Non-Cochrane · intervention · PM42907851
Intraoperative facial nerve monitoring on operative duration in parotidectomy: a systematic review and meta-analysis.
Chen Jheng-Liang, Lin I-Chen, Shen Eric Yi-Liang, et al. · Head & face medicine · 2026 · PubMed · doi:10.1186/s13005-026-00645-7
Findings
24 findings
| Population | ||||
|---|---|---|---|---|
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Malignancy included: no | MD -5.942 [-14.673, 2.789] GRADE not reported 5 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) European studies: no | MD -3.918 [-10.590, 2.755] GRADE not reported 4 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Study design: prospective | MD -3.328 [-12.901, 6.245] GRADE not reported 3 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Publication year > 2010 | MD -2.805 [-10.787, 5.176] GRADE not reported 5 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) European studies: yes | MD -9.520 [-19.270, 0.231] GRADE not reported 4 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) | MD -5.62 [-11.02, -0.23] Low Downgraded: risk of bias 8 studies · 1677 participants |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Malignancy included: yes | MD -7.588 [-18.405, 3.228] GRADE not reported 3 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) IONM: 2 channels | MD -13.104 [-24.389, -1.820] GRADE not reported 3 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Tumor size (cm) | MD 0.04 [-0.32, 0.40] Low Downgraded: risk of bias 5 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Publication year ≤ 2010 | MD -14.082 [-25.646, -2.517] GRADE not reported 3 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Study design: retrospective | MD -7.592 [-15.062, -0.122] GRADE not reported 5 studies |
| Patients undergoing primary superficial or total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) IONM: 4 channels | MD -3.409 [-9.519, 2.701] GRADE not reported 5 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Publication year > 2010 | MD -5.058 [-12.814, 2.698] GRADE not reported 4 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Publication year ≤ 2010 | MD -21.762 [-37.797, -5.727] GRADE not reported 2 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring (IONM) | Parotidectomy without IONM | Operative duration (minutes) Intraoperative · Hospital parotid surgery; United States, Europe, Brazil, Japan, Thailand · European studies: no | MD -5.401 [-16.714, 5.912] GRADE not reported 3 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring (IONM) | Parotidectomy without IONM | Operative duration (minutes) Intraoperative · Hospital parotid surgery; United States, Europe, Brazil, Japan, Thailand · European studies: yes | MD -13.959 [-26.799, -1.120] GRADE not reported 3 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) IONM: 2 channels | MD -13.959 [-26.799, -1.120] GRADE not reported 3 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Study design: prospective | MD -4.929 [-16.771, 6.914] GRADE not reported 2 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring (IONM) | Parotidectomy without IONM | Operative duration (minutes) Intraoperative · Hospital parotid surgery; United States, Europe, Brazil, Japan, Thailand · Malignancy included: yes | Malignancy included: yes: 0 studies; no estimate; P for subgroup difference 0.82 No studies found 0 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) Study design: retrospective | MD -10.663 [-19.992, -1.333] GRADE not reported 4 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Tumor size (cm) | MD -0.20 [-0.46, 0.07] Very low Downgraded: risk of bias, imprecision 3 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) | MD -9.09 [-17.49, -0.70] Very low Downgraded: risk of bias, imprecision 6 studies |
| Patients undergoing primary superficial parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) IONM: 4 channels | MD -5.401 [-16.714, 5.912] GRADE not reported 3 studies |
| Patients undergoing primary total parotidectomy | Intraoperative facial nerve monitoring | No intraoperative facial nerve monitoring | Operative duration (minutes) | MD -7.08 [-43.14, 28.98] Very low Downgraded: risk of bias, imprecision 3 studies |
Included primary studies 8
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Deneuve 2010 Management of parotid gland surgery in a university teaching hospital. PMID:19763597 | 2010 | this review only | not stated | not extracted yet |
| Graciano 2018 Facial nerve dysfunction after superficial parotidectomy with or without continuous intraoperative electromyographic neuromonitoring: a… PMID:30232551 | 2018 | this review only | not stated | not extracted yet |
| Grosheva 2009 Electromyographic facial nerve monitoring during parotidectomy for benign lesions does not improve the outcome of postoperative facial… PMID:19718745 | 2009 | this review only | not stated | not extracted yet |
| Jirawatthanaanan 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kinoshita 2021 Effectiveness of intraoperative facial nerve monitoring and risk factors related to postoperative facial nerve paralysis in patients with… PMID:32994076 | 2021 | this review only | not stated | not extracted yet |
| Savvas 2016 Association Between Facial Nerve Monitoring With Postoperative Facial Paralysis in Parotidectomy. PMID:27310887 | 2016 | this review only | not stated | not extracted yet |
| Terrell 1997 Clinical outcome of continuous facial nerve monitoring during primary parotidectomy. PMID:9339985 | 1997 | this review only | not stated | not extracted yet |
| Zieliński 2022 Prospective Assessment of Intraoperative Facial Nerve Monitoring in Patients Undergoing Partial Parotidectomy. PMID:35360516 | 2022 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients undergoing primary parotidectomy; excluded recurrent disease or revision surgery and preoperative facial nerve weakness | 1677 patients undergoing primary parotidectomy (n=8 studies): superficial parotidectomy (n=6), total parotidectomy (n=3) |
| Intervention | Intraoperative facial nerve monitoring (IONM) | IONM: 2-channel systems (n=3), 4-channel systems (n=5) |
| Comparison | Parotidectomy without IONM | No IONM (n=8) |
| Outcomes | Primary: operative duration; secondary: tumor size | Operative duration overall (n=8), superficial parotidectomy (n=6), total parotidectomy (n=3); tumor size overall (n=5), superficial parotidectomy (n=3); tumor size in total parotidectomy not pooled (limited data) |
| Study designs | Two-arm comparative studies (RCTs assessed with RoB 2; non-randomized studies with ROBINS-I) reporting operative duration; single-arm designs excluded | 1 RCT, 2 prospective and 5 retrospective comparative studies (n=8) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: Yes · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |