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Safe application of continuous intraoperative Neuromonitoring in Parotid surgery with the Saxophone® Electrode – results from a prospective study
Introduction The development of intraoperative neuromonitoring (IONM) has been limited in parotid surgery in recent decades, although this method has been improved the outcomes in thyroidectomy and surgery of the posterior cranial fossa. Here, the paresis rates were lowered by recognizing patterns of impending nerve injury. Our goal was to adopt cIONM to parotid surgery and to demonstrate its safety.
Methods This prospective study was registered at the German Register for Clinical Trials (DRKS-ID: DRKS00011051, http://www.drks.de). Forty patients with preoperative normal facial function (House-Brackmann I) underwent primary parotid surgery from 2016 to 2018 with cIONM using the Saxophone® electrode (AVALANCHE XT, Dr. Langer Medical, Waldkirch, Germany). A control group was selected from patients monitored with intermittent IONM (iIONM).
Results Half of the operated patients had an early facial palsy (fFP), which fully recovered in 39 out of 40 patients within 6 months. There was no statistically significant difference compared to the iIONM group (p = 0.11). No correlation was found for either stimulation threshold (p = 0.74) or duration of nerve stimulation (p = 0.51) and fFP.
Conclusion The cIONM in parotid surgery with the Saxophone® electrode can be performed safely. Future development of this method could reduce the rate of fFP by recognizing the pattern of impending nerve injury.
10 June 2020 (online)
© Georg Thieme Verlag KG
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