[Intraoperative facial nerve monitoring in parotid gland surgery].
ABSTRACT To re-evaluate the value and the methods of intraoperative facial nerve monitoring in parotid gland surgery.
Sixty-five cases received intraoperative facial nerve monitoring in parotidectomy (test group) since 2000 - 2008. The facial nerve was identified through central trunk method (n = 18), branch method (n = 35) and mixed method (n = 12). Most patients accepted general anesthesia by incubation. The operating duration and minimum electronic stimulation threshold values of EMG in evoked facial muscle were recorded. Facial nerve was identified though branch method (n = 44) and no intraoperative facial nerve monitoring was performed in parotidectomy (control group).
There were four cases (6.1%) of mild temporary paralysis and no permanent post-operative paralysis of facial nerve in the test group. The average operating duration was 1.8 hour. The minimum reactive electronic stimulation threshold of EMG in evoked facial muscle was 0.08 mA. The range of suitable electronic stimulation threshold of EMG was from 0.2 mA to 1.0 mA. While there were nine cases (20.5%) of mild temporary paralysis and two cases (4.5%) of permanent post-operative paralysis of facial nerve in the control group and the average operating duration was 3.0 hours.
Intraoperative facial nerve monitoring (IFNM) in parotidectomy can assist a surgeon to confirm and identify the facial nerve and exercise precautions so as to shorten operating duration and prevent potential surgical complications.
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ABSTRACT: To determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. PubMed-NCBI database from 1970 to 2014. A systematic review and meta-analysis of the literature was conducted. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs control). Primary and secondary end points were defined as immediate postoperative and permanent facial nerve weakness (House-Brackmann score, ≥2), respectively. After a review of 1414 potential publications, 7 articles met inclusion criteria, with a total of 546 patients included in the final meta-analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared to the unmonitored group (22.5% vs 34.9%; P = .001). The incidence of permanent weakness was not statistically different in the long term (3.9% vs 7.1%; P = .18). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 9, given an absolute risk reduction of 11.7% This corresponded to a 47% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.53; 95% CI, 0.35 to 0.79; P = .002). In primary cases of parotidectomy, intraoperative FNM decreases the risk of immediate postoperative facial nerve weakness but does not appear to influence the final outcome of permanent facial nerve weakness. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P56-P56. DOI:10.1177/0194599814541627a86 · 1.72 Impact Factor
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ABSTRACT: Münster (Westfalen), Univ., Diss., 2004 (Nicht für den Austausch).