Sood Amit J, Houlton Jeffrey J, Nguyen Shaun A, Gillespie M Boyd
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Otolaryngol Head Neck Surg. 2015 Apr;152(4):631-7. doi: 10.1177/0194599814568779. Epub 2015 Jan 27.
To determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy.
PubMed-NCBI database from 1970 to 2014.
A systematic review and meta-analysis of the literature was conducted. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs control). Primary and secondary end points were defined as immediate postoperative and permanent facial nerve weakness (House-Brackmann score, ≥2), respectively.
After a review of 1414 potential publications, 7 articles met inclusion criteria, with a total of 546 patients included in the final meta-analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared to the unmonitored group (22.5% vs 34.9%; P = .001). The incidence of permanent weakness was not statistically different in the long term (3.9% vs 7.1%; P = .18). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 9, given an absolute risk reduction of 11.7% This corresponded to a 47% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.53; 95% CI, 0.35 to 0.79; P = .002).
In primary cases of parotidectomy, intraoperative FNM decreases the risk of immediate postoperative facial nerve weakness but does not appear to influence the final outcome of permanent facial nerve weakness.
确定术中面神经监测（FNM）在预防原发性腮腺切除术患者术后即刻和永久性面神经麻痹方面的有效性。
1970年至2014年的PubMed-NCBI数据库。
对文献进行系统综述和荟萃分析。纳入的研究包括对照系列，评估原发性腮腺切除术后使用或不使用FNM（术中神经监测与对照组）的面神经功能。主要和次要终点分别定义为术后即刻和永久性面神经麻痹（House-Brackmann评分≥2）。
在对1414篇潜在出版物进行综述后，7篇文章符合纳入标准，最终荟萃分析共纳入546例患者。与未监测组相比，FNM组腮腺切除术后即刻麻痹的发生率显著降低（22.5%对34.9%；P = 0.001）。长期来看，永久性麻痹的发生率无统计学差异（3.9%对7.1%；P = 0.18）。预防1例术后即刻面神经麻痹所需的监测病例数为9例，绝对风险降低11.7%。这相当于即刻面神经功能障碍的发生率降低了47%（优势比，0.53；95%可信区间，0.35至0.79；P = 0.002）。
在原发性腮腺切除术中，术中FNM可降低术后即刻面神经麻痹的风险，但似乎不影响永久性面神经麻痹的最终结果。
