A complication of intraoperative facial nerve monitoring: Facial skin burns

Objective: To report on three cases of severe facial skin bums resulting from intraoperative facial nerve monitoring in patients undergoing parotidectomies. Study Design: This study is a retrospective case review. Setting: A tertiary referral center. Patients: This study includes three patients who underwent parotidectomies with concurrent facial nerve monitoring. Results: Facial skin bums were proven to result from a technical defect of the intraoperative facial nerve monitoring device. Burns were sustained at electrode insertion sites and their extent was related to the duration of monitoring. The most probable explanation of these bums is electrolysis. Conclusions: Successful retracing of technical defaults with biomedical engineers at the device manufacturer have led to the upgrade of the facial nerve monitor apparatus. The benefits of facial nerve monitoring largely outweigh the fortuitous occurrence of skin burns reported in this study. Therefore, this complication should not represent a drawback to the use of facial nerve monitoring.