Facial nerve monitoring in parotid surgery: the standard of care?

Recent reports have suggested that the incidence of permanent facial nerve paralysis or paresis after surgery for benign parotid tumors is between 3% and 5%. The intraoperative use of nerve-integrity monitors has been advocated to reduce the incidence of facial nerve paralysis. The purpose of this study was to compare postoperative facial nerve function after monitored and unmonitored parotid surgical procedures. The charts of 69 consecutive patients with parotid lesions who underwent surgery from 1987 to 1996 were retrospectively surveyed. Sixteen high-risk patients were excluded from the study. The study group consisted of 53 patients (33 unmonitored and 20 monitored) who underwent lateral parotidectomy for mobile tumors of the superficial lobe of the parotid gland. No patient demonstrated permanent facial paralysis. In 9 patients (17%), transient nerve paralysis developed: 5 (15%) of the 33 patients who underwent lateral parotidectomy without the use of a nerve-integrity monitor and 4 (20%) of the 20 patients who underwent lateral parotidectomy with the use of a nerve-integrity monitor. Nerve-integrity monitoring is optional for mobile parotid tumors of the superficial lobe.