Patterns of use of facial nerve monitoring during parotid gland surgery.
OBJECTIVE
To determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States.


METHODS
A questionnaire encompassing surgeon training background, practice setting, patterns of facial nerve monitor usage during parotid gland surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between facial nerve monitor usage and dependent variables were examined by using the chi(2) test. Magnitudes of the associations were determined from odds ratios calculated using logistic regression.


RESULTS
A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy employed facial nerve monitoring some or all of the time. Respondents were 5.6 times more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed more than 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertent nerve injury if they performed more than 10 parotidectomies per year. Surgeons who employed monitoring in their practice were 20.8% less likely to have a history of a parotid surgery-associated lawsuit. Additional information regarding surgeon demographics, types of nerve monitors used, and reasons for and against monitor usage are discussed.


CONCLUSIONS
Permanent facial nerve paralysis after parotidectomy occurs in 0-7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.
Lowry
Thomas R
TR
Department of Otolaryngology--Head and Neck Surgery, Wilford Hall Medical Center, Lackland AFB, TX 78236-5300, USA. thomas.lowry@wpafb.af.mil
Gal
Thomas J
TJ
Brennan
Joseph A
JA
D002983:Clinical Competence; D000075202:Contraindications; D005154:Facial Nerve / Q000502:physiology*; D020220:Facial Nerve Injuries / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010306:Parotid Gland / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires