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The RP is a safe procedure with no significant difference in FNP rates when compared to the AP and, considering the shorter CST and the lesser VHT resected in the RP, it is superior to the AP. Surgeons engaged in parotidectomy should be familiar with both methods of dissection.

Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Despite some drawbacks such as false-positive/negative alarms, technical artefacts, and rare adverse effects, cIONM remains a good instrument which is still under development. Active (acIONM) and passive (pcIONM) methods of cIONM are described in literature. The main fields of cIONM implementation are currently thyroid surgery (in which the vagal nerve is continuously stimulated) and surgery to the cerebellopontine angle (in which the facial nerve is either continuously stimulated or the discharge signal of the nerve is analyzed via pcIONM). In the latter surgery, continuous monitoring of the cochlear nerve is also established.

Kontinuierliches intraoperatives Neuromonitoring (cIONM) in der Kopf-Hals-Chirurgie-eine Übersicht Intraoperatives Neuromonitoring (IONM) zielt darauf ab, gefährdete neuronale Strukturen anatomisch und funktionell zu erhalten und so postoperativ temporäre und dauerhafte Paresen zu vermeiden. Modernes IONM ermöglicht nicht nur Nervenidentifizierung, sondern auch die Erkennung potenziell schädlicher Manipulationen; so kann anhand der intraoperativen Informationen eine Vorhersage der postoperativen Funktion erfolgen. Im Kopf-Hals-Bereich ist das IONM in der HNO-Heilkunde, Neurochirurgie und Schilddrüsenchirurgie etabliert. Hintergrund Die Geschichte des intraoperativen Neuromonitorings (IONM) reicht bis ins Jahr 1898 zurück, als Dr. Fedor Krause aus Berlin die monopolare faradische Stimulation bei der Neurektomie des N. vestibulocochlearis als Therapie eines dekompensierten Tinnitus zur Identifikation des N. facialis einsetzte [13]: Hierbei stimulierte er den Gesichtsnerv und stellte visuell fest, dass Kontraktionen der Ge-Die englische Version dieses Beitrags ist unter

Background Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad). Methods In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured. Results 869 patients were included (183 TEmic; 686 TEtrad). PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p = 0.007). Conclusion Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons.