Intraoperative Neurophysiologic Monitoring: Indications and Techniques for Common Procedures in Otolaryngology–Head and Neck Surgery

Edwards, Bruce M.; Kileny, Paul R.

doi:10.1016/j.otc.2005.03.002

Cited by 22 publications

(11 citation statements)

References 53 publications

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“…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%

“…18 The main goals of FNIM are to track the nerve beforehand, to help identify bony canal dehiscence that might increase the surgical risks, and to assess nerve function after the procedure. 1,11,19 Many factors support FNIM in otology. First, the tridimensional anatomy of the facial nerve within the temporal bone is complex, and the complete delineation of this structure is often hindered by coexisting diseased tissue.…”

Section: Discussionmentioning

confidence: 99%

“…The concerns regarding facial nerve injury have led to the emergence and wide use of intraoperative neuromonitoring systems, which have been thoroughly studied and validated for surgeries under general anesthesia. 1,2 Cochlear implantations, for example, are among the surgeries during which injuries to the seventh cranial nerve are most likely and feared. When performing posterior tympanotomy, the surgical step in which the facial recess is opened and widened to enable the insertion of the electrode array, the nerve lies just underneath the drilling site.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…The excellent anatomical knowledge and also the awareness of various variations in course of the nerve help to prevent the injury while working in the vicinity of nerves. Intraoperative nerve monitoring is increasingly popular with surgeons in an attempt to avoid nerve injury [16]. Whenever possible the cranial nerves integrity should be maintained unless tumor resection is compromised.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Complications of Neck Dissection in Head and Neck Cancers

Kallappa¹,

Dange²

2020

IJCOCR

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The neck dissection has remained a pivotal aspect of head and neck cancer management for over a century. During this time its role has expanded from a purely therapeutic option to an elective setting. Since vital anatomical structures are close, certain risks and complications are inherent to this procedure. Since neck surgery remains the most frequently performed form of therapeutic surgery in head and neck cancer irrespective of primary disease site, our objective is to report the complications in various types neck dissections and to seek improved outcome. A cross sectional retrospective study of 52 patients who underwent neck dissection from August 2015 to August 2019 was conducted to analyse intra operative and post-operative complications which aroused due to neck dissection. Indications for neck dissection depended on neck staging (N): selective neck dissection was done when evident disease was absent; Modified radical neck dissection was done if there was clinically evident neck node, preserving non-lymphatic neck structures (accessory nerve, internal jugular vein and internal jugular vein) as long as surgical completeness was not compromised. Bilateral neck dissection was indicated if contralateral disease was suspected or present. Out of 52 patients, one radical neck dissection, 14 modified radical and 37 selective neck dissection, of which 32 underwent supra omohyoid neck dissection and 5 underwent anterolateral and posterolateral neck dissection. The most frequent complication was marginal mandibular nerve injury (5.5%), followed by accessory nerve injury (2.1%). There was one death. A careful preoperative assessment of the patient, meticulous surgical techniques, good-quality postoperative care and appropriate rehabilitation are the cornerstones of preventing and managing complications of neck dissection.

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“…1 Their approach is best on intraoperative recording of motor evoked potentials in the facial muscles. Providing care is taken to ensure that these responses are truly central in origin and do not arise from extracranial activation of the nerve, these are robust measures of cranial nerve function 2,3 . They compare the latency and amplitude of the potentials between HFS patients and those coming for other skull base surgeries.…”

mentioning

confidence: 99%

Is Hemifacial Spasm of Peripheral or Central Origin?

Norton¹

2014

Can. J. Neurol. Sci.

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Intraoperative Neurophysiologic Monitoring: Indications and Techniques for Common Procedures in Otolaryngology–Head and Neck Surgery

Cited by 22 publications

References 53 publications

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

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

An Analysis of Complications of Neck Dissection in Head and Neck Cancers

Is Hemifacial Spasm of Peripheral or Central Origin?

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