Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2005
Objective assessment of the perineural vascular plexus as a landmark for the horizontal part of the facial nerve in middle ear and mastoid surgery.
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Paleri Vinidh, Watson Carl
Аннотация
OBJECTIVE: To objectively evaluate the usefulness and the reliability of the perineural vascular plexus as a landmark for identification of the facial nerve in surgery for chronic squamous otitis media.
STUDY DESIGN: Prospective case series.
SETTING: Tertiary otologic center.
PATIENTS: Seventy consecutive patients requiring surgery for cholesteatomatous otitis media.
INTERVENTION: Use of a semiquantitative grading system intraoperatively to assess the utility and ease of using the perineural facial plexus as the pointer to the facial nerve.
MAIN OUTCOME MEASURES: Description of the perineural vascular plexus and assessment of the reproducibility of the grading system.
RESULTS: In 82.5% of patients, the plexus was used as the sole pointer to the level of the facial nerve, with other landmarks being used in the remaining 17.5%. A very prominent vessel was used to identify the nerve in 82.5%, therefore being classified as Grade 1. Multiple small vessels were seen in 15.8% (Grade 2), and in 1.5% the vessel plexus was thin and difficult to identify. The average measure intraclass correlation was 0.75 (95% confidence interval, 0.57-0.85), indicating excellent reproducibility of the system.
CONCLUSION: We believe that the perineural vascular plexus is a dependable and reliable landmark for the level of the facial nerve in surgery for chronic otitis media.
STUDY DESIGN: Prospective case series.
SETTING: Tertiary otologic center.
PATIENTS: Seventy consecutive patients requiring surgery for cholesteatomatous otitis media.
INTERVENTION: Use of a semiquantitative grading system intraoperatively to assess the utility and ease of using the perineural facial plexus as the pointer to the facial nerve.
MAIN OUTCOME MEASURES: Description of the perineural vascular plexus and assessment of the reproducibility of the grading system.
RESULTS: In 82.5% of patients, the plexus was used as the sole pointer to the level of the facial nerve, with other landmarks being used in the remaining 17.5%. A very prominent vessel was used to identify the nerve in 82.5%, therefore being classified as Grade 1. Multiple small vessels were seen in 15.8% (Grade 2), and in 1.5% the vessel plexus was thin and difficult to identify. The average measure intraclass correlation was 0.75 (95% confidence interval, 0.57-0.85), indicating excellent reproducibility of the system.
CONCLUSION: We believe that the perineural vascular plexus is a dependable and reliable landmark for the level of the facial nerve in surgery for chronic otitis media.