Intraoperative Facial Nerve Monitoring during Otologic Surgery.
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概要
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Facial nerve injury is a rare but serious complication of otologic surgery for which intraoperative facial nerve monitoring is thought to be useful. We have used the Silverstein Facial Nerve Stimulator/Monitor model S 8, a constant current nerve stimulation system, for intraoperative facial nerve monitoring since February 1999. We evaluated the usefulness of facial nerve monitoring during otologic surgery.<BR>Subjects were 31 patients undergoing otologic surgery at our hospital and divided into 3 groups based on intraoperative facial canal findings. In Group 1, the facial nerve was covered by bone (8 ears); in Group 2, the nerve was uncovered by bone, but covered by soft tissue or mucosa (16 ears); in Group 3, the facial nerve was directly exposed (7 ears). The threshold current was measured for each case by the nerve stimulator. The relationship between intraoperative findings on the horizontal facial canal and the threshold current was studied retrospectively. The threshold current ranged form 0.42 to 0.96 mA in Group 1, from 0.05 to 0.26 mA in Group 2, and from 0.05 to 0.15 mA in Group 3. Statistical differences of threshold were confirmed between Group 1 and others (p <0.0001), and between Group 2 and Group 3 (p=0.0181).<BR>Intraoperative facial nerve monitoring is useful for predicting facial canal condition and exploring the course of the facial nerve through the bony wall and soft tissue during otologic surgery. It is a potentially powerful supportive instrument for avoiding facial nerve injury during otologic surgery.
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