{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:04:15Z","timestamp":1760058255700,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Intraoperative facial nerve monitoring (IFNM) is becoming increasingly prevalent as an established intraoperative aid in parotid gland surgery. To date, however, there are few scientific studies on the postoperative outcomes of submandibular gland surgery, particularly on the postoperative injury of the marginalis mandibulae branch (MMB) of the facial nerve (FN). This branch represents the most frequent and feared complication of this surgery, with an incidence of 1\u20137% of cases. Objective: This retrospective study aims to evaluate the incidence of postoperative MMB paralysis in patients undergoing submandibular sialoadenectomy for benign conditions from 2014 to 2023, focusing on the role of IFNM. Materials and Methods: The patients were divided into two groups: the subjects of Group 1 (G1) had undergone submandibular sialoadenectomy after identification and clamped facial vessels, without the aid of IFNM (from 1 January 2014 to 31 December 2018). Conversely, subjects in Group 2 (G2) underwent IFNM procedures (from 1 January 2019 to 31 December 2023). The classification of any FN malfunctions was conducted following the House\u2013Brackmann grading system. A descriptive analysis was performed, and univariate and multivariate logistic regressions were used to examine the impact of IFNM on surgical timing and the association between G2 deficit (vs. G1) corrected for age, sex, and smoking status. Results: The study population comprised a total of 101 patients with a mean age of 55 \u00b1 16 years. The sample population comprised 50 subjects assigned to Group 1 (49.5%, 24 females and 26 males) and 51 subjects assigned to Group 2 (50.5%, 21 males and 30 females). Postoperative paralysis of the MMB occurred in 23 subjects (22.77%), including 12 of G1 (4 had a grade II and 8 grade III dysfunction) and 11 of G2 (8 had a grade II and 3 grade III dysfunction). A six-month evaluation revealed that only five patients in G1, previously diagnosed with grade II dysfunction, exhibited a residual deficit. The mean surgical time for the entire patient cohort was 99 \u00b1 44 min: 110 \u00b1 43 min for Group 1 and 92 \u00b1 42 min for Group 2 (Beta = \u221219; 95% CI \u221237 at \u22120.16; p-value = 0.048). Furthermore, a longer operative time was observed in smokers than in non-smokers (p-value = 0.008), suggesting that smoking affects the length of surgery (Beta = 0.32; 95% CI \u22120.08 to \u22120.55). Discussion and Conclusions: MMB paralysis is one of the most prevalent complications that may arise in submandibular gland surgery. IFNM provides surgeons with a valuable tool for identifying MMB in submandibular sialoadenectomy. The efficacy of IFNM as an aid is contingent upon the expertise of the operating surgeon.<\/jats:p>","DOI":"10.3390\/diseases13040096","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T10:54:48Z","timestamp":1743159288000},"page":"96","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Intraoperative Facial Nerve Monitoring in Submandibular Gland Surgery: A Retrospective Study of a Single Institution"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6365-8518","authenticated-orcid":false,"given":"Maria Giulia","family":"Cristofaro","sequence":"first","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2522-7768","authenticated-orcid":false,"given":"Francesco","family":"Ferragina","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1979-2599","authenticated-orcid":false,"given":"Giuseppe","family":"Tarallo","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo Ruggero","family":"Sottile","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Grazia","family":"Ioppolo","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Operative Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Arrotta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Anesthesia and Intensive Care, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa Chiara","family":"De Bartolo","sequence":"additional","affiliation":[{"name":"School of Medicine, \u201cMagna Graecia\u201d University, Viale Europa, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3182-5075","authenticated-orcid":false,"given":"Ida","family":"Barca","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Experimental and Clinical Medicine, Renato Dulbecco Hospital, Magna Graecia University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1002\/hed.25078","article-title":"Intraoperative monitoring of marginal mandibular nerve during neck dissection","volume":"40","author":"Tirelli","year":"2018","journal-title":"Head Neck"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1001\/jamaoto.2016.1192","article-title":"Association Between Facial Nerve Monitoring with Post-operative Facial Paralysis in Parotidectomy","volume":"142","author":"Savvas","year":"2016","journal-title":"JAMA Otolaryngol.-Head Neck Surg."},{"key":"ref_3","first-page":"411","article-title":"Excision of the submandibular gland: Minimizing the risk of nerve damage","volume":"59","author":"Kennedy","year":"1989","journal-title":"ANZ J. 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