Objective assessment of the perineural vascular plexus as a landmark for the horizontal part of the facial nerve in middle ear and mastoid surgery.

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.