Feasibility of facial nerve monitoring using adhesive surface electrodes during parotidectomy: a comparative study with needle electrodes.

PURPOSE: Electrophysiological monitoring of the facial nerve during parotidectomy has been reported as an adjunctive method to prevent facial nerve injury. Classically, a needle electrode is used to obtain electromyographic (EMG) signals from facial muscles during facial nerve monitoring (FNM) of parotid surgery, likewise adhesive surface electrodes. This study aimed to investigate the feasibility of performing FNM with surface electrodes during parotid surgery and to compare EMG values with needle electrodes. METHODS: Thirty patients who underwent parotidectomy under FNM using adhesive surface and needle electrodes were included. Two pairs of adhesive surface electrodes and needle electrodes were used for FNM during parotid surgery. Mean amplitudes were collected after electrical facial nerve stimulation at 1 mA after specimen removal. RESULTS: The mean amplitude of the adhesive surface electrodes was 226.50 ± 118.44 µV (orbicularis oculi muscle) and 469.6 ± 306.06 µV (orbicularis oris muscle), respectively. The mean amplitude of the needle electrodes was 449.85 ± 248.10 µV (orbicularis oculi muscle) and 654.66 ± 395.71 µV (orbicularis oris muscle), respectively. The mean amplitude of the orbicularis oris muscle was significantly greater than that of the orbicularis oculi. The amplitude values measured in the orbicularis oculi muscle showed significant differences between the needle and skin electrodes. CONCLUSIONS: Facial nerve monitoring (FNM) using adhesive surface electrodes is feasible in parotid surgery. Although the mean amplitude value of the surface electrode was relatively lower than that of the needle electrode, the surface electrode is considered a feasible and safe EMG recording device for FNM in parotid surgery.

Causes and management of persistent septal deviation after septoplasty.

Septoplasty is one of the most common otolaryngological surgical procedures. The causes of persistent septal deviation after primary septoplasty vary. The purpose of this study was to identify factors associated with failure of primary septoplasty, operative techniques that correct residual septal deviation, and surgical outcomes. Seventy-four adults who underwent revision septoplasty to treat persistent septal deviations were enrolled. The level of hospital in which primary septoplasty was performed, type of septal deviation, septal portion exhibiting persistent deviation, and techniques used to correct the deviation were evaluated. Outcomes were measured subjectively using a visual analog scale (VAS), and objectively using acoustic rhinometry. The first septoplasties were usually performed in primary and secondary hospitals. C-shaped deviations were more common than S-shaped ones in both the anteroposterior and cephalocaudal dimensions. The most common region of persistent septal deviation was the caudal septum (44.6%), followed by multiple sites (20.3%). The corrective techniques included excision of the remnant deviated portion (70.3%), septal cartilage traction suturing (27.0%), spreader grafting (13.5%), and cross-suturing (6.8%). The VAS score improved significantly 6 months after surgery. The minimal cross-sectional area and nasal cavity volume of the convex side increased significantly after revision septoplasty. Patients who underwent septoplasty in primary and secondary hospitals were more likely to require revision septoplasty. The caudal septum was the most common site of persistent septal deviation. Careful preoperative evaluation of the caudal septal deviation and selection of an appropriate surgical technique may reduce the need for revision septoplasty.