Electromyographic (EMG) Neuromonitoring in Otolaryngology-Head and Neck Surgery

Dillon, Francis X.

doi:10.1016/j.anclin.2010.07.011

Cited by 20 publications

(10 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Results of the present study correspond with those from earlier studies that report the tympanic segment is the most common site for dehiscence of the facial nerve (91.8%). The proportion of tympanic segment dehiscence has varied from 85% to 90.7% [4, 9]. Therefore, the tympanic segment is the most critical site of the facial nerve and careful manipulation of the area is necessary.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The optimal and safe intensity for facial nerve stimulation during intraoperative neuromonitoring in middle ear surgery

et al. 2019

View full text Add to dashboard Cite

Objective This study aimed to investigate the optimal and safe intensity for facial nerve stimulation during middle ear surgery. Methods Thirty-seven patients who had their facial nerve exposed prior to surgery were prospectively enrolled in this study, and electromyography (EMG) recordings were obtained from the orbicularis oculi and orbicularis oris muscles. Four pigs were also enrolled in an animal study, and continuous stimulation was performed on the facial nerves of the pigs for 10 minutes. The EMG responses were measured and the pathologic outcomes of the facial nerve after stimulation were determined. Results In the human study, the mean intensity of the minimal electrical stimulation threshold was 0.21 mA (range: 0.1–0.3 mA). A linear correlation was observed between stimulus intensity and response amplitude for intensities below 0.4 mA. Response amplitudes reached a plateau between 0.4 mA and 1.0 mA. The minimal stimulus intensity that could generate a maximal response was 0.4 mA in the orbicularis oculi (244 μV) and orbicularis oris (545 μV). In the animal study, there were no observed changes in EMG or nerve damage incidence after the continuous stimulation of 3.0 mA. Conclusions 0.4 mA is considered to be the optimal intensity of facial nerve stimulation during middle ear surgery, and it was estimated through the animal study that a stimulation of 3.0 mA is safe from facial nerve damage.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In 1965, Shedd and Durham [3] reported the first technique to identify nerves, which was intraoperative neuromonitoring (IONM). This method provides real-time identification and a functional assessment of nerves during surgery [4]. IONM has become frequently used in middle ear surgery.…”

Section: Introductionmentioning

confidence: 99%

The optimal and safe intensity for facial nerve stimulation during intraoperative neuromonitoring in middle ear surgery

et al. 2019

View full text Add to dashboard Cite

show abstract

“…13 Here, current guidelines favor minimally invasive endotracheal tube surface electrodes over invasive electrodes because they allow reliable assessment of peripheral CN X motor function with minimal risk for the patient. 13,18,19 However, in longlasting skull base surgeries with complex positioning of the patient, severe complications were noted by Fukuda et al 20 In their experience, 2 patients undergoing monitoring with endotracheal tube surface electrodes required tracheostomy due to severe bilateral edema of the vocal cords. In our series, no such severe events were seen.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Placement of electrodes at the larynx in the cricothyroid muscle is straightforward, and there is little or no concern regarding shift in their position. Displacement of the endotracheal electrodes from the vocal cords may occur with rotation of the endotracheal tube and also during positioning of the head in preparation for surgery (Chiang et al, 2008;Dillon, 2010;Dionigi et al, 2008;Randolph and Dralle, 2011). A learning curve has been described for their accurate placement, where the EMG endotracheal tube required readjustment for successful recurrent larygneal nerve monitoring after intubation in 10% of the patients (Dionigi et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Alternative Sites for Intraoperative Monitoring of Cranial Nerves X and XII During Intracranial Surgeries

Holdefer

Kinney

Robinson

et al. 2013

Journal of Clinical Neurophysiology

View full text Add to dashboard Cite

During intracranial surgeries, cranial nerve (CN) X is most commonly monitored with electromyographic endotracheal tubes. Electrodes on these endotracheal tubes may be displaced from the vocal folds during positioning, and there is a learning curve for their correct placement. Cranial nerve XII is most commonly monitored with electrodes in the dorsum of the tongue, which are also prone to displacement because of their proximity to the endotracheal tube. A retrospective review was conducted of a consecutive series of 83 skull base surgeries using alternative sites for monitoring CN X and XII. On-going (spontaneous) and evoked electromyography (EMG) were obtained from the cricothyroid muscle for CN X and submental genioglossus for CN XII. Stimulation of CN X or XII evoked specific compound motor action potentials from these muscles, and well-defined on-going EMG was observed during tumor resection in the vicinity of CN X and XII. Volume-conducted responses from the adjacent platysma muscle during CN VII stimulation were identified by concomitant responses from the orbicularis oris and oculi. In conclusion, during skull base surgeries, CN X may be monitored with electrodes in the cricothyroid muscle and CN XII with electrodes in the submental genioglossus. These alternative sites are less prone to displacement of electrodes compared with the more commonly used EMG endotracheal tube and electrodes in the dorsum of the tongue. The cricothyroid muscle should not be used when the recurrent laryngeal nerve is at risk.

show abstract

Electromyographic (EMG) Neuromonitoring in Otolaryngology-Head and Neck Surgery

Cited by 20 publications

References 38 publications

The optimal and safe intensity for facial nerve stimulation during intraoperative neuromonitoring in middle ear surgery

The optimal and safe intensity for facial nerve stimulation during intraoperative neuromonitoring in middle ear surgery

Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle

Alternative Sites for Intraoperative Monitoring of Cranial Nerves X and XII During Intracranial Surgeries

Contact Info

Product

Resources

About