Abstract
Objectives
To assess the diagnostic capacity of intraoperative neurophysiological monitoring with respect to “gold standard” microscopic findings of facial canal dehiscence in middle ear cholesteatoma surgery.
Study design, patients and setting
We carried out a retrospective cohort study of 57 surgical interventions for cholesteatoma between 2008 and 2013 at Hospital Universitario de Canarias, Spain.
Diagnostic interventions
Each patient underwent preoperative computed tomography (CT), intraoperative neurophysiological monitoring and intraoperative inspection of the facial nerve during microsurgery. Diagnostic concordance on the presence/absence of facial canal dehiscence was assessed in 54 surgical interventions.
Main outcome
Presence of facial canal dehiscence.
Results
Of 57 interventions, 39 were primary surgeries; 11 (28.2%) showed facial canal dehiscence. and 18 were revision surgeries; 6 (33.3%) showed facial canal dehiscence. The facial nerve was not damaged in any patient. Facial canal dehiscence was observed in 17 (29.82%) interventions. We used intraoperative microscopic findings as the gold standard. Neurophysiological study showed a sensitivity of 94.1, specificity 97.3, positive predictive value (PPV) 57.8 and negative predictive value of 97.2. CT showed a sensitivity of 64.7, specificity 78.4, PPV 57.8 and negative predictive value of 82.
Conclusions
Our neurophysiological study showed greater sensitivity and higher PPV than CT for the detection of facial canal dehiscence. We found no relationship between disease progression time and the presence of facial canal dehiscence.
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References
Selesnick SH, Lynn-Macrae AG (2001) The incidence of facial nerve dehiscence at surgery for cholesteatoma. Otol Neurotol 22(2):129–132
Nager GT, Proctor B (1982) The facial canal: normal anatomy, variations and anomalies. II. Anatomical variations and anomalies involving the facial canal. Ann Otol Rhinol Laryngol Suppl 97:45–61
Choung YH, Park K, Cho MJ, Choung PH, Shin YR, Kahng H (2006) Systematic facial nerve monitoring in middle ear and mastoid surgeries: “surgical dehiscence” and “electrical dehiscence”. Otolaryngol Head Neck Surg 135(6):872–876
Noss RS, Lalwani AK, Yingling CD (2001) Facial nerve monitoring in middle ear and mastoid surgery. Laryngoscope 111(5):831–836
Silverstein H, Smouha EE, Jones R (1988) Routine intraoperative facial nerve monitoring during otologic surgery. Am J Otol 9(4):269–275
Choe WJ, Kim JH, Park SY, Kim J (2013) Electromyographic response of facial nerve stimulation under different levels of neuromuscular blockade during middle-ear surgery. J Int Med Res 41(3):762–770
Heman-Ackah SE, Gupta S, Lalwani AK (2013) Is facial nerve integrity monitoring of value in chronic ear surgery? Laryngoscope 123(1):2–3
Bernardeschi D, Meskine N, Otaibi NA, Ablonczy R, Kalamarides M, Grayeli AB, Sterkers O (2011) Continuous facial nerve stimulating burr for otologic surgeries. Otol Neurotol 32(8):1347–1351
Ashby D (1991) Practical statistics for medical research. Douglas G. Altman, Chapman and Hall, London, 1991. Stat Med 10(10):1635–1636. https://doi.org/10.1002/sim.4780101015
Linder T, Mulazimoglu S, El Hadi T, Darrouzet V, Ayache D, Somers T, Schmerber S, Vincent C, Mondain M, Lescanne E, Bonnard D (2017) Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study. Clin Otolaryngol 42(3):521–527
Silverstein H, Smouha E, Jones R (1988) Routine identification of the facial nerve using electrical stimulation during otological and neurotological surgery. Laryngoscope 98(7):726–730
Greenberg JS, Manolidis S, Stewart MG, Kahn JB (2002) Facial nerve monitoring in chronic ear surgery: US practice patterns. Otolaryngol Head Neck Surg 126(2):108–114
Wilson L, Lin E, Lalwani A (2003) Cost-effectiveness of intraoperative facial nerve monitoring in middle ear or mastoid surgery. Laryngoscope 113(10):1736–1745
Hu J, Fleck TR, Xu J, Hsu JV, Xu HX (2014) Contemporary changes with the use of facial nerve monitoring in chronic ear surgery. Otolaryngol Head Neck Surg 151(3):473–477
Ryu NG, Kim J (2016) How to avoid facial nerve injury in mastoidectomy? J Audiol Otol 20(2):68–72
Yu Z, Wang Z, Yang B, Han D, Zhang L (2011) The value of preoperative CT scan of tympanic facial nerve canal in tympanomastoid surgery. Acta Otolaryngol 131(7):774–778
Cai YR, Xu J, Chen LH, Chi FL (2009) Electromyographic monitoring of facial nerve under different levels of neuromuscular blockade during middle ear microsurgery. Chin Med J (Engl) 122(3):311–314
Magliulo G, Colicchio MG, Appiani MC (2011) Facial nerve dehiscence and cholesteatoma. Ann Otol Rhinol Laryngol 120(4):261–267
Moreano EH, Paparella MM, Zelterman D, Goycoolea MV (1994) Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: a report of 1000 temporal bones. Laryngoscope 104(3 Pt 1):309–320
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Francisco Arias-Marzán declares that he has no conflict of interest; Gemma de Lucas-Carmona declares that she has no conflict of interest; Esteban Reinaldo Pacheco-Coronel declares that he has no conflict of interest; Pedro Javier Pérez Lorensu declares that he has no conflict of interest; Alejandro Jiménez-Sosa declares that he has no conflict of interest; Blas Pérez-Piñero declares that he has no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Arias-Marzán, F., de Lucas-Carmona, G., Pacheco Coronel, E.R. et al. Facial canal dehiscence in patients with cholesteatoma: concordance between intraoperative inspection, computed tomography and neurophysiological findings. Eur Arch Otorhinolaryngol 276, 1915–1920 (2019). https://doi.org/10.1007/s00405-019-05416-6
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DOI: https://doi.org/10.1007/s00405-019-05416-6