Facial nerve monitoring during parotid gland surgery: a systematic review and meta-analysis

Chiesa‐Estomba, Carlos Miguel; Larruscain-Sarasola, Ekhiñe; Lechien, Jérôme R.; Mouawad, F.; Calvo‐Henríquez, Christian; Diom, Evelyne Siga; Ramírez, Adonis; Ayad, Tareck

doi:10.1007/s00405-020-06188-0

Cited by 45 publications

(29 citation statements)

References 40 publications

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“…Continuous monitoring was rarely used in this series and only for cases of disrupted anatomy such as recurrences, congenital abnormalities or exceedingly large masses. As such, the rates of temporary and permanent facial nerve paralysis with no continuous monitoring reported here are quite favorable compared to published series and systematic reviews evaluating such monitoring 31‐35 . Therefore, monitoring may be considered a useful , but not necessary adjunct to successful parotid surgery.…”

Section: Discussionmentioning

confidence: 58%

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Deschler

Kozin

Kanumuri

et al. 2020

Laryngoscope Investig Oto

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Objective: As large single-surgeon series in the literature are lacking, we sought to review a single-surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered. Materials and Methods: All patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed. Results: A total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, P < .0001). Among patients with intact FN, post-operative short-and long-term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short-and long-term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes. Conclusion: This is the largest single-surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long-and short-term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting.

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Section: Discussionmentioning

confidence: 58%

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Deschler

Kozin

Kanumuri

et al. 2020

Laryngoscope Investig Oto

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“…Facial nerve injury is a relatively common and major complication of parotidectomy that is disheartening to surgeons and the patients. Intraoperative facial nerve monitoring can significantly reduce postoperative facial nerve injury [5][6][7][8]. It is traditionally held that skeletal muscle relaxants should be avoided in general anaesthetic procedures requiring neuromonitoring.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Facial Nerve Monitoring under Different Levels of Neuromuscular Blockade with Cisatracurium Besilate in Parotid Tumour Surgery

Huang

Jiang

Liu

et al. 2021

BioMed Research International

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Background. Anaesthesia can alter neuronal excitability and vascular reactivity and ultimately lead to neurovascular coupling. Precise control of the skeletal muscle relaxant doses is the key in reducing anaesthetic damage. Methods. A total of 102 patients with the normal functioning preoperative facial nerve who required parotid tumour resection were included in this study. Facial nerve monitoring was conducted intraoperatively. The surgeon stimulated the facial nerve at different myorelaxation intervals at TOF% (T4/T1) and T1% (T1/T0) and recorded the responses and the amplitude of electromyogram (EMG). Body movements (BM) or patient-ventilator asynchrony (PVA) was recorded intraoperatively. Results. In parotid tumour resection, T1% should be maintained at a range of 30 to 60% while TOF% should be maintained at a range of 20 to 30%. Analysis of the decision tree model for facial nerve monitoring suggests a partial muscle relaxation level of 30 % < T 1 % ≤ 50 % and TOF ≤ 60 % . A nomogram prediction model, while incorporating factors such as sex, age, BMI, TOF%, and T1%, was constructed to predict the risk of BM/PVA during surgery, showing good predictive performance. Conclusions. This study revealed an adequate level of neuromuscular blockade in intraoperative parotid tumour resection while conducting facial nerve monitoring. A visual nomogram prediction model was constructed to guide anaesthetists in improving the anaesthetic plan.

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“…The use of electromyography in intraoperative facial nerve monitoring was introduced in 1970, and it has become increasingly popular in recent years. One review article from 2020 suggested that the risk of temporary and permanent facial nerve weakness after primary parotid gland surgery may be decreased with the use of a nerve monitoring system 26 . However, only one of the articles included in this study described the use of a nerve monitoring system in the surgical process 18 .…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of modified facelift incision versus modified Blair incision in parotidectomy

Lee

Liao

Yang

et al. 2021

Sci Rep

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Surgical removal is the treatment of choice for many neoplasms of the parotid gland. This meta-analysis aimed to evaluate the differences between parotidectomy using a modified facelift incision (MFI) and parotidectomy using a modified Blair incision (MBI). A systematic search of the available literature in PubMed, Embase and the Cochrane Library was performed. Studies of adult patients who underwent open parotidectomy with presumed benign parotid neoplasms based on preoperative examinations were reviewed. The surgical outcomes of the MFI and MBI groups were collected. Intraoperative and postoperative parameters, including operative time, tumor size, cosmetic satisfaction, and incidences of facial palsy, Frey’s syndrome and salivary complications, were compared. Dichotomous data and continuous data were analyzed by calculating the risk difference (RD) and the mean difference (MD) with the 95% confidence interval (CI), respectively. Seven studies were included in the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher in the MFI group (MD = 1.66; 95% CI 0.87–2.46). The operative duration in the MFI group was significantly longer than that in the MBI group (MD = 0.07; 95% CI 0.00–0.14). The MFI group exhibited a smaller tumor size (MD = − 2.27; 95% CI − 4.25 to − 0.30) and a lower incidence of Frey’s syndrome (RD = − 0.18; 95% CI − 0.27 to − 0.10). The incidence of postoperative temporary facial palsy (RD = − 0.05; 95% CI − 0.12 to 0.03), permanent facial palsy (RD = − 0.01; 95% CI − 0.06 to 0.03) and salivary complications (RD = − 0.00; 95% CI − 0.05 to 0.05) was comparable between the two groups. Based on these results, MFI may be a feasible technique for improving the cosmetic results of patients who need parotidectomy when oncological safety can be ensured.

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Facial nerve monitoring during parotid gland surgery: a systematic review and meta-analysis

Cited by 45 publications

References 40 publications

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

Single‐surgeon parotidectomy outcomes in an academic center experience during a 15‐year period

[Retracted] Facial Nerve Monitoring under Different Levels of Neuromuscular Blockade with Cisatracurium Besilate in Parotid Tumour Surgery

Systematic review and meta-analysis of modified facelift incision versus modified Blair incision in parotidectomy

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