Pinpointing the incidence of iatrogenic facial nerve injury is not a straightforward affair, according to Jack M. Kartush, MD, emeritus professor at the Michigan Ear Institute at Wayne State University in Detroit. That difficulty stems, in part, from the fact that surgeons are not inclined to publish on their rare iatrogenic complications, he noted, pointing out that a commonly cited 1988 American Journal of Otology paper by Arnold Schuring, MD, past chairman of the American Academy of Otolaryngology’s Professional Liability Committee, quoted an incidence of 1% but cited no references.
Explore this issue:May 2014
Other articles estimate a higher incidence of injury, especially with revision surgery; however, “these studies were done at a time when facial nerve monitoring was rarely used for mastoid surgery,” Dr. Kartush said. Consequently, most otologists today estimate that the risk in experienced hands is closer to 0.1%. “How much of this perceived reduction relates to monitoring, versus other factors such as fellowship training, cannot be discerned,” he said.
But even at a “low” risk of one in 1,000 cases, when an iatrogenic facial palsy occurs, it is a devastating complication for both the patient and the surgeon, Dr. Kartush said. “Hence, the need for routine widespread facial nerve monitoring, albeit with practice guidelines in place to ensure competency and expertise.”
David Bronstein is a freelance medical writer based in New Jersey.