Surgical and anesthetic considerations in a unique case of temporary iatrogenic facial nerve paralysis after superficial parotidectomy

Parotid neoplasms are a common indication for parotidectomy, a procedure that carries a risk of facial paralysis. Modern advances in surgical and anesthesia techniques, including facial nerve monitoring have resulted in low rates of permanent facial nerve paralysis. We present a case of temporary postoperative right facial nerve paralysis after intact facial nerve neuromonitoring at the completion of resection. The proposed mechanism of this phenomenon is related to the effects of local anesthetic infiltration from a fat graft used for oncologic reconstruction. This case emphasizes the importance of judicious and carefully timed local anesthetic use, clear facial nerve monitoring, and coordination between care teams.