Reducing the Risks Associated with Peripheral Nerve Injury

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Peripheral nerve injuries account for 12% of medical malpractice claims among otolaryngologists insured by MagMutual. This type of injury represents a significant risk to surgeons operating in the head and neck area.

To help otolaryngologists reduce the occurrence of claims related to peripheral nerve injuries, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of claims related to this injury and developed strategies to improve patient outcomes.

Top Risks

Top Strategies for Reduction

Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

Clinical strategies

• Facial nerve or recurrent laryngeal nerve monitoring can help surgeons identify nerve injury early and take immediate corrective action. Adequate training and experience in nerve monitoring techniques are necessary to ensure reliable interpretation of the data.
• Surgeons should have a thorough understanding of the anatomy of all regions of the neck and should review this anatomy as necessary in their pre-operative planning. This includes a review of all images and a detailed understanding of the location and function of all nerves and vessels that may be at risk of injury during surgery.
• Consider performing a fine needle aspiration biopsy (FNAB) for all questionable neck masses before proceeding to open surgery to reduce the risk of unnecessary surgery and ensure appropriate management of neck masses. The decision to perform an FNAB should be based on a thorough evaluation of the patient's medical history, physical examination and radiologic imaging. Close follow-up is necessary for patients with negative biopsy results to monitor for any changes in the neck mass.

Operational strategies

• It is essential to discuss the specific risks associated with the surgery being performed, including the risk of facial or recurrent laryngeal nerve injury or injury to any other relevant nerves. The discussion should also include potential ramifications of nerve injury, such as difficulty speaking, swallowing or performing facial movements. Document the discussion in the medical record to supplement the consent form.
• Physicians should perform and document post-operative evaluations to determine if a nerve injury has occurred. If a nerve injury is identified, physicians should establish a treatment plan and be familiar with rehabilitative options. For example, vocal fold injection may be required for a recurrent laryngeal nerve injury.

Other Top Risks

While peripheral nerve injuries account for a significant amount of claims among otolaryngologists according to our data, we’ve identified several other drivers of loss based on claims frequency:

Risk Drivers by Top Cause

Risk Drivers by Frequency

Data Collection & Methodology

Data is based on MagMutual closed claims from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.