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Continuous intraoperative neuromonitoring of the facial nerve predicts postoperative facial palsy in parotid surgery: a prospective study

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Facial palsy (FP) is the most significant complication of parotidectomy. Currently, the use of intermittent intraoperative neuromonitoring (iIONM) in parotid surgery facilitates nerve detection, which is paramount to nerve protection. Continuous IONM (cIONM), as applied in thyroid surgery, enables real-time information on electrophysiological nerve status through continuous nerve stimulation, thereby allowing consequent amplitude analysis. To date, the application of cIONM in parotid surgery has not been noted in literature.

Methods

We performed parotidectomies with anterograde facial nerve visualization using cIONM in 32 consecutive patients in a prospective study (German Register of clinical studies—DRKS 00011051) during the period October 2016 to January 2020. After the facial trunk had been exposed, an atraumatic stimulation electrode was placed and the nerve was stimulated at 3 Hz, at a low threshold (0.62 ± 0.06 mA), for the entire duration of the preparation. Selected electrophysiological parameters were collected and compared to postoperative facial nerve function, measured by the House-Brackmann grading system.

Results

In the post hoc analysis, a significant correlation between a drop in amplitude (< 50% of the “baseline” amplitude) and postoperative FP was recorded (p = 0.001). True positive prediction of FP was noted in 14 out of 16 patients and true negative in 10 out of 16. The sensitivity was 87.5% (AUC 0.75), with a high negative predictive value of 83.3%.

Conclusion

cIONM has significant value in predicting postoperative FP in parotidectomy. Future development of an acoustic/optic warning system in IONM devices could prevent nerve injury in real time.

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Funding

This project was funded entirely by the Department of the corresponding author.

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Authors and Affiliations

  1. Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Strasse 2, 04552, Borna, Germany

    Petar Stanković & Thomas Wilhelm

  2. Department of Otolaryngology, Head and Neck Surgery, Philipps-Universität Marburg, Marburg, Germany

    Stephan Hoch & Boris A. Stuck

  3. Medical Faculty, Philipps-Universität Marburg, Marburg, Germany

    Stephan Hoch, Boris A. Stuck & Thomas Wilhelm

Authors
  1. Petar Stanković
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  2. Stephan Hoch
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  3. Boris A. Stuck
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  4. Thomas Wilhelm
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Corresponding author

Correspondence to Petar Stanković.

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Conflict of interest

All authors have indicated that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Saxonian Physician’s Chamber, Germany (EK-BR-53/16-1) in September 2016.

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Informed consent was obtained from all individual participants included in the study.

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Stanković, P., Hoch, S., Stuck, B.A. et al. Continuous intraoperative neuromonitoring of the facial nerve predicts postoperative facial palsy in parotid surgery: a prospective study. Eur Arch Otorhinolaryngol 281, 1483–1492 (2024). https://doi.org/10.1007/s00405-023-08384-0

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  • DOI: https://doi.org/10.1007/s00405-023-08384-0

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