Resumen
Antecedentes: el monitoreo del nervio facial (par craneal VII) durante una parotidectomía nunca debe sustituir el conocimiento anatómico detallado. La manipulación del nervio puede generar neuropraxia con vaina neural íntegra y sólo paresia facial con recuperación completa. La incidencia reportada de parálisis facial completa posterior a parotidectomía varía de 0.5 a 4%. El 100% de los pacientes con tumores parotídeos mayores de 4 cm tiene debilidad neural que no necesariamente es clínica. Se sabe que la preservación del nervio se relaciona con el tamaño inicial del tumor. Objetivo: determinar si el monitoreo del nervio facial durante una parotidectomía se asocia con menor riesgo de parálisis facial que cuando no se monitoriza. Pacientes y método: estudio observacional, descriptivo, longitudinal y retrospectivo, efectuado con pacientes sometidos a parotidectomía. Se incluyeron 78 pacientes parotidectomizados de 1994 a 2008. Posteriormente se revisaron los expedientes clínicos y se identificó en quiénes se hizo monitoreo del nervio facial y en quiénes no. La función facial se comparó entre ambos grupos en el posoperatorio temprano, al mes y a los tres meses. Resultados: la incidencia global de parálisis posoperatoria en los pacientes sometidos a parotidectomía sin monitoreo del nervio facial fue de 2.5% contra 0% de los pacientes que fueron monitoreados. Los resultados obtenidos son comparables con los reportados en la bibliografía. Conclusiones: los criterios o indicaciones del monitoreo durante una parotidectomía están poco estandarizados y éste se considera sólo cuando un tumor es mayor de 6 cm y desplaza trayectos nerviosos. La comparación entre ambos grupos revela que el monitoreo facial cambia mínimamente la incidencia de morbilidad posoperatoria. Palabras clave: parotidectomía, nervio facial, monitoreo.
Palabras clave: monitoreo, nervio facial, parotidectomía
Abstract
Background: The monitoring of the seventh cranial nerve (CN VII) during a parotidectomy should never substitute a detailed anatomic knowledge; the manipulation of the nerve could generate neuropraxia with a complete neural shead that only generates facial paresis with a complete recovery. The reported incidence of complete facial paralysis after a parotidectomy varies from 0.5% to 4%. It is known that 100% of patients with parotid tumors greater than 4cm have neural weakness that isn’t always clinically evident. It has been established that neural preservation is in close relation with initial tumor size. Objective: To determine if parotidectomy assisted with facial nerve monitoring is associated with a lower risk of facial paralysis compared with parotidectomy without monitoring. Patients and methods: A retrospective, longitudinal, descriptive and observational study was issued among 78 patients that underwent parotidectomy from 1994 to 2008. Then, clinical files were reviewed and we identified which procedures were assisted with facial nerve monitoring and which did not. Facial function was assessed between groups in the immediate postoperative and one and three months later. Results: The global incidence of postoperative facial paralysis in patients that underwent parotidectomy without facial monitoring was 2.5% compared with 0% in patients assisted with facial monitoring. The results obtained were comparable with various literature reports. Conclusions: The criteria and indications considered to use facial nerve monitoring during parotidectomy are not completely clear and it is only considered when a tumor larger than 6cm displaces neural pad ways. The comparison between both groups demonstrated that the use of facial monitoring minimally changes the incidence of postoperatory morbidity. Key words: parotidectomy, seventh cranial nerve, monitoring.
Keywords: seventh cranial nerve, parotidectomy, monitoring.
