Patterns of use of facial nerve monitoring during parotid gland surgery

Abstract

Objectives: The purpose of this study was to determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States. Methods: A questionnaire encompassing training background, practice setting, patterns of facial nerve monitor usage during parotid surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between monitor usage and dependent variables were examined using X2 tests, and magnitudes of associations were determined with odds ratios calculated using logistic regression. Results: A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy used facial nerve monitoring some or all of the time. Respondents were 5.6% more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed over 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertant nerve injury if they did more than 10 parotidectomies per year. Surgeons who used monitoring in their practice were 20.8% less likely to have a history of parotid surgery-associated lawsuit. Additional information regarding demographics, type of nerve monitors used, and reasons for and against monitor usage are discussed. Conclusions: Permanent facial nerve paralysis following parotidectomy occurs in 0%-7% of cases. Consequently, a majority of otolaryngologists are turning to facial nerve monitoring during parotid surgery to reduce this complication rate even further. Physician training and surgery caseload are significant factors influencing usage of facial nerve monitoring.