Machine Learning Models for Predicting Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors

Background: Despite the increasing use of intraoperative facial nerve monitoring during parotid gland surgery (PGS) and the improvement in the preoperative radiological assess-ment, facial nerve injury (FNI) remains the most severe complication after PGS. Until now, no studies have been published regarding the application of machine learning (ML) for predicting FNI after PGS. We hypothesize that ML would improve the prediction of patients at risk. Methods: Patients who underwent PGS for benign tumors between June 2010 and June 2019 were included. Results: Regarding prediction accuracy and performance of each ML algorithm, the K-nearest neighbor and the random forest achieved the highest sensitivity, specificity, positive pre-dictive value, negative predictive value F-score, receiver operating characteristic (ROC)-area under the ROC curve, and accuracy globally. The K-nearest neighbor algorithm achieved performance values above 0.9 for specificity, negative predictive value, F-score and ROC-area under the ROC curve, and the highest sensitivity and positive predictive value. Conclusions: This study demonstrates that ML prediction models can provide evidence-based predictions about the risk of FNI to otolaryngologists and patients. It is hoped that such algorithms, which use clinical, radiological, histological, and cytological information, can improve the information given to patients before surgery so that they can be better informed of any potential complications. ? 2021 Elsevier Inc. All rights reserved.