Peripheral Nerve Identification With Fluorescence Guided Surgery in Otolaryngology: A Systematic Review

Introduction: Iatrogenic nerve injury in otolaryngology results in significant morbidity, including but not limited to facial palsy, aspiration, and communication deficits. This study performs a systematic review of the literature to describe advancements in intraoperative, fluorescence-guided peripheral nerve identification during head and neck surgery.

Methods: A systematic review was performed according to the PRISMA workflow using the MEDLINE, EMBASE, and Cochrane Library CENTRAL databases, with search terms including “peripheral nerve,” “head and neck surgery OR otolaryngology” and “fluorescence guided surgery OR fluorescence-guided surgery.” Manual review was then performed to remove irrelevant articles.

Results: Our initial search yielded 19 total articles, and 7 studies remained after manual review. Three studies demonstrated real-time identification of multiple peripheral nerves in the head and neck using a fluorescein-derived peptide-dye conjugate. One study reported successful intraoperative facial nerve identification using systemic indocyanine green during mastoidectomy in 16 patients. Another study demonstrated the utility of near-ultraviolet real-time imaging of the recurrent laryngeal nerve during thyroidectomy in 65 patients. One study characterized features of fluorescence-guided surgery agents with high specificity for nerve tissue, and one described the ongoing clinical trials for fluorescence-guided peripheral nerve identification in otolaryngology. No adverse events related to fluorescence-guided surgery were reported in these studies.

Conclusions: Intraoperative fluorescence-guided peripheral nerve identification has made significant advancements in recent years, and current nerve-targeting agents demonstrate high sensitivity and specificity. This technology shows great potential to reduce iatrogenic injury and improve patient outcomes in otolaryngology.