Outcome of Postoperative Facial Nerve Function Following Electromyographic Facial Nerve Monitoring During Parotidectomy for Benign Lesions: a Retrospective Study.

Does use of Facial nerve monitors during parotidectomy decrease incidence of facial paralysis/paresis without use of facial paresis? This study was done to compare the incidence, grade and risk factors of facial palsy in patients undergoing parotidectomy for benign parotid lesions with and without use of facial nerve monitor. This is a retrospective study. Eighty parotid patients operated for benign parotid lesions from 2013 to 2020 were retrospectively analysed. Demography details, history of the patients, history of addictions, clinical examination findings, investigation findings like the biopsy report, FNAC report, imaging i.e., CT / MRI / USG, use of intraoperative facial nerve monitor, time taken to identify the facial nerve, postoperative facial nerve palsy, facial nerve stimulation test and recovery time were analysed. Fifty patients were operated without use of facial nerve monitor, and 30 patients were operated using facial nerve monitor. Postoperative facial nerve complications were seen in 28 out of 80 patients (35%). Postoperative facial nerve complications were observed in 5 out of 30 patients (20%) in whom facial nerve monitoring was used. Marginal mandibular nerve palsy was observed in 4 patients and 1 patient had weakness of both marginal mandibular and orbital branches. While in postoperative facial nerve complications were observed in 25 out of 50 patients (50%), marginal mandibular nerve palsy was observed in 15 patients (40%), grade 3 facial palsy was observed in 3 out of 50 patients (6%), and grade 4 facial palsy were observed in 2 out of 50 patients (4%). The use of intraoperative FNM significantly lowered the incidence of paralysis.

Simple Technique Using an Additional Landmark to Reliably Identify the Trunk of Facial Nerve During Parotidectomy: a Cadaveric and Clinical Correlation Study.

The incidence of facial palsy in parotid surgeries is up to 50% transient and 17% complete facial palsy. Locating facial nerve trunk during parotid surgery can be tricky despite using the standard landmarks. During a cadaveric dissection, we came across a simple technique to identify the trunk of facial nerve which we have also tried to use it in clinical setting and found it to be useful. Parotidectomy was done in 12 cadaveric hemi-faces. The distance between the mastoid tip and the tympanic segment of facial nerve was measured. The distance of the facial nerve and mastoid tip and tympanomastoid suture and facial nerve was measured. The trunk of facial nerve was found to cross the tympanomastoid sulcus-mastoid tip at around 8-10 mm from the mastoid tip in 70% of the cases. We extrapolated this information in 5 cases of parotidectomy in operative setting. We were able to identify facial nerve trunk accurately in 4/5 cases. Imaginary line connecting the mastoid tip and tympanomastoid suture can be used to locate the probable position of the facial nerve trunk reliably during parotidectomy.

Modified nasolabial flap- the nasomentolabial flap: A new arrow in surgeon's quiver.

AIMS AND OBJECTIVES: To describe an inferior extension of a naso-labial flap as an adjunct to a maleo-labial flap in reconstruction of complete thickness defects around the oral commissure in 2 cases that we performed at our institute. METHODS: Two elderly cases of carcinoma buccal mucosa who underwent wide local excision along with neck dissection had moderately large peri-oral defects that are large to cover with nasolabial flap alone. An inferior extension to the maleo-labial flap was added, making it a naso-mento-labial flap to reconstruct the defects with an acceptable outcome aesthetically and functionally. The reconstructed defects' size was around 7 × 7cms and 8.5 × 6cms full-thickness defect in the buccal mucosa, respectively, with the extension of the defect in both the patients being almost the same with anterior extension to commissure, posteriorly to retro-molar trigone (RMT), laterally full-thickness, medially not involving alveolus. RESULTS: The incision at the donor site was closed primarily. The reconstruction did achieve the patient acceptable aesthetics, functionality, color and texture. The mean follow up of the patients is around 1 year with no complications. CONCLUSION: Naso-mento-labial flap, an inferiorly extended inferiorly based nasolabial flap is a useful addition to surgeon's armamentarium for reconstructing the buccal mucosa and peri-oral defects in patients whose general health prevents the using pedicled or free flaps.

Feasibility of Using Posterior Auricular Artery as Landmark for Identification of Facial Nerve Trunk in Parotid Surgery: A Cadaver Study.

INTRODUCTION: Despite good surgical knowledge of the anatomy of parotid gland and meticulous surgical technique, the incidence of facial palsy in parotid surgeries is up to 26.7% transient and 1.7% complete facial palsy(1). The risk of facial palsy increases further in malignant and revision cases. METHOD: Superficial parotidectomy was done in 14 cadaveric hemi faces in 10 cadavers. Posterior auricular artery and its stylomastoid branch was dissected and facial nerve trunk was identified in all cases. The relationship of posterior auricular artery along with its stylomastoid branch with the facial nerve trunk was studied and recorded. RESULT: Posterior auricular artery was found running inferior to the facial nerve trunk in 12 cadaveric dissection while the posterior auricular artery was found crossing below the main trunk of facial in 2 cadaver dissection. The average distance between PAA and facial nerve trunk was 7 mm (2-14 mm) Stylomastoid artery was found arising from Posterior auricular artery in 12 of 14 and it was found running medial to the facial nerve trunk in all the 8 cadavers. CONCLUSION: Post auricular artery can be used as another landmark for identification of the main trunk of facial nerve in parotid surgeries.