Eren Sabri Baki, Dogan Remzi, Ozturan Orhan, Veyseller Bayram, Hafiz Ayşenur Meriç
*Department of Otorhinolaryngology, Bezmialem Vakif University, Fatih †Department of Otorhinolaryngology, Acibadem University, Sariyer, Istanbul, Turkey.
J Craniofac Surg. 2017 Jan;28(1):56-60. doi: 10.1097/SCS.0000000000003186.
This study was conducted to investigate subclinical electrophysiological deleterious effect due to microtrauma to the nerve in response to the dissection of a tumor and parotid tissue from the facial nerve and its branches and surgical traction experienced during the operation.
The study included 34 adult patients who underwent parotidectomy operations under intraoperative facial nerve monitoring. Three measurements were taken from each patient to evaluate facial nerve functions, with 3 stimuli of different intensities applied with different timing. An initial stimulus of 1 mA was applied to confirm the identification of the main trunk of the facial nerve (Group 1: Initial-Normal). Then, a threshold value was found by stimulating the main trunk until muscle fasciculations were observed on facial muscles (Group 2: Basal-Minimal). The same procedure was repeated after the tumor was resected (Group 3: Final-Minimal).
There was no significant difference between the stimulus thresholds of Group 2 (0.31 mA) and Group 3 (0.30 mA). The highest amplitude in all 3 groups was observed at the mental branch, and the lowest at the frontal. The highest latency value was measured at the frontal branch and the lowest at the mental branch. Five (14.7%) of the patients developed postoperative pareses that was completely resolved by the seventh postoperative day visit in these patients.
This study demonstrated that the surgical trauma of a meticulously conducted dissection and surgical traction did not cause any deleterious electrophysiological alteration on the facial nerve.
本研究旨在调查因手术中从面神经及其分支分离肿瘤和腮腺组织以及手术牵拉导致的神经微创伤所引起的亚临床电生理有害效应。
该研究纳入了34例在术中面神经监测下接受腮腺切除术的成年患者。对每位患者进行三次测量以评估面神经功能，在不同时间施加三种不同强度的刺激。首先施加1毫安的初始刺激以确认面神经主干的识别（第1组：初始-正常）。然后，通过刺激主干直至在面部肌肉上观察到肌肉颤动来确定阈值（第2组：基础-最小）。肿瘤切除后重复相同程序（第3组：最终-最小）。
第2组（0.31毫安）和第3组（0.30毫安）的刺激阈值之间无显著差异。所有3组中，颏支的振幅最高，额支的振幅最低。额支的潜伏期值最高，颏支的潜伏期值最低。5例（14.7%）患者出现术后轻瘫，在术后第7天复诊时这些患者的轻瘫完全缓解。
本研究表明，精心进行的解剖和手术牵拉的手术创伤未对面神经造成任何有害的电生理改变。
