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The facial nerve: the central risk of parotid surgery | CION Cancer Clinics
The main risk of a parotidectomy is harm to the facial nerve, the nerve that moves your forehead, eyelid, cheek and lips. It runs straight through the parotid gland, so the surgeon must find it and lift the lump away from it. Short-lived weakness after surgery is common and usually recovers. Lasting weakness is much less common, and is most likely when a cancer has grown into the nerve. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why is the facial nerve at risk during a parotidectomy?
- What does each branch of the nerve move?
- How do surgeons protect the nerve?
- What do the words about the nerve mean?
- What makes the risk higher or lower for you?
- What do people fear about the nerve that is not true?
- Common questions about the facial nerve and parotid surgery
The short answer
Why is the facial nerve at risk during a parotidectomy?
The facial nerve runs straight through the parotid gland, so the surgeon cannot remove the gland without working right next to it. That is why facial weakness is the main risk every surgeon discusses before this operation.
What the nerve does
The facial nerve carries the signals that move one side of your face. It lets you raise your eyebrow, close your eye, smile, whistle and hold food in your cheek. It does not carry feeling, so the skin still feels touch even if the muscles are weak.
How it passes through the gland
The nerve leaves the skull just below the ear. Within a short distance it enters the parotid gland and divides into several branches that fan out across the face. A lump in the gland can sit on top of these branches, beneath them, or wrapped around them.
Why even a careful operation can cause weakness
To free the lump, the surgeon must find the nerve, follow each branch and lift tissue away from it. Branches are thinner than a thread in places. Gentle stretching, warmth from the instruments and swelling afterwards can all stop a nerve working for a while, even when it has not been cut. This is the most common reason for weakness after surgery.
Weakness from a bruised nerve is not a sign that something went wrong. It usually recovers.The branches
What does each branch of the nerve move?
Weakness can affect one branch or several. Knowing which does what helps you understand what the team is checking when you wake up.
The forehead branch
Raises your eyebrow and wrinkles your forehead. If it is weak, the brow on that side sits lower and the forehead looks smooth.
The eyelid branch
Closes your eye and makes you blink. This matters most, because an eye that cannot close dries out and needs protecting straight away.
The cheek and upper lip branch
Lifts the upper lip and cheek when you smile, and keeps food from collecting between the cheek and gums while you chew.
The lower lip branch
Pulls the corner of the mouth down. It is thin and runs close to the jaw, so it is the branch most often weak after surgery.
You may notice
- A lopsided smile
- Liquid escaping from the lip
The neck branch
Tightens a thin sheet of muscle in the neck. Weakness here is rarely noticed in daily life.
Not sure whether this applies to you?
Ask an oncologistIn the operating theatre
How do surgeons protect the nerve?
Finding the main trunk first
The surgeon uses fixed landmarks near the ear canal and the jaw to find the nerve where it leaves the skull, before it splits. Nothing is removed until it has been seen.
Following each branch
From the trunk, each branch is traced forward through the gland, with fine instruments and magnification where needed, so its path is known at every point.
Lifting the lump away
The lump and surrounding gland are separated from the branches gently, with as little stretching or heat near the nerve as possible.
Checking before closing
At the end, the surgeon looks along the nerve again. Where a nerve monitor is used, a small electrical test confirms the branches still respond.
In your notes
What do the words about the nerve mean?
- Facial nerve preserved
- Every branch was kept whole. Any weakness is expected to be from handling, and usually recovers.
- Paresis
- Weakness. The muscles move, but less than on the other side.
- Palsy
- Loss of movement in the muscles supplied by the nerve or one of its branches.
- Nerve sacrificed
- A branch or the whole nerve was removed on purpose, because cancer had grown into it.
- House-Brackmann grade
- A scale doctors use to describe how well the face moves, from normal to no movement at all.
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Your own risk
What makes the risk higher or lower for you?
The risk is not the same for everyone. It depends mostly on the lump and the size of the operation, not on luck.
The size of the operation
Removing only the outer part of the gland handles the nerve less than removing the deep part as well. Lifting branches to reach beneath them makes short-lived weakness more likely.
The type of lump
Most benign lumps push the nerve aside rather than growing into it. A cancer can grow into the nerve. If your face was already weak before surgery, the team may warn you that part of the nerve might need to be removed.
Repeat surgery or earlier radiotherapy
Scar tissue from a previous operation or radiotherapy makes the nerve harder to find and separate. Tell your surgeon about any earlier treatment to that side of the face.
What this page cannot tell you
It cannot give you a figure for your own risk. Ask your surgeon to describe it for your lump, your operation and their own experience, and write down what they say.
Did you know
Weakness that appears a day or so after surgery, when the face moved well on waking, is usually due to swelling around the nerve. It tends to recover well, because the nerve itself was working at the end of the operation.
Commonly believed
What do people fear about the nerve that is not true?
"If my face is weak, the surgeon cut the nerve."
Most weakness after a parotidectomy happens with the nerve completely whole. Handling, stretching and swelling quieten it for a while. Your operation notes will say whether the nerve was preserved.
"Waiting will make the operation safer for the nerve."
A lump that keeps growing presses on and spreads over more of the nerve. A larger lump is usually harder to separate, not easier. Delay does not lower the risk.
"A nerve monitor means weakness cannot happen."
A monitor helps the surgeon find and follow the nerve. It cannot stop a bruised nerve going quiet afterwards, and it does not replace careful surgery.
"If a branch is removed, nothing can be done."
When a branch has to be removed, the surgeon can sometimes join it with a small graft of nerve from elsewhere, and eyelid and face procedures can help later. Recovery is slower and less complete, but options exist.
Questions we are asked
Common questions about the facial nerve and parotid surgery
How common is facial weakness after parotidectomy?
Some short-lived weakness, often of the lower lip, is common in the days after surgery. Weakness that lasts is much less common, and is most often seen when cancer has grown into the nerve. Ask your surgeon to describe the risk for your own lump and operation, rather than relying on a general figure.
Will I know straight away if the nerve is damaged?
The team checks your face as soon as you wake by asking you to raise your eyebrows, close your eyes and smile. Some weakness shows immediately. Weakness can also appear a day or so later as swelling builds. Either way, the team will explain what they see and what it is likely to mean.
Can the surgeon promise the nerve will be safe?
No honest surgeon can make that promise. What they can tell you is how they plan to protect the nerve, how often they do this operation, and when they would expect weakness to recover. Be cautious of anyone who says there is no risk at all to the nerve.
Why would a surgeon remove the nerve on purpose?
Only when a cancer has grown into it and cannot be separated. Leaving cancer on the nerve would mean leaving cancer behind. This is usually expected before surgery from the scan and from facial weakness already present. Your surgeon should discuss it with you beforehand, including options for repair.
Does the nerve affect feeling in my face?
No. The facial nerve moves muscles. The numbness many people notice around the ear lobe and cheek after surgery comes from a different, small skin nerve. Feeling there usually improves slowly, but some numbness of the ear lobe can remain.
What should I do if my eye will not close?
Tell the team the same day. An eye that cannot close dries out and can be damaged. You will be shown how to use lubricating drops by day, ointment at night and gentle taping of the lid. Pain, redness or blurred vision in that eye needs to be seen that day.
Can I reduce the risk myself?
You cannot change how the nerve lies, but you can help the team. Tell them about any facial weakness before surgery, any earlier operation or radiotherapy on that side, and all your medicines, especially blood thinners. Follow the instructions you are given about which medicines to continue. Do not stop any on your own.
Is the risk higher if the operation is repeated?
Usually yes. Scar tissue from a first operation makes the nerve harder to see and separate. This is one reason surgeons prefer to remove a lump completely the first time, with a layer of normal gland around it, rather than taking out the lump alone.
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Sources
- Cancer Research UK — Surgery for salivary gland cancer
- American Cancer Society — Surgery for salivary gland cancer
- Macmillan Cancer Support — Salivary gland cancer
- National Cancer Institute — Salivary Gland Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Facial weakness after parotidectomy: temporary or permanent?How weakness usually recovers, and what helps if it does notFacial nerve monitoring during surgeryWhat the monitor can and cannot doEye care if the eyelid will not closeProtecting the eye while the nerve recoversComplications and red flagsOther problems to watch for after any cancer operation
Talk to us
Worried about the nerve before your operation?
Tell us what has been found so far. A surgical oncologist will look at your scan and explain where your lump sits in relation to the nerve. One helpline serves every CION centre.