EVALUATION OF THE USE OF NERVE STIMULATION FOR ACCURATE PREOPERATIVE ALLOCATION OF FACIAL NERVE (CLINICAL TRIAL)

Abstract

Introduction: Iatrogenic facial nerve injury is a critical risk in head and neck surgery. This clinical trial evaluates the efficacy of preoperative nerve stimulation for accurate allocation of facial nerve branches as a preventive measure against facial nerve injury. Objectives: Identify branches of the facial nerve, use a nerve stimulator to map the location of the branches of the facial nerve to prevent its iatrogenic injury. Materials and Methods: Sixteen patients (age: 24–50 years) scheduled for head and neck surgery at Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University were enrolled. Preoperative mapping of facial nerve branches was accomplished using a nerve stimulator. Mapping results guided surgical incisions. Electromyography (EMG) and the Facial Motor Evaluation (FAME) scale were used to assess nerve function pre-operatively, immediately post-operatively, after two weeks, and after three months. Results: 93.75% (15/16) of patients maintained intact nerve function postoperatively by EMG. One case (6.25%) had mild, transient weakness attributable to inflammation. 75% of patients responded to nerve mapping. 25% of patients non-responded due to metallic artifacts. All patients had normal facial function restored by three months. Conclusion: Preoperative nerve stimulation accurately localizes facial nerve branches, is safe and cost-effective, and may significantly reduce iatrogenic nerve injuries in oral and maxillofacial surgery. Use of this technique is recommended especially in anatomically complex or reoperative regions.