Abstract：
OBJECTIVE: Facial palsy (FP) is the most significant complication of parotidectomy. Currently, the use of intermittent intraoperative neuromonitoring (iIONM) in parotid surgery facilitates nerve detection, which is paramount to nerve protection. Continuous IONM (cIONM), as applied in thyroid surgery, enables real-time information on electrophysiological nerve status through continuous nerve stimulation, thereby allowing consequent amplitude analysis. To date, the application of cIONM in parotid surgery has not been noted in literature.
METHODS: We performed parotidectomies with anterograde facial nerve visualization using cIONM in 32 consecutive patients in a prospective study (German Register of clinical studies-DRKS 00011051) during the period October 2016 to January 2020. After the facial trunk had been exposed, an atraumatic stimulation electrode was placed and the nerve was stimulated at 3 Hz, at a low threshold (0.62 ± 0.06 mA), for the entire duration of the preparation. Selected electrophysiological parameters were collected and compared to postoperative facial nerve function, measured by the House-Brackmann grading system.
RESULTS: In the post hoc analysis, a significant correlation between a drop in amplitude (< 50% of the \"baseline\" amplitude) and postoperative FP was recorded (p = 0.001). True positive prediction of FP was noted in 14 out of 16 patients and true negative in 10 out of 16. The sensitivity was 87.5% (AUC 0.75), with a high negative predictive value of 83.3%.
CONCLUSIONS: cIONM has significant value in predicting postoperative FP in parotidectomy. Future development of an acoustic/optic warning system in IONM devices could prevent nerve injury in real time.
METHODS: We performed parotidectomies with anterograde facial nerve visualization using cIONM in 32 consecutive patients in a prospective study (German Register of clinical studies-DRKS 00011051) during the period October 2016 to January 2020. After the facial trunk had been exposed, an atraumatic stimulation electrode was placed and the nerve was stimulated at 3 Hz, at a low threshold (0.62 ± 0.06 mA), for the entire duration of the preparation. Selected electrophysiological parameters were collected and compared to postoperative facial nerve function, measured by the House-Brackmann grading system.
RESULTS: In the post hoc analysis, a significant correlation between a drop in amplitude (< 50% of the \"baseline\" amplitude) and postoperative FP was recorded (p = 0.001). True positive prediction of FP was noted in 14 out of 16 patients and true negative in 10 out of 16. The sensitivity was 87.5% (AUC 0.75), with a high negative predictive value of 83.3%.
CONCLUSIONS: cIONM has significant value in predicting postoperative FP in parotidectomy. Future development of an acoustic/optic warning system in IONM devices could prevent nerve injury in real time.
摘要：
目的：面神经麻痹（FP）是腮腺切除术最重要的并发症。目前,在腮腺手术中使用间歇性术中神经监测（iIONM）有助于神经检测，这对神经保护至关重要。连续IONM(cIONM),应用于甲状腺手术，通过连续的神经刺激实现电生理神经状态的实时信息，从而允许随后的振幅分析。迄今为止,cIONM在腮腺手术中的应用尚未见文献.
方法：我们在一项前瞻性研究（德国临床研究注册-DRKS00011051）中，在2016年10月至2020年1月期间，对32名连续患者使用cIONM进行了顺行面神经可视化腮腺切除术。面部躯干暴露后，放置无创伤刺激电极，并以3Hz刺激神经，在低阈值(0.62±0.06mA)下，在整个准备过程中。收集选定的电生理参数，并与术后面神经功能进行比较，由House-Brackmann分级系统测量。
结果：在事后分析中，记录到振幅下降(<"基线"振幅的50%)与术后FP之间存在显著相关性(p=0.001).在16例患者中有14例发现了FP的真阳性预测，在16例患者中有10例发现了真阴性。灵敏度为87.5%（AUC0.75），具有83.3%的高阴性预测值。
结论：cIONM对预测腮腺切除术后FP有重要价值。IONM设备中声学/光学警告系统的未来发展可以实时防止神经损伤。
方法：我们在一项前瞻性研究（德国临床研究注册-DRKS00011051）中，在2016年10月至2020年1月期间，对32名连续患者使用cIONM进行了顺行面神经可视化腮腺切除术。面部躯干暴露后，放置无创伤刺激电极，并以3Hz刺激神经，在低阈值(0.62±0.06mA)下，在整个准备过程中。收集选定的电生理参数，并与术后面神经功能进行比较，由House-Brackmann分级系统测量。
结果：在事后分析中，记录到振幅下降(<"基线"振幅的50%)与术后FP之间存在显著相关性(p=0.001).在16例患者中有14例发现了FP的真阳性预测，在16例患者中有10例发现了真阴性。灵敏度为87.5%（AUC0.75），具有83.3%的高阴性预测值。
结论：cIONM对预测腮腺切除术后FP有重要价值。IONM设备中声学/光学警告系统的未来发展可以实时防止神经损伤。
