Advanced magnetic resonance neurography for preoperative facial nerve assessment and surgical planning in parotid tumors: a review of current evidence and surgical translation.

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.