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

(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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Resection of Accessory Parotid Gland Tumors Through a Peroral Approach With Facial Nerve Monitoring

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e3180338477 ◽

2007 ◽

Vol 18 (6) ◽

pp. 1419-1421 ◽

Cited By ~ 20

Author(s):

Joachim Schmutzhard ◽

Ilona M. Schwentner ◽

Jan Andrle ◽

Andreas R. Gunkel ◽

Georg M. Sprinzl

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Nerve Monitoring ◽

Parotid Gland Tumors ◽

Facial Nerve Monitoring ◽

Accessory Parotid Gland

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

Romanian Journal of Rhinology ◽

10.1515/rjr-2016-0018 ◽

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.

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

Otolaryngology ◽

10.1177/0194599813496044a151 ◽

2013 ◽

Vol 149 (2_suppl) ◽

pp. P192-P192

Author(s):

Jiahui Lin ◽

William I. Kuhel ◽

Erich P. Voigt ◽

Marc A. Cohen ◽

David I. Kutler

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Nerve Monitoring ◽

Parotid Gland Tumors ◽

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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Comparison of the incidence of facial nerve dysfunction in patients submitted to surgery for parotid gland tumors with or without facial nerve monitoring with continuous electromyographic register during the surgery

http://isrctn.com/ ◽

10.1186/isrctn13966417 ◽

2018 ◽

Author(s):

Agnaldo Graciano

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Nerve Monitoring ◽

Parotid Gland Tumors ◽

Facial Nerve Monitoring ◽

Nerve Dysfunction

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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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