Use of steroids for facial nerve paralysis after parotidectomy: A systematic review

Table 1 Characteristics of included studies

Roh and Park[16]
Methods	Randomised controlled trial
Participants	Patients undergoing parotidectomy (superficial, partial, total) ± neck dissection 44 patients Exclusion: 1 Direct FN invasion of FN requiring FN sacrifice and reconstruction 2 Incidental cutting of the facial nerve
Interventions	Started day 1 or day 2 postoperatively Reducing dose of oral prednisolone (50 mg/d for 5 d, 30 mg/d for 3 d and 10 mg/d for 2 d) Placebo group received lactose with similarly formulated doses
Outcomes	House Brackmann grading of FN by two blinded experts Assessed postoperatively: immediately, 1 wk, 1 mo, 3 mo and 6 mo
Results	Overall recovery times from FNP: At 3 mo: 84% had fully recovery At 6 mo: 98% had full recovery Prednisolone vs placebo recovery at 1, 3 and 6 mo (minimal difference) (P > 0.10)
Notes	One patient was lost to follow-up and excluded from the analysis (prednisolone group)
Risk of Bias
Method of randomisation	Not specified
Allocation concealment	Adequate
Other confounding factors	Groups comparable demographically and extent of postoperatively FNP, however tumour size, type or type of parotid surgery not compared in between intervention and placebo groups
Lee et al[14]
Methods	Randomised controlled trial
Participants	Patients undergoing superficial or total parotidectomy 49 patients Exclusion criteria: Diabetes, age < 18, peptic ulcer disease, previous adverse reaction to steroids and any other contraindication to steroids Prior parotid surgery, anticipated section of FN and pre-existing FNP
Interventions	Two doses of dexamethasone (0.51 or 1.41 mg/kg) depending on type of surgery (superficial or total parotidectomy respectively) at 8 and 16 h postoperatively Placebo group received saline at the same intervals
Outcomes	Facial nerve function in the four major regions was assessed (frontal, orbital, midface, upper lip and lower lip) at a percentage 0-100 depending on extent of function Assessed postoperatively: immediately and every month for 12 mo (or until facial nerve function returned to normal)
Results	Average early postoperative facial nerve function: All patients (n = 49): 75.4% Overall: Dexamethasone (69.5%) vs placebo (81.3%) (P = 0.239) Dose of dexamethasone: High (63.9%) vs low (74.7%) (P = 0.118) Type of surgery: Superficial (P = 0.637) and deep (P = 0.465) Time to full recovery of facial nerve (median): Placebo (60 d) vs Dexamethasone (150 d) (no P value stated)
Notes	As intervention administered intravenously, total compliance can be ensured
Risk of Bias
Method of randomisation	Not specified
Allocation concealment	Adequate
Other confounding factors	Initial power calculation required 120 patients, however a nationwide shortage of the intervention drug (dexamethasone) allowed only 52 patients to be enrolled in the trial No comparison of the type of parotid lesion excised within the trial groups (i.e., malignant or benign and tumour size) Operations were conducted by more than one surgeon (including junior residents)