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Label-Free Facial Nerve Identification During Parotidectomy Using Nerve Autofluorescence: An Initial Clinical Series
Fernando Dip1, Rene Aleman2, Alberto Rancati1
1Department of General Surgery, University of Buenos Aires, Buenos Aires, ARG.
Cureus
|August 15, 2026
Summary
Autofluorescence imaging offers a safe and effective method for identifying the facial nerve (FN) during parotidectomy, improving visualization and preventing nerve injury. This technique provides clear contrast, aiding surgeons in complex cases and ensuring excellent functional outcomes.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Medical Imaging
Background:
- Facial nerve (FN) dysfunction is a significant complication of parotidectomy.
- Traditional methods for FN identification, including anatomic dissection and intraoperative monitoring (IONM), can be limited by distorted anatomy.
- Improved techniques for intraoperative FN identification are crucial for reducing surgical morbidity.
Purpose of the Study:
- To evaluate the feasibility, safety, and utility of autofluorescence-guided FN identification during parotidectomy.
- To assess the effectiveness of near-ultraviolet (NUV) autofluorescence imaging in distinguishing the FN from surrounding tissues.
- To determine if this imaging modality can serve as a valuable adjunct to standard FN identification strategies.
Main Methods:
- A retrospective case series of 18 patients undergoing parotidectomy for parotid gland tumors.
- Near-ultraviolet (NUV) autofluorescence imaging was applied immediately after FN exposure.
- Quantitative image analysis measured nerve-to-background ratios and signal homogeneity.
Main Results:
- Autofluorescence imaging provided clear contrast between the FN and surrounding tissue.
- High nerve-to-background ratios (5.40–5.86 native, up to 10.16 with overlay) and uniform signal homogeneity were observed.
- No postoperative FN paralysis occurred, with all patients achieving House-Brackmann grade I function at six months.
Conclusions:
- Autofluorescence-guided FN imaging is feasible and safe during parotidectomy.
- The technique offers consistent visual contrast, aiding in nerve identification.
- Further investigation is warranted to establish autofluorescence imaging as a standard adjunct in parotid surgery.
