Objective Assessment of the Perineural Vascular Plexus as a Landmark for the Horizontal Part of the Facial Nerve in Middle Ear and Mastoid Surgery

Abstract

To objectively evaluate the usefulness and the reliability of the perineural vascular plexus as a landmark for identification of the facial nerve in surgery for chronic squamous otitis media. Prospective case series. Tertiary otologic center. Seventy consecutive patients requiring surgery for cholesteatomatous otitis media. Use of a semiquantitative grading system intraoperatively to assess the utility and ease of using the perineural facial plexus as the pointer to the facial nerve. Description of the perineural vascular plexus and assessment of the reproducibility of the grading system. In 82.5% of patients, the plexus was used as the sole pointer to the level of the facial nerve, with other landmarks being used in the remaining 17.5%. A very prominent vessel was used to identify the nerve in 82.5%, therefore being classified as Grade 1. Multiple small vessels were seen in 15.8% (Grade 2), and in 1.5% the vessel plexus was thin and difficult to identify. The average measure intraclass correlation was 0.75 (95% confidence interval, 0.57-0.85), indicating excellent reproducibility of the system. We believe that the perineural vascular plexus is a dependable and reliable landmark for the level of the facial nerve in surgery for chronic otitis media.