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Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high\u2010level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Literature review and expert opinion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over the years, two models of monitoring have become well\u2010established: 1) monitoring by the surgeon using a stand\u2010alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set\u2010up and provide a basis for context\u2010appropriate interpretation and troubleshooting of recorded signals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4<jats:italic>Laryngoscope<\/jats:italic>, 131:S1\u2013S42, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29459","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T14:16:20Z","timestamp":1615990580000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Best Practices in Facial Nerve Monitoring"],"prefix":"10.1002","volume":"131","author":[{"given":"Jack M.","family":"Kartush","sequence":"first","affiliation":[{"name":"Michigan Ear Institute Farmington Hills Michigan U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent S.","family":"Rice","sequence":"additional","affiliation":[{"name":"NuVasive San Diego California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Minahan","sequence":"additional","affiliation":[{"name":"Department of Neurology Georgetown University Washington District of Columbia U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gene K.","family":"Balzer","sequence":"additional","affiliation":[{"name":"Real Time Neuromonitoring Associates Real Time Neuromonitoring AssociatesNashville Tennessee U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles D.","family":"Yingling","sequence":"additional","affiliation":[{"name":"The Golden Gate Neuromonitoring, Department of Otolaryngology and Head and Neck Surgery Stanford University San Francisco California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4502-4201","authenticated-orcid":false,"given":"Christoph N.","family":"Seubert","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Division of Neuroanesthesiology University of Florida College of Medicine Gainesville Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"25","volume-title":"Complications in Otolaryngology\u2014Head and Neck Surgery","author":"Wiet RJ","year":"1986"},{"key":"e_1_2_10_3_1","first-page":"329","volume-title":"Otology Neurotology","author":"Porter R","year":"2012"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199408000-00002"},{"key":"e_1_2_10_5_1","first-page":"738","volume-title":"Surgery of the Brain and Spinal Cord","author":"Krause F","year":"1912"},{"key":"e_1_2_10_6_1","first-page":"200","volume-title":"Facial Nerve Disorders and Diseases: Diagnosis and Management","author":"Benscoter B","year":"2016"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23995"},{"key":"e_1_2_10_8_1","first-page":"380","volume-title":"Facial Nerve Disorders and Diseases: Diagnosis and Management","author":"Slattery E","year":"2016"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/2473974X18791803"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26238"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816671491"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813514365"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21119"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27359"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27360"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-018-5130-1"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198802000-00018"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815601394"},{"key":"e_1_2_10_19_1","first-page":"17","article-title":"Clinical consensus statements\u201d are now \u201cexpert consensus statements","volume":"39","author":"American Academy of Otolaryngology\u2013Head and Neck Surgery","year":"2020","journal-title":"Bulletin"},{"key":"e_1_2_10_20_1","unstructured":"National Institutes of Health.Consensus statement: acoustic neuroma. 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