顏面神經偵測系統應用於高風險之腮腺手術後顏面神經麻痺探討

Intraoperative Facial Nerve Monitoring in High Risk Group of Parotidectomy-Related Facial Nerve Dysfunction

胡維元(Wei-Yuan Hu) ； 童寶奎(Bau-Kuei Tung) ； 朱本元(Pen-Yuan Chu) ； 戴世光(Shyh-Kuan Tai) ； 王怡芬(Yi-Fen Wang) ； 李宗倫(Tsung-Lun Lee) ； 許彥彬(Yen-Bin Hsu)

《台灣耳鼻喉頭頸外科雜誌》 48卷4期 (2013/12) Pp. 285-293

https://doi.org/10.6286/2013.48.4.285

摘要

BACKGROUND: The risk of facial nerve dysfunction is the primary concern after a parotidectomy. Intraoperative facial nerve monitoring (IFNM) has been developed to reduce post-parotidectomy facial nerve dysfunction. Although many studies had been conducted to evaluate the benefit of IFNM, however, there is no study focusing on the role of IFNM in high risk group of post-parotidectomy facial nerve dysfunction.METHODS: In this retrospective study, 205 patients with 212 parotidectomies between 2004 and 2009 were analyzed to determine the associated risk factors of post-parotidectomy facial nerve dysfunction and to clarify the role of IFNM in patients with these risk factors.RESULTS: Postoperative facial nerve dysfunction was observed in 54 cases (25.5%), which comprise 9 cases of permanent facial paresis (4.2%) and 45 cases of transient facial paresis (21.2%). Tumor involving deep lobe of parotid (p=0.001), total parotidectomy (p＜0.001) and size of tumor ＞ 3 cm (p=0.010) were significant risk factors for development of an immediate postoperative facial nerve dysfunction. For patients with at least one of these risk factors, the rates of immediate and permanent facial nerve dysfunction did not reach a significant difference between the IFNM groups and the control groups.CONCLUSIONS: Risk factors of parotidectomy-related facial nerve dysfunction included tumor involving deep lobe of parotid gland, total parotidectomy, and size of tumor ＞ 3 cm. In high risk group, IFNM showed no statistically significant reduction in facial nerve dysfunction. However, postoperative facial nerve dysfunction was not observed in the only 4 cases of reoperation under IFNM. Thus, a more comprehensive study is necessary to identify the role of IFNM in these high risk groups of post-parotidectomy facial nerve dysfunction.

關鍵字

腮腺手術(parotidectomy) ； 顏面神經功能失常(facial nerve dysfunction) ； 危險因子(risk factors) ； 顏面神經偵測系統(intraoperative facial nerve monitoring)

並列摘要

BACKGROUND: The risk of facial nerve dysfunction is the primary concern after a parotidectomy. Intraoperative facial nerve monitoring (IFNM) has been developed to reduce post-parotidectomy facial nerve dysfunction. Although many studies had been conducted to evaluate the benefit of IFNM, however, there is no study focusing on the role of IFNM in high risk group of post-parotidectomy facial nerve dysfunction.METHODS: In this retrospective study, 205 patients with 212 parotidectomies between 2004 and 2009 were analyzed to determine the associated risk factors of post-parotidectomy facial nerve dysfunction and to clarify the role of IFNM in patients with these risk factors.RESULTS: Postoperative facial nerve dysfunction was observed in 54 cases (25.5%), which comprise 9 cases of permanent facial paresis (4.2%) and 45 cases of transient facial paresis (21.2%). Tumor involving deep lobe of parotid (p=0.001), total parotidectomy (p＜0.001) and size of tumor ＞ 3 cm (p=0.010) were significant risk factors for development of an immediate postoperative facial nerve dysfunction. For patients with at least one of these risk factors, the rates of immediate and permanent facial nerve dysfunction did not reach a significant difference between the IFNM groups and the control groups.CONCLUSIONS: Risk factors of parotidectomy-related facial nerve dysfunction included tumor involving deep lobe of parotid gland, total parotidectomy, and size of tumor ＞ 3 cm. In high risk group, IFNM showed no statistically significant reduction in facial nerve dysfunction. However, postoperative facial nerve dysfunction was not observed in the only 4 cases of reoperation under IFNM. Thus, a more comprehensive study is necessary to identify the role of IFNM in these high risk groups of post-parotidectomy facial nerve dysfunction.