scholarly journals Correlation between Electrophysiological Change and Facial Function in Parotid Surgery Patients

2021 ◽  
Vol 10 (24) ◽  
pp. 5730
Author(s):  
Feng-Yu Chiang ◽  
Chih-Chun Wang ◽  
Che-Wei Wu ◽  
I-Cheng Lu ◽  
Pi-Ying Chang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Weakness ◽  
Nerve Monitoring ◽  
Facial Region ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery ◽  
High Incidence ◽  
Visual Confirmation ◽  
Amplitude Decrease ◽  
Facial Function

This observational study investigated intraoperative electrophysiological changes and their correlation with postoperative facial expressions in parotidectomy patients with visual confirmation of facial nerve (FN) continuity. Maximal electromyography(EMG) amplitudes of the facial muscles corresponding to temporal, zygomatic, buccal and mandibular branches were compared before/after FN dissection, and facial function at four facial regions were evaluated before/after parotidectomy in 112 patients. Comparisons of 448 pairs of EMG signals revealed at least one signal decrease after FN dissection in 75 (67%) patients. Regional facial weakness was only found in 13 of 16 signals with >50% amplitude decreases. All facial dysfunctions completely recovered within 6 months. EMG amplitude decreases often occur after FN dissection. An amplitude decrease >50% in an FN branch is associated with a high incidence of dysfunction in the corresponding facial region. This study tries to establish a standard facial nerve monitoring (FNM) procedure and a proper facial function grading system for parotid surgery that will be useful for the future study of FNM in parotid surgery.

scholarly journals The role of continuous intraoperative neuromonitoring followed by facial nerve stimulation during parotidectomy

2016 ◽  
Vol 6 (23) ◽  
pp. 161-165
Author(s):  
Georgiana Pasu
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Continuous Monitoring ◽  
Benign Tumors ◽  
Neural Function ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery ◽  
Electrophysiological Signals ◽  
Neural Monitoring

Abstract BACKGROUND. Intraoperative neural monitoring (IONM) has begun to be studied in detail by surgeons around the world since several decades ago from the need to verify functional integrity of the neural elements. Parotid gland surgery requires a thorough knowledge of the anatomy of this region by ENT surgeons. Also, the surgeons performing parotid surgery need to have important strategies of management which include: handiness to identify facial nerve, dissection nerve branches and application of neuromonitoring in order to preserve nerve functions. OBJECTIVE. This study has analysed the usefulness of intraoperative continuous monitoring in superficial or in total parotidectomy. It identifies the facial nerve and reduces the risk of postoperative facial palsy. We have been using intraoperative continuous monitoring - evoked facial nerve electromyograms (EMG). MATERIAL AND METHODS. Continuous intraoperative facial nerve monitoring was prospectively achieved in the case of three patients diagnosed with benign tumors, on which parotidectomy with the preservation of the nerve was carried out in order to highlight the value and efficacy of this method. RESULTS. In our country, continuous intraoperative facial nerve monitoring performance is still not a common practice in ENT Departments. It revealed postoperatively that the incidence of temporary or permanent facial palsy was 0% and the minimal stimulation was obtained at levels equal to 0,5 mA, which implies integral functioning of the facial nerve. CONCLUSION. In parotid surgery, facial nerve IONM represents the gold standard in recognition of real-time electrophysiological signals, electromyography waves and auditory signals to enable the correct approach wherever possible, avoiding extensive nerve damage. It is known the importance of continuous IONM in postoperative prognosis of the neural function and intraoperative decision making regarding the technical surgery.

Patterns of Use of Facial Nerve Monitoring During Parotid Gland Surgery

2005 ◽  
Vol 133 (3) ◽  
pp. 313-318 ◽  
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.

Intra-operative facial nerve monitoring. Its predictive value after skull base surgery

1997 ◽  
Vol 111 (8) ◽  
pp. 715-718 ◽  
Author(s):  
Giuseppe Magliulo ◽  
Francesco Zardo
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Predictive Value ◽  
Skull Base Surgery ◽  
Evoked Response ◽  
Nerve Function ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Stimulation Current ◽  
Facial Function

AbstractPurposeFacial nerve monitoring can be used to predict post-operative facial function after skull base surgery. In this study three methods of prediction of facial function were compared. These methods utilize various parameters of the evoked electromyographic monitoring.Material and methodsTwenty-three patients who underwent surgery for skull base diseases were retrospectively reviewed. Amplitude of ongoing electromyographic activity, stimulation current thresholds and amplitude of evoked response were analysed. The predictive value of the three methods was correlated with post-operative facial nerve function.ResultsThe method that used only the stimulation thresholds predicted the final post-operative facial function in 86.9 per cent of the patients. The second employed a mathematical ratio which combined the amplitude of evoked response and the stimulation current thresholds and confirmed the prediction of the facial function in 91.3 per cent of the patients. The last method does not consider the stimulation thresholds greater than 0.05 mA and failed to predict the final VIIth nerve function in patients in whom the stimulation was greater than 0.05 mA.ConclusionAnalysis of prognostic value demonstrates that the first two methods had the smaller degree of variation showing the better sensitivity.

Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome

2005 ◽  
Vol 102 (4) ◽  
pp. 643-649 ◽  
Author(s):  
Douglas E. Anderson ◽  
John Leonetti ◽  
Joshua J. Wind ◽  
Denise Cribari ◽  
Karen Fahey
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Nerve Monitoring ◽  
Content Type ◽  
Nerve Preservation ◽  
Facial Nerve Monitoring ◽  
Facial Function ◽  
Fine Print

Object. Vestibular schwannoma surgery has evolved as new therapeutic options have emerged, patients' expectations have risen, and the psychological effect of facial nerve paralysis has been studied. For large vestibular schwannomas for which extirpation is the primary therapy, the goals remain complete tumor resection and maintenance of normal neurological function. Improved microsurgical techniques and intraoperative facial nerve monitoring have decreased the complication rate and increased the likelihood of normal to near-normal postoperative facial function. Nevertheless, the impairment most frequently reported by patients as an adverse effect of surgery continues to be facial nerve paralysis. In addition, patient assessment has provided a different, less optimistic view of outcome. The authors evaluated the extent of facial function, timing of facial nerve recovery, patients' perceptions of this recovery and function, and the prognostic value of intraoperative facial nerve monitoring following resection of large vestibular schwannomas; they then analyzed these results with respect to different surgical approaches. Methods. The authors retrospectively reviewed a database of 67 patients with 71 vestibular schwannomas measuring 3 cm or larger in diameter. The patients had undergone surgery via translabyrinthine, retrosigmoid, or combined approaches. Clinical outcomes were analyzed with respect to intraoperative facial nerve activity, responses to intraoperative stimulation, and time course of recovery. Eighty percent of patients obtained normal to near-normal facial function (House—Brackmann Grades I and II). Patients' perceptions of facial nerve function and recovery correlated well with the clinical observations. Conclusions. Trends in the data lead the authors to suggest that a retrosigmoid exposure, alone or in combination with a translabyrinthine approach, offers the best chance of facial nerve preservation in patients with large vestibular schwannomas.

scholarly journals The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

2017 ◽  
Vol 33 (8) ◽  
pp. 400-404 ◽  
Author(s):  
I-Cheng Lu ◽  
Pi-Ying Chang ◽  
Miao-Pei Su ◽  
Po-Nien Chen ◽  
Hsiu-Ya Chen ◽  
...  
Keyword(s):  
Facial Nerve ◽  
General Anesthesia ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery

scholarly journals Incidence of postoperative facial weakness in parotid tumor surgery: a tumor subsite analysis of 794 parotidectomies

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hokyung Jin ◽  
Bo Young Kim ◽  
Heejung Kim ◽  
Eunkyu Lee ◽  
Woori Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Facial Nerve ◽  
Old Age ◽  
Malignant Tumors ◽  
Tumor Surgery ◽  
Parotid Tumor ◽  
Facial Weakness ◽  
Nerve Monitoring ◽  
Deep Lobe ◽  
Facial Nerve Monitoring

Abstract Background The reported incidence of facial weakness immediately after parotid tumor surgery ranges from 14 to 65%. The purpose of this study was to evaluate the incidence of postoperative facial weakness related to parotidectomy with use of preoperative computed tomography (CT), intraoperative facial nerve monitoring, and surgical magnification. Also, we sought to elucidate additional information about risk factors for postoperative facial weakness in parotid tumor surgery, particularly focusing on the tumor subsites. Methods We retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009–2016). Patients with pretreatment facial palsy were excluded from the analyses. Tumor subsites were stratified based on their anatomical relations to the facial nerve as superficial, deep, or both. Multivariable logistic regression analyses were conducted to identify risk factors for postoperative facial weakness. Results The overall incidences of temporary and permanent (more than 6 months) facial weakness were 9.2 and 5.2% in our series utilizing preoperative CT, intraoperative facial nerve monitoring, and surgical magnification. Multivariable analysis revealed that old age, malignancy, and recurrent tumors (revision surgery) were common independent risk factors for both temporary and permanent postoperative facial weakness. In addition, tumor subsite (tumors involving superficial and deep lobe) was associated with postoperative facial weakness, but not tumor size. Extent of surgery was strongly correlated with tumor pathology (malignant tumors) and tumor subsite (tumors involving deep lobe). Conclusion Aside from risk factors for facial weakness in parotid tumor surgery such as old age, malignant, or recurrent tumors, the location of tumors was found to be related to postoperative facial weakness. This study result may provide background data in a future prospective study and up-to-date information for patient counseling.

scholarly journals The Utility of Facial Nerve Monitoring for Parotid Surgery

2012 ◽  
Vol 147 (2_suppl) ◽  
pp. P51-P51
Author(s):  
Christian G. Samuelson ◽  
Michael Friedman ◽  
Craig S. Hamilton
Keyword(s):  
Facial Nerve ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery

Stratifying the risk of facial nerve palsy after benign parotid surgery

2014 ◽  
Vol 128 (2) ◽  
pp. 159-162 ◽  
Author(s):  
N Sethi ◽  
P H Tay ◽  
A Scally ◽  
S Sood
Keyword(s):  
Risk Factors ◽  
Facial Nerve ◽  
Facial Palsy ◽  
Significant Risk ◽  
Chi Square ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery ◽  
Potential Risk Factors ◽  
Chi Square Test

AbstractIntroduction:Post-operative facial palsy is the most important potential complication of parotid surgery for benign lesions. The published prevalence of facial weakness is up to 57 per cent for temporary weakness and up to 7 per cent for permanent weakness. We aimed to identify potential risk factors for post-operative facial palsy.Materials and methods:One hundred and fifty patients who had undergone parotid surgery for benign disease were retrospectively reviewed. Tumour factors (size, location and histopathology), patient factors (age and sex) and operative factors (operation, surgeon grade, surgeon specialty and use of intra-operative facial nerve monitoring) were all analysed for significant associations with post-operative facial palsy.Results and analysis:The overall incidence of facial palsy was 26.7 per cent for temporary weakness and 2.6 per cent for permanent weakness. The associations between facial palsy and all the above factors were analysed using Pearson's chi-square test and found to be non-significant.Conclusion:These outcomes compare favourably with the literature. No significant risk factors were identified, suggesting that atraumatic, meticulous surgical technique is still the most important factor affecting post-operative facial palsy.

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