What must be avoided when monitoring the facial nerve?

When monitoring the facial nerve, it is essential to avoid long-lasting muscle relaxants because they can significantly impact the ability to accurately assess neuromonitoring data. Facial nerve monitoring relies on observing muscle responses, particularly in the muscles of facial expression. Long-lasting muscle relaxants can diminish or completely block these responses, making it difficult to determine the integrity of the facial nerve during surgical procedures. This can lead to a misinterpretation of the nerve's functional status and potentially increase the risk of nerve damage during surgery.

In contrast, while certain practices regarding electrode use or anesthetic agents may have implications, they do not affect the neuromonitoring process to the same extent. For instance, bipolar electrodes can be used safely without directly impacting facial nerve monitoring, and although inhalational anesthetic agents may influence neuromuscular transmission, they do not have the same profound and immediate effect as muscle relaxants do. Needle electrodes in the masseter may pose a different set of risks but do not inherently compromise the monitoring of the facial nerve as muscle relaxants do.