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. 2024 Mar;281(3):1483-1492.
doi: 10.1007/s00405-023-08384-0. Epub 2023 Dec 21.

Continuous intraoperative neuromonitoring of the facial nerve predicts postoperative facial palsy in parotid surgery: a prospective study

Petar Stanković  1 , Stephan Hoch  2   3 , Boris A Stuck  2   3 , Thomas Wilhelm  4   3
Affiliations

Continuous intraoperative neuromonitoring of the facial nerve predicts postoperative facial palsy in parotid surgery: a prospective study

Petar Stanković et al. Eur Arch Otorhinolaryngol. 2024 Mar.

Abstract

Purpose: Facial palsy (FP) is the most significant complication of parotidectomy. Currently, the use of intermittent intraoperative neuromonitoring (iIONM) in parotid surgery facilitates nerve detection, which is paramount to nerve protection. Continuous IONM (cIONM), as applied in thyroid surgery, enables real-time information on electrophysiological nerve status through continuous nerve stimulation, thereby allowing consequent amplitude analysis. To date, the application of cIONM in parotid surgery has not been noted in literature.

Methods: We performed parotidectomies with anterograde facial nerve visualization using cIONM in 32 consecutive patients in a prospective study (German Register of clinical studies-DRKS 00011051) during the period October 2016 to January 2020. After the facial trunk had been exposed, an atraumatic stimulation electrode was placed and the nerve was stimulated at 3 Hz, at a low threshold (0.62 ± 0.06 mA), for the entire duration of the preparation. Selected electrophysiological parameters were collected and compared to postoperative facial nerve function, measured by the House-Brackmann grading system.

Results: In the post hoc analysis, a significant correlation between a drop in amplitude (< 50% of the "baseline" amplitude) and postoperative FP was recorded (p = 0.001). True positive prediction of FP was noted in 14 out of 16 patients and true negative in 10 out of 16. The sensitivity was 87.5% (AUC 0.75), with a high negative predictive value of 83.3%.

Conclusion: cIONM has significant value in predicting postoperative FP in parotidectomy. Future development of an acoustic/optic warning system in IONM devices could prevent nerve injury in real time.

Keywords: Facial palsy; Intraoperative neuromonitoring; cIONM.

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References

    1. Kadletz L, Grasl S, Grasl MC, Perisanidis C, Erovic BM (2017) Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: the Vienna Medical School experience: outcomes of parotid gland surgery. Head Neck 39(2):356–360. https://doi.org/10.1002/hed.24598 - DOI - PubMed
    1. Grosheva M, Klussmann JP, Grimminger C et al (2009) Electromyographic facial nerve monitoring during parotidectomy for benign lesions does not improve the outcome of postoperative facial nerve function: a prospective two-center trial. Laryngoscope 119(12):2299–2305. https://doi.org/10.1002/lary.20637 - DOI - PubMed
    1. Bova R, Saylor A, Coman WB (2004) Parotidectomy: review of treatment and outcomes. ANZ J Surg 74(7):563–568. https://doi.org/10.1111/j.1445-2197.2004.02988.x - DOI - PubMed
    1. Prats-Golczer VE, Gonzalez-Cardero E, Exposito-Tirado JA, Montes-Latorre E, Gonzalez-Perez LM, Infante-Cossio P (2017) Impact of dysfunction of the facial nerve after superficial parotidectomy: a prospective study. Br J Oral Maxillofac Surg 55(8):798–802. https://doi.org/10.1016/j.bjoms.2017.07.006 - DOI - PubMed
    1. Savvas E, Hillmann S, Weiss D, Koopmann M, Rudack C, Alberty J (2016) Association between facial nerve monitoring with postoperative facial paralysis in parotidectomy. JAMA Otolaryngol Neck Surg 142(9):828. https://doi.org/10.1001/jamaoto.2016.1192 - DOI

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