Patterns of Use of Facial Nerve Monitoring During Parotid Gland Surgery

Abstract

Permanent facial nerve paralysis after parotidectomy occurs in 0-7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.

Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns

“…This is a common limitation of voluntary surveys and for this reason a reminder email was sent during the data collection phase. Despite this, our response rate was less than that of the other survey-based studies examined [15][16][17][18]. As a consequence of this limitation, the results may be confounded by selection bias.…”

“…In the case of thyroid and mastoid surgery, this is a higher usage rate than that reflected by the UK and USA studies [15,17,18]. In the case of parotid surgery, it is a similar rate to that described in the UK study and higher than that described in the US study [15,16]. It should be noted that the abovementioned studies were published between two and 10 years ago, and our reported rates may reflect the changing attitudes towards intraoperative nerve monitoring and its availability to surgeons.…”

“…Hopkins et al surveyed 409 ENT surgeons in the UK and found that nerve monitoring was used by 24% of those performing thyroid surgery, 90% in parotid surgery, and 51% in mastoid surgery [15]. Lowry et al examined use of facial nerve monitoring in parotid surgery in the USA by surveying 1548 otolaryngologists and found that 60% used monitoring at least some of the time [16]. Both Horne et al and Sturgeon et al focused on use of RLN monitoring in thyroid surgery in the USA.…”

“…Whilst it is generally accepted that direct visualisation of the nerve is the gold standard, intraoperative nerve monitoring is being used increasingly as an adjunct to help identify the nerve. The use of intraoperative nerve monitoring has been previously reported in the UK and USA [15][16][17][18]. To date, no such literature exists to describe practice in other parts of the world.…”

Facial nerve mapping and monitoring in lymphatic malformation surgery

“…Intraoperative facial nerve monitoring during parotid surgery allows for early identification of the FN, mapping of its course through the facial region, warning of unexpected stimulation during dissection, and determination of FN prognosis at conclusion of surgery. A majority of otolaryngologists in the U.S. use some form of intraoperative nerve monitoring during parotid gland surgery [10]. Current methods of intraoperaFacial nerve Lymphangioma Monitoring Mapping…”