Abstract
PurposeEarly facial nerve palsy (eFNP) is the most frequent complication of the parotidectomy. Intraoperative neuromonitoring (IONM) in parotid surgery, which aims at reducing eFNP, has not evolved any further than the mere differentiation between the nerve and the surrounding tissue. Continuous IONM (cIONM), used in thyroid and posterior fossa surgery, has developed over the past years and has proved beneficial in reducing the rate of paresis in cases where a pattern of impending nerve injury is identified. In this study, we aim to demonstrate the safety of using the stimulating electrode (Saxophone®) for cIONM in parotid surgery.MethodsFrom 2016 to 2018, 40 patients who were referred for primary parotidectomy under cIONM according to our study protocol (registered at the German Clinical Trials Register, DRKS-ID: DRKS00011051, http://www.drks.de; http://apps.who.int/trialsearch) were included in this study. All patients with a normal preoperative facial nerve function [House–Brackman (HB)-Index 1] underwent surgery using continuous facial nerve stimulation with the Saxophone® electrode (system AVALANCHE XT, Dr. Langer Medical, Waldkirch, Germany). A control group which underwent parotidectomies with only intermittent IONM was recruited from our records.ResultsHalf of the patients in our study group suffered from eFNP. All except one regained normal facial nerve function within 6 months of surgery. There was no significant difference regarding eFNP when compared to the control group without cIONM (p = 0.11). No statistically significant correlation between the stimulation threshold (p = 0.74) or the duration of nerve stimulation and eFNP was found (p = 0.51).ConclusionWe have demonstrated the safety of using the Saxophone®-electrode for cIONM of the facial nerve in parotid surgery. Future development of this method could enable the recognition of impending nerve injury and thus reduce eFNP.
Highlights
Facial nerve palsy is the most frequent complication of parotidectomy with reported rates of 28.8–77.2% in primary surgery [1,2,3,4,5]
Efforts have been made to reduce the rate of Early facial nerve palsy (eFNP) by making use of intraoperative neuromonitoring (IONM)
We have aimed to demonstrate the safety of this Continuous IONM (cIONM) by comparing the results of a prospective study cohort to a retrospective patient group who had solely undergone intermittent IONM. cIONM of the facial nerve of up to 1 mA proved a safe procedure and was not connected to a higher rate of eFNP
Summary
Facial nerve palsy (eFNP) is the most frequent complication of parotidectomy with reported rates of 28.8–77.2% in primary surgery [1,2,3,4,5]. This pertains to superficial lateral or partial superficial lateral parotidectomy with nerve dissection. It has been shown that eFNP has a significant impact on the physical and psychosocial well-being of the patient [5]. Efforts have been made to reduce the rate of eFNP by making use of intraoperative neuromonitoring (IONM). A recent meta-analysis showed IONM to significantly reduce eFNP [6]. The history of IONM started in 1969 [7], no significant breakthrough in the method has been noted and IONM in parotid
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