Ayurveda-based supportive management in parotid malignancy with facial nerve palsy

Facial nerve palsy in the setting of a parotid mass is a high-risk clinical presentation and is frequently associated with aggressive salivary gland malignancy and perineural invasion. Symptom burden during multimodal oncology care is substantial, highlighting the need for safe, coordinated supportive care. A 51-year-old male presented with a progressively enlarging right parotid mass, otalgia, weight loss, and facial weakness graded as House–Brackmann IV at first oncology evaluation. Imaging suggested perineural involvement and nodal disease; fine-needle aspiration cytology/biopsy and postoperative histopathology supported a diagnosis of high-grade mucoepidermoid carcinoma of the parotid gland with perineural and lymphovascular invasion (clinical stage cT3N2M0). The patient underwent radical parotidectomy with facial nerve sacrifice and neck dissection, followed by adjuvant radiotherapy. The presentation was interpreted within an Ayurvedic framework as Mamsa–Raktaja Granthi/Arbuda with Vata Prakopa manifesting as Ardita, accompanied by Agnimandya and Ojakshaya features. Baseline documentation included Prakriti/Vikriti, Agni, Koshtha, Bala, Sara, Srotas involvement, and Manas status. An Ayurveda-based supportive care protocol (Rasayana, Deepana–Pachana, Medhya/Nidra support, Anulomana, and local mucosal soothing measures) was delivered for 12 weeks alongside conventional oncology care, with herb–drug interaction screening and safety monitoring. Clinically meaningful improvements were documented in pain intensity, sleep quality, appetite, fatigue, and quality-of-life scores. Radiotherapy-associated mucositis and xerostomia were mild and manageable. Facial motor recovery was limited due to surgical nerve sacrifice; however, facial tone and coping improved. No serious adverse events attributable to the Ayurvedic regimen were observed. This case illustrates the feasibility of a structured Ayurveda-based supportive approach integrated with standard management of advanced parotid malignancy, emphasizing objective symptom outcomes, safety monitoring, and oncology coordination.