The Role of Intraoperative Facial Nerve Monitoring during Parotidectomy for Benign Parotid Gland Tumors

Objective This study assesses the role of facial nerve monitoring (FNM) for intraoperative decision making during otologic surgery and possible benefits beyond protecting facial nerve integrity. Study Design This prospective study examines intraoperative FNM data and structured interviews collected during 52 otologic procedures. Setting Tertiary referral center. Subjects and Methods Subjects include adults and children undergoing middle ear or mastoid surgery. Data include intraoperative neuromonitoring activity and structured interviews conducted with the operating surgeon immediately following surgery. Results Facial nerve stimulation was used to confirm the position of the nerve in 42 of 52 surgical procedures. In 26.9% of cases, the patient became “light” and moved under anesthesia, which was predicted by neuromonitoring 71.4% of the time. Through structured interviews, the operating surgeons reported the following. (1) The facial nerve took an unexpected anatomic course in 7.8% of patients and was difficult to identify in 39.2%. (2) The nerve was at increased risk of injury in 66.7% of cases due to chronic disease or previous surgery. (3) Among these high-risk cases, the monitor helped reduce the risk of nerve damage 100% of the time. (4) Neuromonitoring allowed the surgeon to operate faster 86.5% of the time, and (5) FNM allowed the resident to perform more of the operation 68.9% of the time. No patients experienced postoperative facial weakness. Conclusions Beyond potentially protecting facial nerve integrity, this study identified additional benefits of FNM, including warning of patient movement during anesthesia, confirming facial nerve anatomic location, reducing operative time, and enhancing resident surgical experience.

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92. The role of blink reflex in intraoperative neurophysiological facial nerve monitoring during cerebellopontine angle (CPA) surgery

Clinical Neurophysiology ◽

10.1016/j.clinph.2013.06.119 ◽

2013 ◽

Vol 124 (11) ◽

pp. e209

Author(s):

E. Diozzi ◽

E. Sette ◽

J.G.Capone ◽

G. Villani ◽

V. Simioni ◽

...

Keyword(s):

Facial Nerve ◽

Cerebellopontine Angle ◽

Blink Reflex ◽

Nerve Monitoring ◽

Facial Nerve Monitoring

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Facial nerve monitoring in giant malignant tumor ex pleomorphic adenoma of parotid gland

JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY ◽

10.5106/jjshns.27.351 ◽

2018 ◽

Vol 27 (3) ◽

pp. 351-356

Author(s):

Munehito Moriyama ◽

Takashi Hirano ◽

Keigo Fujita ◽

Masashi Suzuki

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Pleomorphic Adenoma ◽

Malignant Tumor ◽

Nerve Monitoring ◽

Facial Nerve Monitoring

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Artificial Neural Network as a Tool to Predict Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors

Medical Sciences ◽

10.3390/medsci8040042 ◽

2020 ◽

Vol 8 (4) ◽

pp. 42

Author(s):

Carlos M Chiesa-Estomba ◽

Jon A Sistiaga-Suarez ◽

José Ángel González-García ◽

Ekhiñe Larruscain ◽

Giovanni Cammaroto ◽

...

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Prediction Models ◽

Facial Nerve Palsy ◽

Benign Tumors ◽

Proof Of Concept ◽

Nerve Monitoring ◽

Facial Nerve Monitoring ◽

Artificial Neural ◽

And Performance

(1) Background: Despite the increasing use of intraoperative facial nerve monitoring during parotid gland surgery or the improvement in the preoperative radiological assessment, facial nerve injury (FNI) continues to be the most feared complication; (2) Methods: patients who underwent parotid gland surgery for benign tumors between June 2010 and June 2019 were included in this study aiming to make a proof of concept about the reliability of an artificial neural networks (AAN) algorithm for prediction of FNI and compared with a multivariate linear regression (MLR); (3) Results: Concerning prediction accuracy and performance, the ANN achieved the highest sensitivity (86.53% vs 46.23%), specificity (95.67% vs 92.59%), PPV (87.28% vs 66.94%), NPV (95.68% vs 83.37%), ROC–AUC (0.960 vs 0.769) and accuracy (93.42 vs 80.42) than MLR; and (4) Conclusions: ANN prediction models can be useful for otolaryngologists—head and neck surgeons—and patients to provide evidence-based predictions about the risk of FNI. As an advantage, the possibility to develop a calculator using clinical, radiological and histological or cytological information can improve our ability to generate patients counselling before surgery.

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8:38 AM: Parotidectomy Complications: Role of Facial Nerve Monitoring

Otolaryngology ◽

10.1016/s0194-5998(96)80694-2 ◽

1996 ◽

Vol 115 (2) ◽

pp. P100-P101

Author(s):

Pavel Dulguerov

Keyword(s):

Facial Nerve ◽

Nerve Monitoring ◽

Facial Nerve Monitoring

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Clinical Usefulness of a Special Mosquito Clamp for Intraoperative Facial Nerve Monitoring for Tumors of the Parotid Gland and Parapharyngeal Space

Practica Oto-Rhino-Laryngologica ◽

10.5631/jibirin.104.911 ◽

2011 ◽

Vol 104 (12) ◽

pp. 911-916

Author(s):

Yutaka Tokumaru ◽

Noboru Habu ◽

Akihito Shindo ◽

Kimitaka Kaga ◽

Masato Fujii

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Parapharyngeal Space ◽

Clinical Usefulness ◽

Nerve Monitoring ◽

Facial Nerve Monitoring

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Patterns of Use of Facial Nerve Monitoring During Parotid Gland Surgery

Otolaryngology ◽

10.1016/j.otohns.2005.03.010 ◽

2005 ◽

Vol 133 (3) ◽

pp. 313-318 ◽

Cited By ~ 42

Author(s):

Thomas R. Lowry ◽

Thomas J. Gal ◽

Joseph A. Brennan

Keyword(s):

United States ◽

Parotid Gland ◽

Facial Nerve ◽

The United States ◽

Nerve Monitoring ◽

Patterns Of Use ◽

Facial Nerve Monitoring ◽

Parotid Surgery ◽

History Of ◽

Training Background

OBJECTIVE: To determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States. STUDY DESIGN AND SETTING: A questionnaire encompassing surgeon training background, practice setting, patterns of facial nerve monitor usage during parotid gland surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between facial nerve monitor usage and dependent variables were examined by using the χ 2 test. Magnitudes of the associations were determined from odds ratios calculated using logistic regression. RESULTS: A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy employed facial nerve monitoring some or all of the time. Respondents were 5.6 times more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed more than 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertent nerve injury if they performed more than 10 parotidectomies per year. Surgeons who employed monitoring in their practice were 20.8% less likely to have a history of a parotid surgery-associated lawsuit. Additional information regarding surgeon demographics, types of nerve monitors used, and reasons for and against monitor usage are discussed. CONCLUSION: Permanent facial nerve paralysis after parotidectomy occurs in 0-7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.

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