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<p>Intraoperative facial nerve monitoring (IOFNM) is a vital adjunct used in mastoid surgeries and lateral skull base surgeries, which prevents iatrogenic facial nerve injury, a complication with major cosmetic, functional, psychological, and legal consequences. To evaluate the potential benefits of intraoperative facial nerve monitoring (IOFNM) during chronic ear surgeries. A prospective observational study was conducted from January 2021 to May 2025 assess the integrity of the facial nerve in 140 patients undergoing mastoid surgery, lateral skull base surgery, and cochlear implant surgery, while utilizing Intraoperative Electromyographic (EMG) Facial Nerve monitoring. Muscle activity in response to nerve stimulation was recorded by inserting needle electrodes into particular facial muscles. The frontalis (forehead), orbicularis oculi (around the eye), and orbicularis oris (around the mouth) are common sites, and the ground electrodes are placed over the sternum. The facial nerve trunks or branches were gently touched and stimulated during surgery with a ball-tip monopolar stimulation probe. Correct functioning of the system was checked, and the facial nerve was stimulated and located. The use of intraoperative facial nerve monitoring (IOFNM) was found to be beneficial in 60.78% of cases of revision canal wall-up and canal wall-down mastoidectomies, 54.9% of cases with cholesteatoma and granulation disease, 66.67% with anatomical variation, and all patients of cochlear implant surgeries and lateral skull base surgeries. It was found to be beneficial in all cases for resident training and also provided advantages in terms of medico-legal protection. When 3&#xa0;mA current was used, even without inserting the probe, we could detect the stretch on the nerve during granulation removal, thereby preventing neuropraxia. Intraoperative nerve monitoring is a useful technological advancement in the field of ear surgery, especially in intra-temporal facial nerve monitoring, as the course of the facial nerve in the temporal bone is extremely unpredictable with many variations. It is helpful in revision cases and granulation disease. It is a good teaching tool. It increases the confidence in difficult cases and can prevent facial nerve palsy.</p>

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Utility of Intraoperative Facial Nerve Monitoring in Chronic Ear Surgeries: Insights from a Rural Indian Teaching Centre

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Harshil Dobariya,
  • Shraddha Jain

摘要

Intraoperative facial nerve monitoring (IOFNM) is a vital adjunct used in mastoid surgeries and lateral skull base surgeries, which prevents iatrogenic facial nerve injury, a complication with major cosmetic, functional, psychological, and legal consequences. To evaluate the potential benefits of intraoperative facial nerve monitoring (IOFNM) during chronic ear surgeries. A prospective observational study was conducted from January 2021 to May 2025 assess the integrity of the facial nerve in 140 patients undergoing mastoid surgery, lateral skull base surgery, and cochlear implant surgery, while utilizing Intraoperative Electromyographic (EMG) Facial Nerve monitoring. Muscle activity in response to nerve stimulation was recorded by inserting needle electrodes into particular facial muscles. The frontalis (forehead), orbicularis oculi (around the eye), and orbicularis oris (around the mouth) are common sites, and the ground electrodes are placed over the sternum. The facial nerve trunks or branches were gently touched and stimulated during surgery with a ball-tip monopolar stimulation probe. Correct functioning of the system was checked, and the facial nerve was stimulated and located. The use of intraoperative facial nerve monitoring (IOFNM) was found to be beneficial in 60.78% of cases of revision canal wall-up and canal wall-down mastoidectomies, 54.9% of cases with cholesteatoma and granulation disease, 66.67% with anatomical variation, and all patients of cochlear implant surgeries and lateral skull base surgeries. It was found to be beneficial in all cases for resident training and also provided advantages in terms of medico-legal protection. When 3 mA current was used, even without inserting the probe, we could detect the stretch on the nerve during granulation removal, thereby preventing neuropraxia. Intraoperative nerve monitoring is a useful technological advancement in the field of ear surgery, especially in intra-temporal facial nerve monitoring, as the course of the facial nerve in the temporal bone is extremely unpredictable with many variations. It is helpful in revision cases and granulation disease. It is a good teaching tool. It increases the confidence in difficult cases and can prevent facial nerve palsy.