A new device, the Nerve Integrity Monitor or NIM, is now available to help monitor the nerves. A needle electrode is inserted in the muscle to be studied and if the nerve is near our dissection an alarm is sounded. In addition, a probe is used that exposes the nerve to less current injury than the traditional nerve stimulator.

In the past, it was felt that surgery should not visualize the nerves around the face or larynx. We now know that it is far better to expose and dissect of the nerves in order to remove a mass.

Salivary (parotid and sub-mandibular) masses, neck nodes, neck dissection and some thyroid lesions deserve consideration for use of the NIM.

Neck and facial incisions require elevation of skin flaps. Then, the facial, laryngeal or accessory nerves are visually identified and often confirmed with a nerve stimulator probe. The patient under anesthesia must not be given muscle-paralyzing agents to allow a muscle twitch for the NIM.