Terrell J E, Kileny P R, Yian C, Esclamado R M, Bradford C R, Pillsbury M S, Wolf G T
Department of Otolaryngology, University of Michigan, Department of Veterans Affairs, Ann Arbor,USA.
Arch Otolaryngol Head Neck Surg. 1997 Oct;123(10):1081-7. doi: 10.1001/archotol.1997.01900100055008.
To assess whether continuous facial nerve monitoring during parotidectomy is associated with a lower incidence of facial nerve paresis or paralysis compared with parotidectomy without monitoring and to assess the cost of such monitoring.
A retrospective analysis of outcomes for patients who underwent parotidectomy with or without continuous facial nerve monitoring.
University medical center.
Fifty-six patients undergoing parotidectomy in whom continuous electromyographic monitoring was used and 61 patients in whom it was not used.
(1) The incidence of early and persistent facial nerve paresis or paralysis and (2) the cost associated with facial nerve monitoring.
Early, unintentional facial weakness was significantly lower in the group monitored by electromyograpy (43.6%) than in the unmonitored group (62.3%) (P=.04). In the subgroup of patients without comorbid conditions or surgeries, early weakness in the monitored group (33.3%) remained statistically lower than the rate of early weakness in the unmonitored group (57.5%) (P=.03). There was no statistical difference in the final facial nerve function or incidence of permanent nerve injury between the groups or subgroups. After multivariate analysis, nonmonitored status (odds ratio [OR], 3.22), advancing age (OR, 1.47 per 10 years), and longer operative times (OR, 1.3 per hour) were the only significant independent predictive variables significantly associated with early postoperative facial weakness. The incremental cost of facial nerve monitoring was $379.
The results suggest that continuous electromyographic monitoring of facial muscle during primary parotidectomy reduces the incidence of short-term postoperative facial paresis. Advantages and disadvantages of this technique need to be considered together with the additional costs in deciding whether routine use of continuous monitoring is a useful, cost-effective adjunct to parotid surgery.
评估在腮腺切除术中进行连续面神经监测与未进行监测的腮腺切除术相比，是否能降低面神经轻瘫或瘫痪的发生率，并评估这种监测的成本。
对接受或未接受连续面神经监测的腮腺切除术患者的结局进行回顾性分析。
大学医学中心。
56例接受腮腺切除术并使用连续肌电图监测的患者以及61例未使用该监测的患者。
（1）早期和持续性面神经轻瘫或瘫痪的发生率；（2）与面神经监测相关的成本。
肌电图监测组早期意外面部无力的发生率（43.6%）显著低于未监测组（62.3%）（P = 0.04）。在无合并症或手术史的患者亚组中，监测组的早期无力发生率（33.3%）在统计学上仍低于未监测组（57.5%）（P = 0.03）。两组或亚组之间的最终面神经功能或永久性神经损伤发生率无统计学差异。多因素分析后，未监测状态（优势比[OR]，3.22）、年龄增长（OR，每10年1.47）和手术时间延长（OR，每小时1.3）是与术后早期面部无力显著相关的仅有的重要独立预测变量。面神经监测的增量成本为379美元。
结果表明，在初次腮腺切除术中对面部肌肉进行连续肌电图监测可降低术后短期面神经轻瘫的发生率。在决定连续监测的常规使用是否是腮腺手术有用且具有成本效益的辅助手段时，需要综合考虑该技术的优缺点以及额外成本。
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