Facial nerve monitoring in parotid gland surgery: Design and feasibility assessment of a potential standardized technique.

Background: Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve, it surely offers some advantages over the traditional approach. Different from thyroid surgery, where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but-most importantly-the function of the recurrent laryngeal nerve, in parotid gland surgery, a formal guideline to follow while dissecting the facial nerve has yet to be described. Methods: A five-year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring. The operative findings regarding the neuromonitoring process, particularly in regard to the amplitude of two main branches, were revised. A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered. Results: Fifty-five patients were operated on using the Nim 3 Nerve Monitoring System (Medtronic); 31 were female patients, and 47 patients had benign lesions. Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation. There were only three articles discussing the term loss of signal during parotid gland surgery. Conclusion: Today, no sufficient attention has been given to the facial nerve monitoring process during parotidectomy. This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation.

Intraabdominal desmoid tumor. Clinical clinical case and literature review.

Desmoid tumors are clinical entities rarely diagnosed at an initial presentation because of its low incidence, they are characterized by a locally aggressive presentation and high rates of local relapse. Its presentation can be intra- or extra-abdominal. We present a clinical case of a female, 15 year old patient, with three months of abdominal pain, a giant intra-abdominal mass was diagnosed with histologic diagnosis of desmoid tumor. Several surgical procedures were performed, having a las a R1 resection (focally microscopic margins). In this case association with pregnancy, abdominal trauma, previous surgeries and genetic syndromes were discarded.

Los tumores desmoides son afecciones benignas raramente reconocidas de manera inicial por su baja incidencia. Se caracterizan por un comportamiento local agresivo y altas tasas de recurrencia. Su presentación puede ser extraabdominal o intraabdominal. Presentamos el caso de una paciente de 15 años con cuadro de dolor abdominal de 3 meses de evolución, en la que se documentó una gran masa intraabdominal con diagnóstico histológico de tumor desmoide y fue sometida a múltiples intervenciones quirúrgicas con las que se logró una resección R1 (microscópicamente positivo). Se descartó su asociación con embarazo, trauma abdominal, cirugías previas y síndromes genéticos.