Advanced MR neurography and 3D modeling provide supplemental preoperative planning for facial nerve assessment in parotid tumors

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Frontiers in Medicine Published June 9, 2026 Medically reviewed June 9, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note that advanced MR neurography supports preoperative planning but cannot replace intraoperative monitoring or judgment.

This narrative review evaluates advanced MR neurography—including high-resolution MRI sequences, quantitative diffusion metrics, and radiomic analysis—alongside 3D modeling to assist in preoperative facial nerve assessment for parotid tumors. The authors synthesize findings regarding the visualization of the facial nerve trunk and primary bifurcation, which are reliably identified using these advanced imaging sequences.

However, the review notes significant limitations: mapping distal nerve branches remains technically challenging, and quantitative parameters or radiomic profiles are not currently validated as standalone methods for detecting occult perineural invasion or microscopic malignant features. While 3D modeling provides structural information that may facilitate targeted surgical approaches like retrograde nerve tracing, it is presented as a supportive tool rather than a definitive diagnostic.

Clinically, these advanced imaging modalities serve as adjunctive tools to optimize preoperative planning but cannot replace intraoperative judgment, continuous neuromonitoring, or meticulous surgical technique. Practitioners should consider these technologies as complementary resources for risk stratification and anatomical mapping while maintaining standard safety protocols.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Conventional parotid surgery has historically relied on indirect anatomical landmarks, which often fail when faced with pathological distortions. This narrative review evaluates the clinical utility of advanced magnetic resonance neurography and 3D modeling for preoperative facial nerve assessment, aiming to bridge the gap between radiological advancements and practical surgical planning. A comprehensive literature search was conducted to evaluate mature clinical tools and experimental techniques. We assessed high-resolution MRI sequences, quantitative diffusion metrics, and radiomic analysis, focusing on their ability to provide supportive planning information and their reported associations with clinical outcomes. Current evidence confirms that advanced imaging sequences enable reliable visualization of the facial nerve trunk and its primary bifurcation, though mapping distal nerve branches remains technically challenging. Quantitative parameters and radiomic profiles may contribute to peritumoral risk stratification, but they are not yet validated as standalone methods for detecting true occult perineural invasion or microscopic malignant features. Fusing these imaging findings with patient-specific 3D models provides structural information that may facilitate the consideration of targeted surgical approaches, such as retrograde nerve tracing. While these advanced modalities serve strictly as adjunctive tools to optimize preoperative planning, they cannot replace intraoperative judgment or established safety protocols—continuous neuromonitoring and meticulous surgical technique remain essential for optimizing functional outcomes.