Continuous facial nerve monitoring during pleomorphic adenoma recurrence surgery.
OBJECTIVE
Surgery of recurrent pleomorphic adenoma (RPA) is known to lead to a high facial nerve complication rate. The efficacy of the continuous facial nerve monitoring (CFNM) technique remains to be proven in RPA surgery. The goal was thus to evaluate facial nerve palsy rates and the recovery period after parotidectomy for RPA using CFNM by way of continuous electromyography and to compare these rates and the operation time with those of patients who had undergone surgery without facial nerve monitoring.


METHODS
Cohort study.


METHODS
Forty-seven patients were referred for RPA (1981-2003). Among them, 32 (18 unmonitored and 14 monitored) patients displayed no preoperative facial palsy, and histologic analyses revealed evidence of recurrence. The operation time and the extent and duration of postoperative facial nerve palsy were examined in both groups (monitored vs. unmonitored). Both groups had a similar clinical appearance distribution.


RESULTS
Facial nerve paralysis was estimated using the House-Brackmann grading scale. CFNM reduced the intensity of facial nerve paralysis independently of the kind of surgery performed. The complete deficit rates were 0% for the monitored group and 5.6% for the unmonitored group. Postoperative facial nerve paralysis was significantly lower (P = .01) in the monitored group than in the unmonitored group. CFNM improved the duration of facial paralysis (P = .001) in the monitored group. The operation time was significantly lower in the monitored group than in the unmonitored group (P = .001).


CONCLUSIONS
Routine use of CFNM during RPA surgery improves the surgical outcome. The facial nerve deficit can be reduced, and the recovery of facial nerve function is faster.
Service ORL Chirurgie Cervico-Faciale, CHU Montpellier, Montpellier, France. m-makeieff@chu-montpellier.fr
Marc
M
Makeieff
Frédéric
F
Venail
César
C
Cartier
Renaud
R
Garrel
Louis
L
Crampette
Bernard
B
Guerrier
D008949:Adenoma, Pleomorphic / Q000601:surgery*; D015331:Cohort Studies; D005154:Facial Nerve / Q000503:physiopathology*; D005158:Facial Paralysis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D016343:Monitoring, Intraoperative; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011183:Postoperative Complications; D012468:Salivary Gland Neoplasms / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors