Abstract
To develop a technique to reliably secure facial nerve monitoring electrodes, NeurosignTM facial nerve monitor electrodes were attached as per the manufacturer’s instructions. The electrodes were secured with ½ inch steristripsTM before connecting leads were brought to the contralateral side of the face and a single torque loop was created and secured with either more Steri-StripsTM, Micropore tapeTM, or a TegedermTM. By creating a single torque loop, a buffer between the electrode and its anchor point to the contralateral face was formed. This allowed for the secure attachment of leads from the electrodes by removing tension, thereby reducing the likelihood of displacement. We have used this technique successfully for the last three years in over 50 parotid procedures and 50 middle ear explorations. Facial nerve monitoring is an important surgical tool used in otology and head and neck surgery. Using torque loops when preparing a patient for surgery prevents the dislodgement of electrodes during operation, thereby ensuring the safety of the patient in a sometimes perilous environment.
Highlights
Post-operative facial nerve paralysis is a devastating complication of otological and head and neck surgery
Facial nerve monitoring is a common adjuvant used during procedures that can place the facial nerve at risk of injury, its routine use in parotid surgery remains controversial [2]
A prospective questionnaire in the United States reported that facial nerve monitors had been used in 60% of parotid surgery performed by ear, nose and throat (ENT) surgeons [1]
Summary
Post-operative facial nerve paralysis is a devastating complication of otological and head and neck surgery. The current literature estimates that up to 7% of patients will suffer permanent facial nerve injury following parotid surgery [1]. A prospective questionnaire in the United States reported that facial nerve monitors had been used in 60% of parotid surgery performed by ear, nose and throat (ENT) surgeons [1]. The authors have reported that respondents to their survey were 20.8% less likely to have a lawsuit from parotid gland surgery if they employed facial nerve monitoring in their practice [1]. A retrospective study of US civil trials from 1987–2011 revealed 26 cases of malpractice for parotid surgery, 10 of which involved injury to the facial nerve, with the largest indemnity awarded of $7,272,087 [3]
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