Intraoperative identification of the facial nerve by needle electromyography stimulation with a burr

Abstract

Despite the existing possibilities of using modern surgical equipment and modern diagnostic techniques, there is still a risk of damaging the facial nerve during otological surgery (1,2). This is caused by the anatomic proximity of the facial nerve to the structures of the middle and inner ear (3-5). The facial nerve becomes more vulnerable to injury during repeated (sanifying) surgery on the middle ear, with the presence of dehiscence in the Fallopian canal, during the removal of masses in the middle ear (2,6), in cases of malformation of the middle or inner ear (7,8).Many scientific works study the anatomy of the facial nerve (3-5). Most of them provide a general description of the microtopographic characteristics of the facial canal and, at the same time, lack information on the thickness of its bone walls.Intraoperative damage causes paresis (paralysis) of the facial muscles, which leads to a degradation of the patients' quality of life. According to literary sources, during original surgery, the risk of dysfunction of the facial nerve is 0.6-3.7% of cases (9, 10). During repeated invasive surgery, the risk rises up to 4-10% of cases (1,11,12).The appearance of intraoperative facial nerve monitoring allowed identifying the nerve throughout the entire surgery (13-15), since this method of studying the neuromuscular system registers fluctuation of the electric potential of muscles in response to nerve stimulation.Despite considerable success in the development of machines for intraoperative monitoring of the facial nerve, the most important restriction remained, which was related to the fact that the system could not warn surgeons if they were operating near the facial nerve, whi-

Sanation of petrous bone cholesteatoma in the otosurgical practice

“…Оперативное вмешательство выполнялось под эндотрахеальным наркозом, трансмастоидальным доступом. В 18 (86%) случаях проводился мониторинг лицевого нерва методом игольчатой электромиографии [14].…”