Clin Exp Otorhinolaryngol.  2021 Feb;14(1):131-136. 10.21053/ceo.2019.01900.

Application of an Intraoperative Neuromonitoring System Using a Surface Pressure Sensor in Parotid Surgery: A Rabbit Model Study

• Sung ES
• Kwon HK
• Shin SC
• Cheon YI
• Lee JW
• Park DH
• Choi SW
• Kim HB
• Park HJ
• Lee JC
• Ro JH
• Lee BJ

• KMID: 2512891
• DOI: http://doi.org/10.21053/ceo.2019.01900

Abstract

Objectives
. Facial nerve monitoring (FNM) can be used to identify the facial nerve, to obtain information regarding its course, and to evaluate its status during parotidectomy. However, there has been disagreement regarding the efficacy of FNM in reducing the incidence of facial nerve palsy during parotid surgery. Therefore, instead of using electromyography (EMG) to identify the location and state of the facial nerve, we applied an intraoperative neuromonitoring (IONM) system using a surface pressure sensor to detect facial muscle twitching. The objective of this study was to investigate the feasibility of using the IONM system with a surface pressure sensor to detect facial muscle twitching during parotidectomy.
Methods
. We evaluated the stimulus thresholds for the detection of muscle twitching in the orbicularis oris and orbicularis oculi, as well as the amplitude and latency of EMG and the surface pressure sensor in 13 facial nerves of seven rabbits, using the same stimulus intensity.
Results
. The surface pressure sensor detected muscle twitching in the orbicularis oris and orbicularis oculi in response to a stimulation of 0.1 mA in all 13 facial nerves. The stimulus threshold did not differ between the surface pressure sensor and EMG.
Conclusion
. The application of IONM using a surface pressure sensor during parotidectomy is noninvasive, reliable, and feasible. Therefore, the IONM system with a surface pressure sensor to measure facial muscle twitching may be an alternative to EMG for verifying the status of the facial nerve.

Keyword

Intraoperative Neurophysiological Monitoring; Surface Pressure Sensor; Electromyography; Facial Nerve; Parotidectomy

Figure

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  Fig. 1. Surface pressure sensor and surgical field. (A) Photograph of the patch-type surface pressure sensor. (B) Photograph of the surgical field in the rabbit, demonstrating facial nerve dissection. Black arrow, buccal branch of the facial nerve; white arrow, zygomatic branch of the facial nerve. (C) Stimulation of the buccal branch of the facial nerve using the nerve probe. (D) Illustration of a pair of electromyography needle electrodes inserted into the orbicularis oris and orbicularis oculi muscles. Simultaneously, a surface pressure sensor was attached to the skin above the orbicularis oris and oculi muscles.

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  Fig. 2. Electromyography (EMG) and surface pressure sensor recordings showing the amplitude and latency of EMG and the pressure sensor for a stimulation of 0.3 mA using the nerve integrity monitor 3.0 system in a rabbit. (A) Pressure sensor signal. (B) EMG signal.

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