This is a literature review of 16 papers using the PRISMA protocol.
In comparing the two techniques, not surprisingly, they found that extracapsular dissection was associated with a reduced incidence of facial nerve paralysis and Frey’s syndrome and a shorter operation time, but also a reduced recurrence rate.
It was noted that rupture and spillage was the main risk factor for recurrence. They deduced that whilst it has been shown that continuous facial nerve monitoring may reduce facial nerve paralysis, only two of the studies used such monitoring if required by the surgeon. They therefore feel that the use or non-use of facial nerve monitoring does not appear to affect the outcome of facial nerve weakness. Their conclusion is that extra-capsular dissection is the superior method and could be the gold standard technique, but outline the significant selection bias in this statement.