title: Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.
abstract: OBJECTIVE
  To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting.
  
  
  METHODS
  Multicentre retrospective study in eight tertiary referral hospitals over 17 years.
  
  
  METHODS
  Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised.
  
  
  METHODS
  Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded.
  
  
  RESULTS
  In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves.
  
  
  CONCLUSIONS
  We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Linder
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Luzerner Kantonsspital, Luzern, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Mulazimoglu
authors.affiliation: Hearing and Balance Center, Dr El Hadi ENT Private Practice, Fès, Morocco.
authors.forename: T
authors.initials: T
authors.lastname: El Hadi
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Darrouzet
authors.affiliation: Otology-Neurotology Unit, Fondation Adolphe De Rothschild, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Ayache
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Antwerp, Antwerp, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Somers
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Grenoble, Grenoble, France.
authors.forename: S
authors.initials: S
authors.lastname: Schmerber
authors.affiliation: Department of Otolaryngology, Lille University, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Vincent
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Montpellier, Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Mondain
authors.affiliation: Department of Otolaryngology, Tours University, Tours, France.
authors.forename: E
authors.initials: E
authors.lastname: Lescanne
authors.affiliation: Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, Bordeaux, France.
authors.forename: D
authors.initials: D
authors.lastname: Bonnard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D005060:Europe / Q000453:epidemiology; D020220:Facial Nerve Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D000074406:Mastoidectomy / Q000009:adverse effects*; D008875:Middle Aged; D010033:Otitis Media / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult