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Preoperative Identification, Mapping In Head, Neck And Facial Plastic Surgery Prevents Nerve Damage

Preoperative percutaneous nerve mapping appears promising as an adjunct to head, neck and plastic facial surgery according to recent research.

Alerting surgeons to specific risk areas containing nerves, the procedure enables them to avoid incisions where the potential for nerve damage is high.

In a prospective study, surgeons from Indiana University School of Medicine, United States, evaluated this new method, designed to locate peripheral branches of the cranial nerves and map them to guide the operator.

They recruited 142 patients scheduled for head, neck and facial plastic surgery at private surgery sites, a surgical centre and regional medical centres between August 1994 and July 1999. Surgeons performed preoperative percutaneous nerve mapping prior to surgery under deep sedation or general anaesthesia without muscle paralysis.

A monoplane probe was used to stimulate nerves, and electromyographic reading was undertaken using intramuscular bipolar recording electrodes. In addition surgeons used a nerve monitor.

Testing of the mandibular area was done in 142 patients, the frontal division was tested in 60 cases, the accessory nerve in 12 patients and hypoglossal in three. From the 142 mandibular division 115 cases were successfully mapped, 49 cases from the 60 in the frontal division, eight of the accessory division and one case of the three hypoglossal nerve.
Archives of Facial Plastic Surgery 2003;5:5:86-91. "Preoperative Percutaneous Cranial Nerve Mapping in Head and Neck Surgery"

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