Ajith John George1, Pranay Gaikwad2, Vasanth Mark Samuel3, Cecil T. Thomas4, Amit J. Tirkey5, Rajinikanth J.6, Bijesh Yadav7
BACKGROUND
Salivary gland diseases are rare but an important group of disorders. Following
surgeries involving the parotid gland, facial nerve paresis is a common
postoperative complication. The reported worldwide incidence of facial nerve
paresis following parotidectomy is approximately 20 - 60 %. We need to determine
the incidence of facial nerve paresis in the post-operative period following
superficial, adequate, or extra-capsular parotidectomy of benign parotid tumours
with the use of intraoperative facial nerve monitoring.
METHODS
A non-randomised interventional trial was initiated once cleared by the institutional
review board. With the calculated sample size of 44, the patients underwent nervemonitoring
for the identification of the branches of the facial nerve. Clinical grading
of the nerve function was done using the House-Brackmann score on the
postoperative days 2, 7, and 60. The findings were compared with the historical
controls (HC) of 53 patients who underwent similar procedures but with no
intraoperative facial nerve monitoring. All patients were recruited in continuity for
over two years.
RESULTS
The incidence of facial nerve paresis was 30 - 40 % and 10 - 20 % in the historical
control and nerve monitoring group, respectively (P = 0.07). The duration of
surgery in the nerve monitoring group was 83 ± 30 minutes and 95 ± 15 minutes
in the HC group. The incidence of nerve paresis was similar among the trainees
and consultants suggestive of adequate training.
CONCLUSIONS
Intraoperative facial nerve monitoring is a useful adjunct to reduce the incidence
of early postoperative facial nerve paresis. The technique would not prolong the
duration of the procedure. The technique may be utilized safely on a routine basis
even during surgical training.
