Carlos Miguel Chiesa-Estomba1,2, Ekhiñe Larruscain-Sarasola3, Jérome Rene Lechien4,5, Francois Mouawad6, Christian Calvo-Henriquez7,5, Evelyne Siga Diom8, Adonis Ramirez9, Tareck Ayad10,5. 1. Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Calle Doctor Begiristain, #1. CP. 20014, San Sebastian-Donostia, Guipuzkoa, Basque Country, Spain. chiesaestomba86@gmail.com. 2. Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France. chiesaestomba86@gmail.com. 3. Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Calle Doctor Begiristain, #1. CP. 20014, San Sebastian-Donostia, Guipuzkoa, Basque Country, Spain. 4. Department of Human Anatomy and Experimental Oncology, University of Mons, Mons, Belgium. 5. Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France. 6. Department of Otorhinolaryngology-Head and Neck Surgery, CHRU de Lille, Lille, France. 7. Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain. 8. ENT and Head and Neck Departement, CHU de La Paix, UFR Santé de l'Université Assane Seck, Ziguinchor, Sénégal. 9. Head and Neck Surgery, Clinica Medilaser Neiva, Neiva, Colombia. 10. Division of Otolaryngology-Head and Neck Surgery, Center Hospitalier de l'Université de Montréal, Montreal, Canada.
Abstract
INTRODUCTION: Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland surgery among Otolaryngologist-Head and Neck Surgeons continues to be a matter of debate. MATERIALS AND METHODS: A systematic review and meta-analysis of the literature was conducted including articles from 1970 to 2019 to try to determine the effectiveness of intraoperative facial nerve monitoring in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without intraoperative facial nerve monitoring. RESULTS: Ten articles met inclusion criteria, with a total of 1069 patients included in the final meta-analysis. The incidence of immediate and permanent postoperative weakness following parotidectomy was significantly lower in the IFNM group compared to the unmonitored group (23.4% vs. 38.4%; p = 0.001) and (5.7% vs. 13.6%; p = 0.001) when all studies were included. However, when we analyze just prospective data, we are not able to find any significant difference. CONCLUSION: Our study suggests that IFNM may decrease the risk of immediate post-operative and permanent facial nerve weakness in primary parotid gland surgery. However, due to the low evidence level, additional prospective-randomized trials are needed to determine if these results can be translated into improved surgical safety and improved patient satisfaction.
INTRODUCTION:Facial nerve injury remains the most severe complication of parotid gland surgery. However, the use of intraoperative facial nerve monitoring (IFNM) during parotid gland surgery among Otolaryngologist-Head and Neck Surgeons continues to be a matter of debate. MATERIALS AND METHODS: A systematic review and meta-analysis of the literature was conducted including articles from 1970 to 2019 to try to determine the effectiveness of intraoperative facial nerve monitoring in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without intraoperative facial nerve monitoring. RESULTS: Ten articles met inclusion criteria, with a total of 1069 patients included in the final meta-analysis. The incidence of immediate and permanent postoperative weakness following parotidectomy was significantly lower in the IFNM group compared to the unmonitored group (23.4% vs. 38.4%; p = 0.001) and (5.7% vs. 13.6%; p = 0.001) when all studies were included. However, when we analyze just prospective data, we are not able to find any significant difference. CONCLUSION: Our study suggests that IFNM may decrease the risk of immediate post-operative and permanent facial nerve weakness in primary parotid gland surgery. However, due to the low evidence level, additional prospective-randomized trials are needed to determine if these results can be translated into improved surgical safety and improved patient satisfaction.
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