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Objective <p>To evaluate electrophysiological monitoring parameters and postoperative facial nerve outcomes during extracapsular dissection (ECD) of benign parotid tumors</p> Methods <p>A retrospective consecutive cohort study included adult patients who underwent ECD with intraoperative facial nerve monitoring between 2020 and 2025. Monitoring consisted of continuous free-running electromyography (EMG) and intermittent bipolar stimulation. Facial nerve function was assessed using the House–Brackmann scale. Intraoperative electrophysiological parameters included stimulation intensity, compound muscle action potential (CMAP) amplitude changes, and monitoring safety.</p> Results <p>Thirty-eight patients were analyzed with a mean follow-up of 30.7 months. No technical failures or loss of signal occurred. The minimal effective stimulation intensity was 1.8 ± 0.9 mA (range 0.5 – 4.4 mA). Mean maximal stimulation intensity used for neural mapping was 4.5 ± 2.5 mA. Intraoperative EMG amplitude reduction occurred in two patients (5.3%), both of whom developed transient facial paresis (House–Brackmann II) with complete recovery within three months. No permanent facial paralysis was observed.</p> Conclusions <p>Intraoperative facial nerve monitoring during ECD demonstrated a favorable safety profile. EMG amplitude reduction may represent an early marker of reversible neural stress, particularly in tumors with close nerve proximity. Stimulation currents during intraparenchymal dissection should be interpreted primarily as neural mapping parameters rather than fixed electrophysiological thresholds.</p>

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Electrophysiological benchmarks of intraoperative facial nerve monitoring during extracapsular dissection

  • 期刊论文

  • 发表日期：

    2026年3月15日

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  • Ranna Gabriela Sala,
  • Roberta Oliveira De Almeida,
  • Rodrigo Nascimento Pinheiro,
  • Carlos Eduardo Santa Ritta Barreira

摘要

Objective

To evaluate electrophysiological monitoring parameters and postoperative facial nerve outcomes during extracapsular dissection (ECD) of benign parotid tumors

Methods

A retrospective consecutive cohort study included adult patients who underwent ECD with intraoperative facial nerve monitoring between 2020 and 2025. Monitoring consisted of continuous free-running electromyography (EMG) and intermittent bipolar stimulation. Facial nerve function was assessed using the House–Brackmann scale. Intraoperative electrophysiological parameters included stimulation intensity, compound muscle action potential (CMAP) amplitude changes, and monitoring safety.

Results

Thirty-eight patients were analyzed with a mean follow-up of 30.7 months. No technical failures or loss of signal occurred. The minimal effective stimulation intensity was 1.8 ± 0.9 mA (range 0.5 – 4.4 mA). Mean maximal stimulation intensity used for neural mapping was 4.5 ± 2.5 mA. Intraoperative EMG amplitude reduction occurred in two patients (5.3%), both of whom developed transient facial paresis (House–Brackmann II) with complete recovery within three months. No permanent facial paralysis was observed.

Conclusions

Intraoperative facial nerve monitoring during ECD demonstrated a favorable safety profile. EMG amplitude reduction may represent an early marker of reversible neural stress, particularly in tumors with close nerve proximity. Stimulation currents during intraparenchymal dissection should be interpreted primarily as neural mapping parameters rather than fixed electrophysiological thresholds.