Guntinas-Lichius Orlando, Eisele David W
Adv Otorhinolaryngol. 2016;78:46-52. doi: 10.1159/000442124. Epub 2016 Apr 12.
Facial nerve monitoring has been increasingly routinely used as an intraoperative adjunctive method to help the head and neck surgeon to identify and minimize facial nerve injury during parotid surgery. The goals, current applications, recent technical advances, and limitations of the method are reviewed. A main focus of this chapter is a review of several prospective clinical trials that have been performed in recent years that have analyzed the benefit of electrophysiological nerve monitoring during parotid surgery. It has been demonstrated that nerve monitoring reduces the risk of early postoperative facial nerve dysfunction in primary surgery, but not in revision surgery. The effect is more pronounced in total than in superficial parotidectomy. Monitoring is associated with shorter surgical times in primary superficial parotidectomy compared to total parotidectomy. Facial nerve stimulation at the completion of parotidectomy helps to prognosticate the facial nerve functional outcome. A lower postdissection to predissection ratio of the maximal response amplitude is associated with early postoperative facial dysfunction. Facial nerve monitoring also helps the surgeon to avoid facial nerve injury when the facial nerve is not exposed during parotid surgery, such as during extracapsular dissection of a parotid neoplasm or sentinel node biopsy.
面神经监测已越来越常规地用作术中辅助方法，以帮助头颈外科医生在腮腺手术中识别并尽量减少面神经损伤。本文回顾了该方法的目标、当前应用、近期技术进展及局限性。本章的一个主要重点是回顾近年来进行的几项前瞻性临床试验，这些试验分析了腮腺手术中电生理神经监测的益处。已证明神经监测可降低初次手术中术后早期面神经功能障碍的风险，但在翻修手术中则不然。该效果在全腮腺切除术中比在浅叶腮腺切除术中更明显。与全腮腺切除术相比，初次浅叶腮腺切除术中监测与手术时间缩短有关。腮腺切除术后的面神经刺激有助于预测面神经功能结果。最大反应振幅的解剖后与解剖前比值较低与术后早期面部功能障碍有关。当在腮腺手术中面神经未暴露时，如在腮腺肿瘤的囊外解剖或前哨淋巴结活检期间，面神经监测也有助于外科医生避免面神经损伤。
