Postoperative Facial Nerve Injury Research Articles

Modified Endaural Approach With a Peripheral Dissection of the Superficial Musculoaponeurotic System to Access the Temporomandibular Joint to Prevent Facial Nerve Injury.

The purpose of this study was to assess the effects of protecting the facial nerve with a modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint which allows an excellent operative field of visualization, multiple surgical procedures of the temporomandibular joint, and general care which improves the immediate postoperative period, making this a less morbid surgery. This study included 33 patients (39 sides) who underwent surgical treatment for disorders of the temporomandibular joint from the years 2021 to 2023 at the maxillofacial department of the clinic "Colsanitas" located in Bogota, Colombia. Therapeutic results were evaluated by postoperative facial nerve injury, with the House-Brackman scale; every patient was examined for adequate facial musculature function immediately after surgery. Notably, zero patients presented facial nerve injury. These results imply that the modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint reduces the incidence of facial nerve injuries, improves operative site exposure, and lowers the frequency of complications.

Risk factors for postoperative facial nerve injury in retromandibular-approach surgery: A retrospective study including CT measurements of maxillofacial bone structure

The purpose of this retrospective study was to identify risks of postoperative facial nerve injury (FNI) in mandibular condylar fractures. A total of 59 consecutive cases of condyle fracture or plate removal with a retromandibular transparotid approach (RMTA) were divided into FNI and non-FNI groups that were evaluated for associations with age, sex, laterality, fracture type, height, weight, body mass index (BMI), and maxillofacial bone height and width diameters on computed tomography (CT).FNI occurred in 11 of 59 patients (18.64%), all of them female (p = 0.0011). Other statistically significant factors on univariate analysis for FNI included a short height (156.95 ± 8.16 cm vs. 164.29 ± 9.89 cm, p = 0.04), low weight (46.08 ± 8.03 kg vs. 58.94 ± 11.79 kg, p = 0.003), low BMI (18.64 ± 2.63 kg/m2 21.68 ± 3.02 kg/m2, p = 0.007), short condylion–anterior fracture distance (19.34 ± 3.15 mm vs. 22.26 ± 3.96 mm, p = 0.04) and short condylion–posterior fracture distance (20.12 ± 3.98 mm vs. 25.45 ± 5.02 mm, p = 0.009).Our retrospective study suggested that FNI with RMTA surgery occurs particularly in female patients and may occur more frequently in patients who are short, lean or have high condyle fractures.

Transoral Excision of a Large Accessory Parotid Gland Tumor.

Accessory parotid gland (APG) tumors account for 1% to 7% of all parotid gland neoplasms but are more likely to be malignant than main parotid gland tumors. Management of APG neoplasms entails surgical excision. Four primary approaches to resection have been described in the literature with varying facial nerve outcomes. We report a case of a 4-cm APG pleomorphic adenoma utilizing a transoral approach for excision without postoperative facial nerve injury. A transoral approach is known to mitigate patients' cosmetic concerns; however, prior reports utilized endoscopic assistance on patients with smaller tumors. We conclude that large APG tumors can be excised through a transoral approach without undue risk to the distal facial nerves, though this transoral approach ultimately may not be appropriate for malignant neoplasms or difficult dissections.

Clinical application of midpiece facial nerve dissection in regional parotidectomy

To propose and evaluate the clinical effect of midpiece facial nerve dissection through transparotid approach in regional parotidectomy. A total of 136 patients with benign parotid tumors were categorized into three groups according to the way of facial nerve dissection: anterograde dissection from main trunk (anterograde, n=70), retrograde dissection from distal branches (retrograde, n=34), and midpiece dissection through transparotid approach (middle dissection, n=32). Surgery duration, facial nerve injury, salivary fistula, earlobe sensation, Frey's syndrome, and aesthetic evaluation were compared. The surgery duration in the middle dissection group was significantly shorter than that in the other two groups. The proportion of salivary fistula was higher in the anterograde group (9 cases, 12.9%; P<0.05) compared with that in the other groups. Postoperative facial nerve injury was similar between the middle dissection (1 case, 3.1%) and anterograde groups (3 cases, 4.3%) with lower injury rate compared with the retrograde group (7 cases, 20.6%). The anterograde group had more cases of hypoesthesia of the earlobe (12 cases, 17.1%; P<0.05) than the other two groups. Aesthetic score was higher in the anterograde and middle dissection groups compared with that in the retrograde group (P<0.05). Midpiece facial nerve dissection is technically feasible and clinically viable in regional parotidectomy.

Facelift Surgery Following Superficial Parotidectomy: Is it Safe?

Patients who have previously undergone superficial parotidectomy may also seek facelift surgery for facial aging and rejuvenation. These patients present unique challenges compared to a standard facelift patient. Most concerning is the location of facial nerve branches, which may be superficial and displaced. In addition, significant contour deformities and abnormal scar patterns may be present. The purpose of the study is to review our series of patients and assess potential morbidity and safety of facelift surgery in superficial parotidectomy patients. A retrospective case series was performed reviewing all patients who underwent facelift surgery following superficial parotidectomy from 2000 to 2017. Data were collected for: postoperative facial nerve deficit, soft tissue contour and scar deformities, facelift technique, ancillary soft tissue augmentation procedures and pre- and postoperative photographs. An evidence-based treatment algorithm to address specific problems in this patient population was developed. A total of seven patients were identified who underwent facelift surgery following parotidectomy. Patients underwent one of the standard SMAS procedure on the non-parotidectomy side, and surgical modifications were made to address the parotidectomy side; soft tissue augmentation was performed in two patients. Precautions to identify the facial nerve and prevent injury, including nerve monitoring and stimulation, were utilized in all seven patients. No permanent postoperative facial nerve injury was noted. Facelift following superficial parotidectomy was safely performed in all cases. Special consideration should be given to contour deformities, facial nerve location and scar placement. However, if approached properly, these patients can still be considered as suitable candidates for facelift surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

CRB modification to retromandibular approach for management of subcondylar fractures.

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular subcondylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was carried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was recorded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of retromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome.

An investigation of life quality of patients after two different acoustic neuroma resections

Background: Patients may suffer postoperative facial nerve injury, hearing loss, or other postoperative complications after the operation, which seriously affect their postoperative life quality.Aims/objectives: To investigate the differences in QOL (quality of life) of patients with acoustic neuroma resection by the translabyrinthine or retrosigmoid approach.Material and methods: Patients with acoustic neuroma resection in our department were enrolled in this experimental study, among which fifty patients underwent the translabyrinthine approach resection, the other 50 patients underwent the retrosigmoid approach resection. Different scores by the SF-36 scale between these two groups of patients one month after discharge were then analyzed.Results: Scores of patients undergoing the retrosigmoid approach were higher in the three dimensions of Social Functioning, Role-emotional and Mental Health than those of patients undergoing the translabyrinthine approach with statistical significance. However, scores of patients undergoing the translabyrinthine approach were higher in the two dimensions of Body Pain and Vitality than those of the patients undergoing the retrosigmoid approach.Conclusions and significance: The results indicated that individual nursing interventions for different patients are necessary to improve the QOL of patients after hospitalization. Moreover, the operated patients with translabyrinthine approach were more advantage than patients with retrosigmoid approach.

A Modified Pre-Auricular Approach in the Treatment of Orbital Zygomatic Maxillary Complex Fractures.

This study aimed to evaluate the safety of a modified pre-aricular approach in the treatment of orbital zygomatic maxillary complex fractures. This was a retrospective study of clinical data from 108 adults who were diagnosed with orbital zygomatic maxillary complex fractures and undergo open reduction and internal fixation through a modified pre-auricular approach. Exophthalmometry and limitation of extraocular muscle movement were determined using a Hertel exophthalmometer or synoptophore examination respectively. Primary complications were recorded, and postoperative facial nerve injury was tested by electrophysiologic analysis. All patients received satisfied functional and cosmetic results at least 6 moths postoperatively. There were 2 cases (1.85%) involving complete or incomplete facial nerve injury confirmed by electrophysiologic analysis. The incidence of other postoperative complications including a hematoma rate of 1.85% patients and permanent hypesthesia or paresthesia in 2.78% of patients, and no cases of clinically significant temporal hollowing, alopecia, infection, or unacceptable scars encountered during a mean follow-up period of 2 years. A modified pre-auricular approach with dissection deep to the temporalis fascia offers a safe and reliable surgical technique for accessing the malar arch in orbital zygomatic maxillary complex fractures.

Comparison of two approach for facial nerve surgery on facial nerve injury in the parotid benign tumor

Objective:To compare the function of facial nerves in patients with parotid benign tumors underwent surgery with retrograde method to expose nerve trunk or the marginal mandibular branch.Method:Fifty-five hospital patients from March 2013 to september 2015 were involved in this study and divided into group A(facial nerve trunk exposure, 27 cases), B group(facial nerve mandible branch exposure, 28 cases). Facial nerve injury in two groups was evaluated by observation of abnormal facial performance and electrophysiological techniques. Result:After a follow up of 1 year, the postoperative incidence of facial nerve injury in group A and group B were 7.41% and 25%, respectively, which was evaluated by observation of abnormal facial performance. Moreover,the rates were 14.81%, 30.29%, respectively, which was evaluated by electrophysiological techniques. The rate of postoperative facial nerve injury in group B of patients with was significantly higher than that of group A(P<0.05). Conclusion:Operation with facial nerve trunk exposure can obviously reduce the occurrence of symptoms of facial paralysis in diameter <5 cm of the parotid benign tumor surgery, is suitable for clinical application.

NIMG-09. PREDICTION OF FACIAL NERVE POSITION IN LARGE VESTIBULAR SCHWANNOMA USING DIFFUSION TENSOR IMAGING TRACTOGRAPHY AND ITS INTRA-OPERATIVE CORRELATION

Resection of large vestibular schwannomas (VS), can be associated with postoperative facial nerve injury. Diffusion-based tractography has emerged as a powerful tool for three- dimensional imaging and reconstruction of white matter fibers; however, tractography of the cranial nerves has not been well studied. In this prospective study, we aim to predict the position of facial nerve in large vestibular schwannomas (> 3cm) using Diffusion Tensor Imaging (DTI) tractography and correlate it with intra-operative finding of the position of facial nerve. Twenty patients with large vestibular schwannomas (>3cm) undergoing surgery were subjected to preoperative DTI imaging to predict the position of facial nerve in relation to the tumor. The surgeon was blinded to the results of the preoperative DTI tractography. A comparative analysis was then made during operation. The location of the facial nerve in relation to the tumor was recorded during surgery using facial nerve stimulator. Out of the twenty patients who underwent DTI tractography, it was not possible to preoperatively identify facial nerve in one patient. In another patient, although DTI tractography predicted the position of facial nerve, it was not identified intraoperatively. Out of the remaining 18 patients, DTI tractography predicted facial nerve position was in sync with intraoperative facial nerve position in 16 patients (89 % concordance). It was discordant in two patients (11%), but this was not found to be statistically significant (p value -0.3679). This study validates the reliability of facial nerve diffusion tensor (DT) imaging–based fiber tracking for prediction of facial nerve position in patients with large vestibular schwannomas. The reliable preoperative visualization of facial nerve location in relation to VS would allow surgeons to plan tumor removal accordingly and may increase the safety of surgery.

Prediction of facial nerve position in large vestibular schwannomas using diffusion tensor imaging tractography and its intraoperative correlation.

Resection of large Vestibular Schwannomas (VSs) can be associated with postoperative facial nerve injury. Diffusion-based tractography has emerged as a powerful tool for three-dimensional imaging and reconstruction of white matter fibers; however, tractography of the cranial nerves has not been well studied. In this prospective study, we aim to predict the position of facial nerve in large VSs (>3 cm) using Diffusion Tensor Imaging (DTI) tractography and correlate it with the intraoperative finding of the position of facial nerve. Twenty patients with a large VS (>3 cm) undergoing surgery were subjected to preoperative DTI to predict the position of the facial nerve in relation to the tumor. The surgeon was blinded to the results of the preoperative DTI tractography. A comparative analysis was then made during operation. The location of the facial nerve in relation to the tumor was recorded during surgery using facial nerve stimulator. Of the 20 patients who underwent DTI tractography, it was not possible to preoperatively identify facial nerve in one patient. In another patient, although DTI tractography predicted the position of facial nerve, it was not identified intraoperatively. In the remaining 18 patients, DTI tractography accurately predicted the facial nerve position. The predicted position was in synchronization with the intraoperative facial nerve position in 16 patients (89% concordance). It was discordant in two patients (11%), but this was not found to be statistically significant (P = -0.3679). This study validates the reliability of facial nerve DTI-based fiber tracking for prediction of the facial nerve position in patients with large VSs. The reliable preoperative visualization of facial nerve location in relation to the VS will allow surgeons to plan tumor removal accordingly and may increase the safety of surgery.

Intraoperative facial nerve monitoring during cochlear implant surgery: an observational study.

Iatrogenic facial nerve injury is one of the most severe complications of cochlear implantation (CI) surgery. Intraoperative facial nerve monitoring (IFNM) is used as an adjunctive modality in a variety of neurotologic surgeries. The purpose of this retrospective study was to assess whether the use of IFNM is associated with postoperative facial nerve injury during CI surgery. The medical charts of 645 patients who underwent CI from 1999 to 2014 were reviewed to identify postoperative facial nerve palsy between those who did and did not receive IFNM. Four patients (3 children and 1 adult) were found to have delayed onset facial nerve weakness. IFNM was used in 273 patients, of whom 2 had postoperative facial nerve weakness (incidence of 0.73%). The incidence of facial nerve weakness was 0.54% (2/372) in the patients who did not receive IFNM. IFNM had no significant effect on postoperative delayed facial palsy (P = 1.000). All patients completely recovered within 3 months after surgery. Interestingly, all 4 cases of facial palsy received right CI, which may be because all of the surgeons in this study used their right hand to hold the drill. When right CI surgery is performed by a right-handed surgeon, the shaft of the drill is closer to the inferior angle of the facial recess, and it is easier to place the drilling shaft against the medial boundary (facial nerve) when the facial recess is small. The facial nerve sheaths of another 3 patients were unexpectedly dissected by a diamond burr during the surgery, and the monitor sounded an alarm. None of these 3 patients developed facial palsy postoperatively. This suggests that IFNM could be used as an alarm system for mechanical compression even without current stimulation. Although there appeared to be no relationship between the use of monitoring and delayed facial nerve palsy, IFNM is of great value in the early identification of a dehiscent facial nerve and assisting in the maintenance of its integrity. IFNM can still be used as an additional technique to optimize surgical success.

A REVIEW OF 27 PATIENTS TREATED WITH PAROTIDECTOMY AT AL-YARMOUK TEACHING HOSPITAL

Background &#x0D; Parotid gland tumors are the majority of tumors which arise in the salivary glands. Recommended treatment for parotid pathologies is surgical excision. Injury of the facial nerve is the most common complication encountered after parotid surgery.&#x0D; Objective&#x0D; Analyzing the clinical presentations, histopathology and complications following parotid surgery. &#x0D; Methods&#x0D; Patient’s documents were reviewed for those underwent parotidectomy between September 2006 to June 2012. Diagnosis and surgical procedure were standardized in all cases. All patients were monitored thoroughly specially for facial nerve injury and they were followed up for six months.&#x0D; Results&#x0D; 27 patients underwent Parotidectomy with a mean age of 51 years, with male to female ratio 2.8:1. There were two false negative (FN) and one false positive (FP) reported cases by ne needle aspiration cytology (FNAC) with sensitivity of 50% and a speci city of 95.65%. Pleomorphic adenoma was the commonest benign pathology (55.56%). Postoperative facial nerve injury encountered in (37.04 %). 80% of cases were completely recovered in 6 months.&#x0D; Conclusion&#x0D; FNAC should be performed in all patients but regarded only as a helpful investigation for management. And the risk of facial nerve palsy is related to the type, size and extend of the tumour and radicality of the resection done.

Postoperative Complications Following TECA-LBO in the Dog and Cat

The medical records for 133 total ear canal ablations combined with lateral bulla osteotomies (TECA-LBOs) performed on 82 dogs (121 ears) and 11 cats (12 ears) between 2004 and 2010 were reviewed to determine if the duration of preoperative clinical signs was associated with the incidence of postoperative facial nerve injury and Horner's syndrome. Other perioperative complications, such as a head tilt, nystagmus, incisional drainage, draining tracts, hearing loss, as well as bacterial culture results, were noted. Postoperative facial nerve paresis occurred in 36 of 133 ears (27.1%), and paralysis occurred in 29 of 133 ears (21.8%), with no significant difference between species. Thus, postoperative facial nerve deficits occurred in 48.9% of ears. The median duration of clinically evident temporary facial nerve deficits was 2 wk for dogs and 4 wk for cats. Dogs had a significantly longer duration of preoperative clinical signs and were less likely than cats to have a mass in the ear canal. Dogs were less likely to have residual (> 1 yr) postoperative facial nerve deficits. The incidence of postoperative Horner's syndrome was significantly higher in cats than dogs. The duration of preoperative clinical signs of ear disease was not associated with postoperative facial nerve deficits.

Evaluation of facial nerve function following surgical approaches for maxillofacial trauma

Purpose:The aim of this study was to report facial nerve injury following extraoral surgical approaches for the treatment of maxillofacial trauma, using the House–Brackmann facial nerve grading system (HBFNGS) as a means of classifying and measuring the degree and type of injury.Materials and Methods:The sample comprised 100 consecutive cases of various maxillofacial trauma in which extraoral surgical approaches were used. Variety of surgical approaches such as coronal, preauricular, endaural, retromandibular, and submandibular approach and its modifications were used based on the anatomic location of the fracture and the accessibility required for its reduction and fixation. Facial nerve function of all patients was evaluated preoperatively and 24 hours after surgery. Patients who presented postoperative facial nerve injury were likewise examined using the HBFNGS at 24 hours, 1 week, 1 month, 3 months, and 6 months.Results:Of the 100 patients, temporofacial branch involvement was seen in 11 cases, whereas cervicofacial branch involvement was seen in 6 cases. Complete recovery of the temporofacial branches was seen in a period of 3–4 months; whereas cervicofacial branches recovered in 5–6 months postoperatively.Conclusion:The frequency of facial nerve injury was related to various surgical approaches in maxillofacial trauma. Facial nerve impairment was found to be temporary in all cases, although the recovery of cervicofacial branches took a longer time. Moreover, there is a need to standardize the reporting of facial nerve recovery.

Microsurgical excisions of vestibular schwannomas: A tumor-size-based analysis of neurological outcomes and surgical complications.

Introduction:Vestibular schwannomas (VS) are benign tumors originating from Schwann cells in vestibulocochlear nerve. This study aimed at evaluating outcomes of microsurgical resections of VS based on tumor sizes in a South Asian country.Methods:The chart notes of 71 patients who underwent microsurgical resections of VS at a single academic center over a 20-year period (1990–2009) were reviewed, and relevant information was extracted. For analyzing outcomes, patients were divided into two groups based on tumor size at initial presentation: (1) Group A (tumor size ≤ 4 cm) and (2) Group B (tumor size > 4 cm). Pearson's chi-square and Fisher's exact tests were used for comparison of proportions; the independent sample t-test was used for comparison of means.Results:The average tumor diameter was 4.1 ± 1.5 (range, 1–6.6) cm. Complete resection was achieved more frequently in patients in Group A (P < 0.001). Duration of hospital stay and cost of treatment were significantly higher in Group B patients (P < 0.003 and P < 0.04, respectively). The severity of postoperative facial nerve injury, assessed by House–Brackmann grading system, was significantly higher in Group B (P < 0.01). Cerebrospinal fluid (CSF) leak and lower cranial nerve deficits also occurred more frequently after resection in Group B (P = 0.031 and P = 0.003, respectively).Conclusion:We conclude that advanced stage tumors suggestive of delayed presentation are fairly common in Pakistan, and limit curative resection in the majority of patients. Postoperative morbidity is significantly higher in patients with tumor size > 4 cm.

Delayed facial nerve paresis after using the KTP laser in the treatment of cholesteatoma despite inter-operative facial nerve monitoring

To describe an unforeseen complication that occurred in three patients following the use of the KTP laser. We present a case series including three consecutive patients (two boys and one girl, mean age 11.7 years) who underwent tympanomastoidectomy using a KTP laser and standard intra-operative facial nerve monitoring, and in whom a post-operative facial nerve injury was identified. Intra-operatively, the facial nerve was not encountered or exposed, and the KTP laser was not used directly on the nerve. The facial nerve monitor did not alarm. The three patients began experiencing a paresis from POD #7–9, with House–Brackmann facial nerve score of II–III at maximum severity. This resolved fully between 4 and 7 weeks after the onset of the paralysis. The KTP laser during cholesteatoma surgery has been shown to decrease residual disease but may however also cause a temporary, delayed, mild facial nerve paresis. We discuss the mechanisms for injury and the role of intra-operative facial nerve monitoring in the context of this uncommon and unforeseen complication.

Spinal Accessory Nerve Monitoring in Posterior Fossa Surgery

The role of intraoperative monitoring of lower cranial nerves is not well established. In this study, the authors retrospectively analyzed the intraoperative monitoring data and the clinical outcome of the spinal accessory nerve (SAN) in patients who have undergone posterior fossa surgery. SAN was monitored in 19 patients. Subcutaneous needle electrodes were placed in the trapezius, and any abnormal spontaneous activity was documented for duration and amplitude. A bipolar stimulation probe was used for triggered electromyogram, with a maximum stimulation intensity of 3 mA. All patients were clinically evaluated for SAN dysfunction postoperatively 24 hours and 7 days. Neurotonic discharges, lasting between 3 and 90 minutes were seen in 84% of the patients. Continuous discharges lasting longer than 5 minutes were seen in 36% of the patients. The SAN was stimulated in 57.8% of the patients. With clinical examination, none of our patients had postoperative SAN dysfunction. Long lasting dense neurotonic discharges and high stimulation thresholds have been correlated with postoperative facial nerve injury; however, this does seem be true in the case of SAN monitoring. Neurotonic discharges are commonly false-positive and stimulation intensity up to 3 mA can be related with a good outcome. The intraoperative monitoring of SAN may not be valuable as much as facial nerve monitoring.

Prospective Study of Facial Nerve Function After Surgical Procedures for the Treatment of Temporomandibular Pathology

The aim of this prospective study was to report facial nerve injury following surgical procedures for the treatment of temporomandibular pathology, using the House-Brackmann facial nerve grading system (HBFNGS) as a means of classifying and measuring the degree and type of injury. The sample consisted of 32 patients who underwent temporomandibular joint (TMJ) surgery. A total of 50 approaches were carried out. Surgical procedures consisted of TMJ reconstruction, gap arthroplasty, eminectomy, bone plates for the treatment of chronic mandibular luxation, and disc plication. Facial nerve function of all patients was evaluated preoperatively and 24 hours after surgery. Patients who presented postoperative facial nerve injury were likewise examined using the HBFNGS at 24 hours, 1 week, 1 month, and 3 months. Of the 32 patients, 12.5% (ie, 8% of the 50 approaches) showed signs of facial nerve injury after TMJ surgery. The prevalence of postoperative facial nerve injury was significantly greater in the patients who had ankylosis (P = .014) and in those submitted to gap arthroplasty (P = .011). At 24 hours, none of the patients showed total nerve paralysis or severe dysfunction, only a moderately severe dysfunction (50%), or moderate dysfunction (50%). The forehead was the most affected area measured. At 3 months, all patients had recovered their normal facial nerve function. The overall improvement in facial nerve function was 40% for the patients classified initially with moderately severe dysfunction and 60% for those with moderate dysfunction. The frequency of facial nerve injury was related to the diagnosis of the temporomandibular pathology and surgical procedures. Facial nerve impairment was shown to be of a temporary nature. Moreover, there is a need to standardize the reporting of facial nerve recovery.

Continuous Intraoperative Facial Nerve Monitoring in Predicting Postoperative Injury During Parotidectomy

To assess whether the use of continuous intraoperative facial nerve monitoring correlates to postoperative facial nerve injury during parotidectomy. A retrospective analysis. Forty-five consecutive parotidectomies were performed using an electromyograph (EMG)-based intraoperative facial nerve monitor. Of those, 37 had complete data for analysis. Intraoperative findings and final interpretation of the EMGs were analyzed by a senior neurologist and neurophysiologist. All patients were analyzed, including those with preoperative weakness and facial nerve sacrifice. The overall incidence of facial paralysis (House-Brackmann scale > 1) was 43% for temporary and 22% for permanent deficits. This includes an 11% incidence of preoperative weakness and 14% with intraoperative sacrifice. An abnormal EMG occurred in only 16% of cases and was not significantly associated with permanent or temporary facial nerve paralysis (chi, P < 1.0; Fisher's exact P < .68). Of the eight patients with permanent paralysis, only two had abnormalities on the facial nerve monitor. Also, only one of five patients with intraoperative sacrifice of the facial nerve had an abnormal EMG. Factors significantly associated with the incidence of facial paralysis include malignancy, advanced age, extent of parotidectomy, and dissection beyond the parotid gland (chi and Fisher's, P < .05). The results suggest that abnormalities on the intraoperative continuous facial nerve monitor during parotidectomy do not predict facial nerve injury. The incidence of permanent and temporary facial nerve paralysis compare favorably with the literature given that this study includes patients with revision surgery, intraoperative sacrifice, and preoperative paralysis. Standard of care implications will be discussed.