Contemporary Changes with the Use of Facial Nerve Monitoring in Chronic Ear Surgery

Hu, Jinwei; Fleck, Terry; Xu, Jane; Hsu, Jeffrey; Xu, Helen

doi:10.1177/0194599814537223

Cited by 20 publications

(20 citation statements)

References 13 publications

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“…Cost-benefit analysis favors routine use of FNM for primary and revision otologic surgery for the greatest savings and greatest improvement in quality-adjusted life-years. 7-9…”

Section: Discussionmentioning

confidence: 99%

Additional Benefits of Facial Nerve Monitoring during Otologic Surgery

Casano

Giangrosso

Mankekar

et al. 2020

Otolaryngol.--head neck surg.

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Objective This study assesses the role of facial nerve monitoring (FNM) for intraoperative decision making during otologic surgery and possible benefits beyond protecting facial nerve integrity. Study Design This prospective study examines intraoperative FNM data and structured interviews collected during 52 otologic procedures. Setting Tertiary referral center. Subjects and Methods Subjects include adults and children undergoing middle ear or mastoid surgery. Data include intraoperative neuromonitoring activity and structured interviews conducted with the operating surgeon immediately following surgery. Results Facial nerve stimulation was used to confirm the position of the nerve in 42 of 52 surgical procedures. In 26.9% of cases, the patient became “light” and moved under anesthesia, which was predicted by neuromonitoring 71.4% of the time. Through structured interviews, the operating surgeons reported the following. (1) The facial nerve took an unexpected anatomic course in 7.8% of patients and was difficult to identify in 39.2%. (2) The nerve was at increased risk of injury in 66.7% of cases due to chronic disease or previous surgery. (3) Among these high-risk cases, the monitor helped reduce the risk of nerve damage 100% of the time. (4) Neuromonitoring allowed the surgeon to operate faster 86.5% of the time, and (5) FNM allowed the resident to perform more of the operation 68.9% of the time. No patients experienced postoperative facial weakness. Conclusions Beyond potentially protecting facial nerve integrity, this study identified additional benefits of FNM, including warning of patient movement during anesthesia, confirming facial nerve anatomic location, reducing operative time, and enhancing resident surgical experience.

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“…Cost-benefit analysis favors routine use of FNM for primary and revision otologic surgery for the greatest savings and greatest improvement in quality-adjusted life-years. 7-9…”

Section: Discussionmentioning

confidence: 99%

Additional Benefits of Facial Nerve Monitoring during Otologic Surgery

Casano

Giangrosso

Mankekar

et al. 2020

Otolaryngol.--head neck surg.

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show abstract

“…12 The indications for facial nerve monitoring have become increasingly diverse, and include parotidectomies, revision tympanoplasties and/or tympanomastoidectomies, cochlear implantations, surgical treatment of middle or posterior fossa tumors, and any other otologic procedure that may pose a risk to the VII cranial nerve. 1,13 Besides, a study by Hu et al 14 suggests a contemporary trend toward the increased use of nerve monitoring by younger surgeons.…”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Intraoperative Monitoring in Otologic Surgeries under Sedation and Local Anesthesia – A Case Series and Literature Review

Mangia

Santos

Mansur

et al. 2020

Int Arch Otorhinolaryngol

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Introduction Local anesthesia with sedation has been employed for an increasingly number of otolaryngology procedures, and might be associated with lower surgical morbidity and costs. Facial nerve monitoring is often advisable in otology to minimize the risks of injuries to this cranial nerve, but the principles, techniques and parameters involved have only been studied for procedures under general anesthesia. Objective To report the preliminary outcomes of intraoperative facial nerve monitoring during otologic procedures under sedation and local anesthesia. Methods A total of five procedures and their respective intraoperative electrophysiological main findings were described. Facial neuromonitoring was performed using the same device by an electrophysiologist. The monitor sensitivity was set at 100 mV, and a stimulating probe was used whenever needed. Results Progressively decreasing low-amplitude baseline values were usually obtained as the level of anesthesia increased, with isolated oscillations possibly related to some degree of voluntary muscular activity. These oscillations could be easily distinguished from those of the surgical manipulation or electrical stimulation of the nerve, which tended to be of much greater amplitude and shorter latency, occurring during specific surgical steps. Conclusion With a surgical team with proper procedural knowledge and broad expertise regarding the technique, intraoperative facial nerve monitoring under local anesthesia with sedation seemed both feasible and reliable. Thus, the need for intraoperative neuromonitoring should not be an obstacle for otologic procedures under less aggressive anesthetic management.

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“…Hu et al reported that facial nerve monitoring should be considered in chronic ear surgery, especially in younger surgeons. 7 It is a well-known that the surgeon performing otological surgery can encounter many kinds of difficulties. It could be due to the distorted anatomy of the mastoid by varying pathologies including cholesteatoma, bony erosion, or revision of previous surgery.…”

Section: Discussionmentioning

confidence: 99%

Anomalies of the facial nerve: a surgeon’s nightmare

Thomas

Ghate

Kumar

2018

Int J Otorhinolaryngol Head Neck Surg

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Background: Most of the anomalies of the facial nerve have been encountered during otological surgery or dissection of the temporal bones. ENT surgeons are taught from a nascent stage to always be wary of an anomalous facial nerve during otological surgery. Today’s surgeon is assisted with high definition imaging and nerve monitoring; yet iatrogenic facial palsy still is encountered even today.Methods: This study was conducted in a select population of patients who reported with aural symptoms with an aim to see the number of facial nerve anomalies one encounters during aural surgery. The filter applied was no patient with congenital anomaly was considered and patients with squamous COM were also excluded. Results: Almost 4.5% of the patients subjected to surgery had varying kinds of facial nerve anomaly, the most common being dehiscence of the fallopian canal.Conclusions: Facial nerve anomalies are not so uncommon as one expects it to be. So it is mandatory that every ENT surgeon should be well versed with facial nerve anatomy and be wary of any structural anatomical abnormality, and irrespective of the experience it pays to be extra cautious when operating on the ear because in the event of damage to the facial nerve the patient has to carry the stigma of a facial deformity for his/her life.

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Contemporary Changes with the Use of Facial Nerve Monitoring in Chronic Ear Surgery

Abstract: There is a growing trend for routine facial nerve monitoring in the setting of chronic ear surgery.

Cited by 20 publications

References 13 publications

Additional Benefits of Facial Nerve Monitoring during Otologic Surgery

Additional Benefits of Facial Nerve Monitoring during Otologic Surgery

Facial Nerve Intraoperative Monitoring in Otologic Surgeries under Sedation and Local Anesthesia – A Case Series and Literature Review

Anomalies of the facial nerve: a surgeon’s nightmare

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