Study on Clinical Application of Nerve Monitor in Parotid Tumor Surgery
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【Abstract】Objective The purpose of the study is to explore the application value of the nerve monitor adopted to pinpoint facial nerves before anatomization during a parotid tumor surgery. Methods Facial nerves of 36 patients were pinpointed by N800 nerve monitor produced by Shandong Weigao Group Medical Polymer Co. Ltd before being anatomized and exposed in parotid surgeries in order to protect the corresponding facial nerve branch and complete the related surgery. Results All the facial nerves of the 36 patients were located precisely and 108 related facial nerves were successfully anatomized and protected without any damage. Conclusion Pinpointing the facial nerve branch with a nerve monitor before anatomization promotes not only the efficiency of the surgery but also the safety of it and is proved to be more significant in a secondary surgery.
【key words 】Parotid Tumor； Facial Nerve； Nerve Monitor
【CLC】R739.8 【Document code】B【Article number】1004-4949（2014）01-0237-01
Parotid gland tumor，which accounts for 80% of salivary gland tumor and 30% of head and neck tumor， often needs to be excised by surgery. Face-lift incision is needed during the parotidectomy surgery. Besides， the parotid gland is closely connected to facial nerve in various ways[1].Separating the facial nerve， as a result， is the key step in a parotid tumor surgery. There are different approaches to dissecting facial nerves [2] ，but all of them have their own risks. In order to minimize the potential risks， our department has introduced nerve monitor since 2011. And we adopt the nerve monitor in parotid gland tumor surgery to pinpoint the facial nerve branch before anatomizing， exposing and preserving them. We have applied this method to 36 cases of parotid gland surgery and have achieved satisfying achievements.
Case Report：
1 Materials and methods
1.1 clinical Materials
There are 36 patients in total with 21 males and 15 females aged from 25 years old to 76 years old. The average age is 45.5 years old. Among the 36 cases， there are 25 pleomorphic adenoma， 4 Warthin tumor， 3 monomorphic adenoma， 2 basal cell adenoma， 1 adenoid cystic carcinoma of the parotid gland and 1 mucoepidermoid carcinoma of parotid. All facial nerves of these patients were reserved. Surgical parotid procedures were performed on all the patients， including 30 superficial lobe parotidectomies， 4 deep lobe paratidectomies， and 2 enlargement lobe parotidectomies. Of all the patients， 2 have experienced a surgery before but suffered a recurrence of parotid gland tumor then..
3.2 Advantages of the nerve monitor in the facial nerve anatomy application
nerve monitoring technology was at the very beginning， applied in the protection of facial nerves and was introduced to China comparatively later than other countries[5]. N400 nerve monitor is a kind of evoking EMG instrument， which， via pulse current， stimulating facial nerves so as to evoke its corresponding muscle to practice electromyography activity. And by inserting multi-channel electrodes into the muscle or the surface of the muscle， the equipment can collect and record the information of the compound muscle action， namely electromyography. The stimulating current intensity varies from 0. 01 to 3.00mA and can be selected according to specific circumstances. The stimulating electrode may be optionally unipolar or bipolar with its pulse duration up to 3.1 ms. The monitor is equipped with four EMG electromyography channel， built-in stimulator and a sonorous speaker. N400 is the ideal equipment especially when the surgery is close to motor neurons or mixed nerves. The stimulator of this machine can be used to trace the influencing branch fibers so as to locate and identify nerves and accelerate the surgical process.
When nerves are stimulated by single machine or electricity， they will evoke the response of facial muscles EMG activity， which serves as the proof to determine the process of the anatomy of facial nerves. Although the application of the nerve monitor plays a significant role in the protection of the facial nerve， it can not be used continuously during the surgery and its damage also can not be completely avoided. In secondary or multiple surgeries[6]， due to the partial adhesion， and the already changed normal anatomical structures， it is more likely to make damage to nerves. Pinpointing facial nerves with nerve monitor before anatomizing would save a lot of time and would not damage nerve if the monitor is gently applied. Find the nerve and continue to dissect until it is completely separated from the parotid gland. Expose the operating area of facial nerves and remove the parotid tumor. Such a procedure can greatly reduce the risk of intraoperative facial nerve branch injury and can also lower the complexity to seek the nerve especially when the facial nerve is anatomically varied. This surgical approach can avoid the possible damage caused by unreasoning anatomization， and can also overcome the shortcomings of pure and simple monitoring， so that has greatly improved the security of the operation especially in the parotid full cut and secondary surgery.