Intraoperative monitoring of marginal mandibular nerve during neck dissection

• Published in: Head & neck Vol. 40; no. 5; pp. 1016 - 1023
• Main Authors: Tirelli, Giancarlo, Bergamini, Pier Riccardo, Scardoni, Alessandro, Gatto, Annalisa, Boscolo Nata, Francesca, Marcuzzo, Alberto Vito
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-05-2018
• Subjects: Aged; Aged, 80 and over; Dissection; facial nerve; Female; Head and neck; Head and Neck Neoplasms - surgery; Humans; Intraoperative Complications - prevention & control; Intraoperative Neurophysiological Monitoring; Male; Mandible; Mandibular Nerve - physiology; marginal mandibular nerve; Metastases; Middle Aged; Neck; neck dissection; Neck Dissection - adverse effects; nerve integrity monitoring (NIM); Paralysis; Prospective Studies; Trigeminal Nerve Injuries - prevention & control; marginal mandibular nerve; neck dissection; nerve integrity monitoring (NIM); facial nerve
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.25078

Background
The purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection.
Methods
This prospective study compared 36 patients undergoing NIM‐assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor.
Results
The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM‐assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy.
Conclusion
In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissection.