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

Lookup NU author(s): Professor Vinidh Paleri, Dr Catherine Watson


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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 semi quantitative 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.

Publication metadata

Author(s): Paleri V, Watson C

Publication type: Article

Publication status: Published

Journal: Otology & Neurotology

Year: 2005

Volume: 26

Issue: 2

Pages: 280-283

ISSN (print): 1531-7129

ISSN (electronic): 1537-4505

Publisher: Lippincott Williams & Wilkins


DOI: 10.1097/00129492-200503000-00027


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