Ahn Dongbin, Kwak Ji Hye, Kim Geun-Jeon, Kim Heejin, Lee Dong Won, Cho Kwang Jae
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu 41566, Republic of Korea.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Diagnostics (Basel). 2024 Oct 13;14(20):2277. doi: 10.3390/diagnostics14202277.
This study aimed to evaluate the current practices and trends of intraoperative facial nerve (FN) monitoring (IOFNM) during parotidectomy. A questionnaire containing 33 questions collecting information on the usage, indications, settings, techniques, loss of signal (LOS) management, anesthesiologist cooperation, and perception of usefulness of IOFNM was distributed among 348 members of the Korean Society of Head and Neck Surgery (KSHNS) via a dedicated website. The response rate was approximately 25.6%, and 97% of the respondents reported using IOFNM selectively or routinely during parotidectomy. IOFNM usage decreased as the surgeon's level of experience increased ( = 0.089), from 100% in those with less than 5 years of experience to 75% in those with 20 or more years. Approximately 95% of respondents reported that the initial event threshold for electromyography activity used was 50-149 μV. Moreover, 52.4% of respondents performed neural mapping of the FN before visual identification. Initial management of LOS in visually intact FNs included checking the IOFNM system (75.3%), confirmation of muscle relaxant dosage (75.3%), and facial twitch identification (58.8%). Further management included proceeding with surgery regardless of persistent LOS (81.2%) and steroid administration sometimes or all of the time (72.9%). Overall, 98.8% of respondents found IOFNM beneficial for safe execution of parotidectomy. The majority of KSHNS surgeons used IOFNM during parotidectomy, although the clinical implementation of the procedure and LOS management varied between practitioners. This could be attributed to the lack of standardized protocols for IOFNM, emphasizing the need for the development of evidence-based consensus guidelines for all institutions.
本研究旨在评估腮腺切除术期间术中面神经（FN）监测（IOFNM）的当前实践和趋势。通过一个专门网站，向韩国头颈外科学会（KSHNS）的348名成员分发了一份包含33个问题的问卷，收集有关IOFNM的使用、适应证、设置、技术、信号丢失（LOS）管理、麻醉医生合作以及对其有用性的认知等信息。回复率约为25.6%，97%的受访者报告在腮腺切除术期间选择性或常规使用IOFNM。随着外科医生经验水平的提高，IOFNM的使用有所下降（ = 0.089），从经验不足5年的医生中的100%降至经验20年及以上医生中的75%。约95%的受访者报告所使用的肌电图活动初始事件阈值为50 - 149 μV。此外，52.4%的受访者在视觉识别FN之前进行了神经绘图。对于外观正常的FN，LOS的初始处理包括检查IOFNM系统（75.3%）、确认肌肉松弛剂剂量（75.3%）以及识别面部抽搐（58.8%）。进一步的处理包括无论LOS持续与否都继续手术（81.2%）以及有时或一直给予类固醇（72.9%）。总体而言，98.8%的受访者认为IOFNM对腮腺切除术的安全实施有益。KSHNS的大多数外科医生在腮腺切除术期间使用IOFNM，尽管不同从业者在该操作的临床实施和LOS管理方面存在差异。这可能归因于IOFNM缺乏标准化方案，强调了为所有机构制定基于证据的共识指南的必要性。
