Facial Nerve Monitoring

Introduction

Salivary gland surgery requires knowledge of facial nerve anatomy and meticulous dissection technique. In both adults and children, temporary facial weakness following parotid gland surgery is relatively common, with reported rates ranging from 20% to 40%. Permanent facial nerve injury occurs in a much smaller percentage of patients, 0% to 4%, and is more likely to be associated with malignant pathologies. A study of 102 patients presenting to an academic facial nerve center with iatrogenic facial nerve injury found that parotidectomy accounted for 52% of the injuries, with submandibular gland excision accounting for 8% of injuries. While the risk of permanent facial nerve injury following salivary gland surgery is low, the consequences can be devastating as regards both cosmetic and functional outcomes. The use of facial nerve monitoring during salivary gland surgery has become increasingly common, and published data would suggest that nerve monitoring decreases temporary postoperative paralysis.