Facial nerve monitoring in parotid gland surgery: Design and feasibility assessment of a potential standardized technique

Duque, Carlos S.; Londoño, Andrés F.; Duque, Ana María Henao; Tobón, John Jairo Zuleta; Marulanda, Marcela; Otálvaro, Lina M.; Agudelo, Miguel; Dueñas, Juan Pablo; Palacio, María F.; Dionigi, Gianlorenzo

doi:10.1002/wjo2.90

Cited by 3 publications

(1 citation statement)

References 35 publications

(208 reference statements)

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“…Like other authors such as Duque et al or Zieliński M et al, we recommend using facial nerve neuromonitoring to improve functional outcomes and avoid unwanted injuries. This follow-up does not affect surgery or its duration but helps to reduce the prevalence of transient facial nerve paralysis after parotid tumor surgery or, even worse, permanent lesions [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Warthin’s Tumor of the Parotid Gland With Degeneration to Diffuse Large B-cell Lymphoma: A Case Report and Review of Literature

Gutierrez-Alvarez¹,

Martínez²,

M.D.³

et al. 2023

Cureus

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Parotid gland neoplasms are rare; some benign lesions, such as Warthin's tumor (WT), can present as malignant degeneration to carcinomas or, even rarer, to lymphomas. In the literature, there are fewer than 30 reported cases of primary lymphoma of the parotid gland. We present a case of a 65-year-old male patient with a first diagnosis of WT of the parotid gland who later presented a tumor recurrence and underwent a second surgery, reporting diffuse large B-cell lymphoma of the parotid gland. He underwent a right parotidectomy and chemotherapy, and at his 5-month follow-up, he remains free of recurrence. These tumors may look clinically like benign tumors. However, it is essential to be always alert to detect potentially malignant neoplasms and to emphasize examining the lymphoid component of WT to have an early-stage diagnosis of possible lymphomas and treat them before morbidity and mortality increase.

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Section: Discussionmentioning

confidence: 99%

Warthin’s Tumor of the Parotid Gland With Degeneration to Diffuse Large B-cell Lymphoma: A Case Report and Review of Literature

Gutierrez-Alvarez¹,

Martínez²,

M.D.³

et al. 2023

Cureus

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Facial Nerve Injury after Extracapsular Dissection for Benign Parotid Tumors with and without Intraoperative Monitoring: A Retrospective Study of a Single Center

Cristofaro,

Colangeli,

Ferragina

et al. 2024

Diagnostics

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Background: Facial nerve injury (FNI) is the most common complication of parotid surgery and manifests as FN paralysis. The use of intraoperative facial nerve monitoring (IFNM) is becoming an established intraoperative aid for surgeons, assisting in the identification of the location and dissection of the facial nerve trunk or branches. The postoperative outcomes of parotid surgery with and without monitoring have been addressed in only a limited number of studies. Objective: The objective of this study is to evaluate the incidence of postoperative paralysis in patients undergoing extracapsular dissection (ED) for benign parotid tumors concerning the use or non-use of IFNM. Materials and Methods: The retrospective study was conducted at the Maxillo-Facial Department of the Magna Graecia University of Catanzaro. The patients were divided into two groups: Group 1 consisted of patients who underwent surgery without IFNM (1 January 2015 to 31 December 2018); Group 2, on the other hand, consisted of patients who underwent surgery with IFNM (1 January 2019 to 31 December 2022). Group 2 employed the Nerve Integrity Monitor (Medtronic’s NIM®). To classify the FN function, we employed the modified House–Brackmann classification system. To evaluate the dependence between the “use of IFNM” and “postoperative paralysis”, a descriptive analysis was conducted, including applying the Chi-squared test and calculating the Pearson correlation. Subsequently, a binary logistic regression model was applied to further evaluate the correlation between the latter. The level of statistical significance was set at p < 0.05. Results: A total of 276 patients were included in the study: 120 subjects were assigned to Group 1 (43.5%, comprising 60 men and 60 women) and 156 subjects were assigned to Group 2 (56.5%, comprising 93 men and 63 women). In 91.7% of the cases (n. 253, precisely 105 in Group 1 and 148 in Group 2), no FNI occurred. In 8.33% of the cases (n. 23, specifically 15 in Group 1 and 8 in Group 2), postoperative paralysis was observed. Of these subjects, only two in Group 1 had permanent paralysis (8.69%); therefore, 91.31% had transient paralysis. As a result, 91.31% of the subjects exhibited transient paralysis. In the case of FNI, 78% of the cases involved the marginal mandibular branch (n. 18), 13% involved the temporo-zygomatic branch (n. 3), and 7% involved more than one branch (n = 2). The results of the multivariable binary logistic regression analysis demonstrated that the use of IFNM was a statistically significant influencing factor, with an estimated reduction in postoperative paralysis of approximately 62% (OR 0.378; 95% CI: 0.155–0.92). In Group 2, the occurrence of transient complications was significantly reduced (OR 0.387; 95% CI: 0.149–1.002 with p < 0.05). Discussion and Conclusions: The use of IFNM in the ED for benign parotid tumors significantly reduces the rate of FNI and, consequently, postoperative FN paralysis. On the other hand, the use of monitoring systems must not replace the experience and anatomical knowledge of the surgeon.

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Intraoperative Facial Nerve Monitoring during Parotidectomy: The Current Practices and Patterns of the Korean Society of Head and Neck Surgery (KSHNS)

Ahn,

Kwak,

Kim

et al. 2024

Diagnostics

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Objectives: This study aimed to evaluate the current practices and trends of intraoperative facial nerve (FN) monitoring (IOFNM) during parotidectomy. Methods: A questionnaire containing 33 questions collecting information on the usage, indications, settings, techniques, loss of signal (LOS) management, anesthesiologist cooperation, and perception of usefulness of IOFNM was distributed among 348 members of the Korean Society of Head and Neck Surgery (KSHNS) via a dedicated website. Results: The response rate was approximately 25.6%, and 97% of the respondents reported using IOFNM selectively or routinely during parotidectomy. IOFNM usage decreased as the surgeon’s level of experience increased (p = 0.089), from 100% in those with less than 5 years of experience to 75% in those with 20 or more years. Approximately 95% of respondents reported that the initial event threshold for electromyography activity used was 50–149 μV. Moreover, 52.4% of respondents performed neural mapping of the FN before visual identification. Initial management of LOS in visually intact FNs included checking the IOFNM system (75.3%), confirmation of muscle relaxant dosage (75.3%), and facial twitch identification (58.8%). Further management included proceeding with surgery regardless of persistent LOS (81.2%) and steroid administration sometimes or all of the time (72.9%). Overall, 98.8% of respondents found IOFNM beneficial for safe execution of parotidectomy. Conclusions: The majority of KSHNS surgeons used IOFNM during parotidectomy, although the clinical implementation of the procedure and LOS management varied between practitioners. This could be attributed to the lack of standardized protocols for IOFNM, emphasizing the need for the development of evidence-based consensus guidelines for all institutions.

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Facial nerve monitoring in parotid gland surgery: Design and feasibility assessment of a potential standardized technique

Cited by 3 publications

References 35 publications

Warthin’s Tumor of the Parotid Gland With Degeneration to Diffuse Large B-cell Lymphoma: A Case Report and Review of Literature

Warthin’s Tumor of the Parotid Gland With Degeneration to Diffuse Large B-cell Lymphoma: A Case Report and Review of Literature

Facial Nerve Injury after Extracapsular Dissection for Benign Parotid Tumors with and without Intraoperative Monitoring: A Retrospective Study of a Single Center

Intraoperative Facial Nerve Monitoring during Parotidectomy: The Current Practices and Patterns of the Korean Society of Head and Neck Surgery (KSHNS)

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