ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Kartush Facial Nerve Monitoring Protocol

by Jack Kartush, MD • May 8, 2014

  • Tweet
  • Email
Print-Friendly Version

1. Ensure anesthesia avoids long-acting muscle relaxants. If in doubt, check train-of-four electromyography (EMG) response.

You Might Also Like

No related posts.

Explore This Issue
May 2014

2. Be wary of local anesthetics (lidocaine or bupivacaine), which can chemically induce a temporary facial paresis, rendering monitoring useless.

3. Place bipolar electrodes in ipsilateral orbicularis oculi and oris. Use uniform color coding for electrodes = “blue eyes, red lips.” The electrode pair should be close to, but not touching, each other.

4. Place a green ground electrode in sternum above a white anode electrode.

5. Plug the electrodes into proper channels on the patient interface box, preferably color coded to match the above protocol.

6. Ensure that the electrode impedance is less than 5 kOhm and that the interelectrode impedance is less than 1 kOhm for each electrode pair.

7. Perform a tap test on the skin surface above the electrodes to elicit an artifactual response (which only tests the recording portion of the system).

8. Adjust the volume of the nerve monitor so that it can be heard above the ambient noise of the OR.

9. Once the procedure has begun, always confirm that current flow is present by using a stimulating probe or Kartush surgical instrument to touch muscle, soft tissue, or wet bone. These tissues conduct nearly 100% of the current due to their low impedance and therefore require less current to elicit a confirmatory. If the monitor confirms proper current flow (visually or audibly), then the stimulating portion of the system has been appropriately confirmed.

10. Obtain a baseline response to stimulation at an early point in surgery, before any significant nerve manipulation is performed. If the nerve is visible, initial stim levels of 0.5mA to 0.8mA are appropriate. If the nerve is covered in bone, granulation tissue, cholesteatoma, or tumor, progressively increase the initial stim up to 2mA. Once an initial baseline response has been recorded, the integrity of the entire stim and recording system has been properly confirmed.

11. Stim during surgical dissection. If surgical dissection is required along the facial nerve, titrate the optimal stim levels based on nerve proximity and intervening tissue. Higher stim levels should be used to “map” the general location of the nerve and then lowered once it is found.

Stim levels as low as 0.1mA are often sufficient when dissecting along the bare nerve in the cerebellopontine angle. During cholesteatoma dissection along a slightly dehiscent tympanic facial nerve, 0.5 – 0.8mA may be more appropriate to alert the surgeon when the dehiscence is below the stim probe or stimulating dissection instrument.

Pages: 1 2 | Single Page

Filed Under: Departments, Online Exclusives, Otology/Neurotology, Practice Focus, Special Reports Tagged With: facial nerve monitoringIssue: May 2014

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Second Victims: The Effects of a Medical Error on Physicians Can Be Devastating
    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?
    • Keeping Watch for Skin Cancers on the Head and Neck
    • Complications for When Physicians Change a Maiden Name
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • What Happens to Medical Students Who Don’t Match?
    • Complications for When Physicians Change a Maiden Name
    • Qualitative Research Shows How Patients Feel About Quality-of-Life Issues
    • How to: A Dynamic Endonasal Columellar Strut Placement
    • Second Victims: The Effects of a Medical Error on Physicians Can Be Devastating
    • Advanced Degrees Can Help Otolaryngologists Better Understand the Business of Medicine
    • Laser Laryngeal Surgery Is Safe Under THRIVE

Polls

Have you ever been, or have you ever known someone who has been a second victim?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2023 The Triological Society. All Rights Reserved.
ISSN 1559-4939