[Intraoperative facial nerve monitoring for parotid gland surgery]

Abstract

Introduction: The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present.

Aim of the study: Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery.

Material and methods: Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007-2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system.

Results: Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery.

Conclusions: Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.