Introduction The facial nerve is an important structure related to parotid gland surgery. Its identification at the time of surgery is critical. Multiple anatomical landmarks have been described to aid in its identification. The objective of this study is to assess whether the tympanomastoid suture is a better surgical landmark than the tragal pointer for identifying the facial nerve while performing parotidectomy.
Materials and Methods: Sixty patients presenting over a period of 3 years from 2016 to 2018 with a parotid swelling without pre-operative facial weakness were included in the study. The average distances between the facial nerve (FN) and the tragal pointer (TP), and the facial nerve (FN) and tympanomastoid suture (TMS) were calculated intra-operatively and compared.
Results: Out of the 60 patients operated, 54 underwent superficial parotidectomy and 6 underwent total conservative parotidectomy. The mean distance between the FN (main trunk) and TP was found to be 18.38 ± 6.85 mm and that between FN and TMS was found to be 2.92 ± 0.6 mm (p <0.0001).
Conclusion: Tympanomastoid suture is a fairly constant and consistent bony landmark to locate the facial nerve during parotid surgeries as compared to the more commonly used cartilaginous tragal pointer. The results of this study can guide surgeons during parotidectomy, to correctly and promptly identify the facial nerve thereby reducing the risk of injury.
Pather N, Osman M. Landmarks of the facial nerve: implications for parotidectomy. Surgical and Radiologic Anatomy. 2006;28(2):170-5.
Wong DS. Surface landmarks of the facial nerve trunk: a prospective measurement study. ANZ Journal of Surgery. 2001;71(12):753-6.
Cannon CR, Replogle WH, Schenk MP. Facial nerve in parotidectomy: a topographical analysis. The Laryngoscope.2004;114(11):2034-7.
Panda NK, Kaushal D, Verma R. Do we need to modify the parotidectomy incision? Indian Journal of Otolaryngology and Head & Neck Surgery. 2016;68(4):487-9.
Ji YD, Donoff RB, Peacock ZS, Carlson ER. Surgical landmarks to locating the main trunk of the facial nerve in parotid surgery: a systematic review. Journal of Oral and Maxillofacial Surgery. 2018;76(2):438-43.
Rea PM, McGarry G, Shaw-Dunn J. The precision of four commonly used surgical landmarks for locating the facial nerve in anterograde parotidectomy in humans. Annals of Anatomy-Anatomischer Anzeiger. 2010;192(1):27-32.
De Ru JA, Van Benthem PP, Bleys RL, Lubsen H, Hordijk GJ. Landmarks for parotid gland surgery. Journal of Laryngology and Otology. 2001;115(2):122-5.
Nishida M, Matsuura H. A landmark for facial nerve identification during parotid surgery. Journal of Oral and Maxillofacial Surg 1993; 51:451–3.
Kaushal, D., Gugliani, A., Sharma, V., Goyal, A., Choudhury, B., & Soni, K. (2021). Identifying the Facial Nerve in Parotid Surgeries: How We Do It. Iranian Journal of Otorhinolaryngology, 33(2), 93-96. doi: 10.22038/ijorl.2020.43760.2446
MLA
Darwin Kaushal; Abhishek Gugliani; Vidhu Sharma; Amit Goyal; Bikram Choudhury; Kapil Soni. "Identifying the Facial Nerve in Parotid Surgeries: How We Do It", Iranian Journal of Otorhinolaryngology, 33, 2, 2021, 93-96. doi: 10.22038/ijorl.2020.43760.2446
HARVARD
Kaushal, D., Gugliani, A., Sharma, V., Goyal, A., Choudhury, B., Soni, K. (2021). 'Identifying the Facial Nerve in Parotid Surgeries: How We Do It', Iranian Journal of Otorhinolaryngology, 33(2), pp. 93-96. doi: 10.22038/ijorl.2020.43760.2446
VANCOUVER
Kaushal, D., Gugliani, A., Sharma, V., Goyal, A., Choudhury, B., Soni, K. Identifying the Facial Nerve in Parotid Surgeries: How We Do It. Iranian Journal of Otorhinolaryngology, 2021; 33(2): 93-96. doi: 10.22038/ijorl.2020.43760.2446
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