk for injury due to brisk bleeding and imprecise dissection. Even though previous experiences with Nd:YAG lasers in surgery had raised concerns of energy dispersion, the contact sapphire tips used in this series allowed accurate precise dissection and hemostasis, limiting complications. Close facial nerve dissection was done at 8-12 watts, for an average total of 8,000-12,000 joules per case. No significant or permanent facial nerve complications resulted from the use of the laser tips, except for expected transient and reversible postoperative ipsilateral marginal mandibular nerve paresis observed in 43% of the patients-less than the generally quoted 50% expected after uneventful lateral lobe parotidectomy. This review concludes that the contact Nd:YAG laser may offer significant technical and safety advantages, and no direct associated complications in the dissection and preservation of the facial nerve in parotidectomy.