Anatomical relationship of facial nerve with extratemporal markers and surgical significance

Yıl 2022, Cilt: 6 Sayı: 1, 89 - 94, 27.01.2022

Gulsah Zeybek Ozlem Yuksel Cosar

https://doi.org/10.30621/jbachs.979194

Öz

Purpose: Correct identification of the location of the facial nerve trunk, which is likely to be damaged during surgical intervention, is very important to minimize possible complications. Therefore, it is aimed to provide a more practical way to evaluate the anatomical relationship between the facial nerve and surrounding structures and to determine the facial nerve trunk during surgery.
Methods: Adult cadaver heads were used in 12 (6 Female - 6 Male) fresh frozen cadavers included in the cadaver collection of Dokuz Eylül University Faculty of Medicine, Department of Anatomy. Measurements were taken by determining the lower end of the Tragal pointer (TP) and the tip of the mastoid process (M) surrounding the nerve.
Results: The mean distance between facial nerve truncus and tragal pointer was 6,538 mm; the tip of the mastoid process, 8,225 mm. Facial nerve truncus is approximately 8.446 mm deep to the line extending between the Tragal pointer-Mastoid tip.
Conclusion: Instead of using the tragal pointer and the mastoid tip separately for the determination of the facial nerve truncus, the facial nerve trunk can be determined more reliably in the depth of the plane between the structures and does not carry the risk of nerve damage.

Anahtar Kelimeler

anatomy, facial nerve trunk, mastoid tip, parotid surgery, tragal point

Kaynakça

• 1. Bailey BJ, Johnson JT, Newlands SD. Newlands Head & Neck Surgery Otolaryngology. 4th ed. Lippincott Williams & Wilkins Publisher; 2006. pp. 1524.
• 2. Grosheva M, Klussmann JP, Grimminger C, Wittekindt C, Beutner D, Pantel M, Volk GF, Guntinas-Lichius O. Electromyographic facial nerve monitoring during parotidectomy for benign lesions does not improve the outcome of postoperative facial nerve function: a prospective two-center trial. Laryngoscope 2009; 119(12):2299-2305.
• 3. Laccourreye H, Laccourreye O, Cauchois R, Jouffre V, Menard M, Brasnu D. Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: a 25-year experience with 229 patients. Laryngoscope 1994; 104(12):1487-1494.
• 4. Meier JD, Wenig BL, Manders EC, Nenonene EK. Continuous intraoperative facial nerve monitoring in predicting postoperative injury during parotidectomy. Laryngoscope 2006; 116(9):1569-1572.
• 5. Sood AJ, Houlton JJ, Nguyen SA, Gillespie MB. Facial nerve monitoring during parotidectomy: a systematic review and metaanalysis. Otolaryngol Head Neck Surg. 2015; 152(4):631-637.
• 6. Upton DC, McNamar JP, Connor NP, Harari PM, Hartig GK. Parotidectomy: ten-year review of 237 cases at a single institution. Otolaryngol Head Neck Surg. 2007; 136(5):788-792.
• 7. Witt RL. Facial nerve function after partial superficial parotidectomy: an 11-year review (1987-1997). Otolaryngol Head Neck Surg. 1999; 121(3):210-213.
• 8. Dulguerov P, Marchal F, Lehmann W. Postparotidectomy facial nerve paralysis: possible etiologic factors and results with routine facial nerve monitoring. Laryngoscope 1999; 109:764-762
• 9. Musani MA, Zafar A, Suhail Z, Malik S, Mirza D. Facial nerve morbidity following surgery for benign parotid tumours. J Coll Physicians Surg Pak 2014; 24(8):569-572.
• 10. Graciano AJ, Fischer CA, Coelho GV, Steck JH, Paschoal JR, Chone CT. Facial nerve dysfunction after superficial parotidectomy with or without continuous intraoperative electromyographic neuromonitoring: a prospective randomized pilot study. Eur Arch Otorhinolaryngol 2018; 275(11):2861-2868. doi: 10.1007/s00405-018-5130-1.
• 11. Saha S, Pal S, Sengupta M, Chowdhury K, Saha VP, Mondal L. Identification of facial nerve during parotidectomy: a combined anatomical & surgical study. Indian J Otolaryngol Head Neck Surg 2014; 66(1):63-68.
• 12. Pather N, Osman M. Landmarks of the facial nerve: implications for parotidectomy. Surg Radiol Anat 2006; 28:170–175.
• 13. Cannon CR, Replogle WH, Schenk MP. Facial nerve in parotidectomy: a topographical analysis. Laryngoscope 2004; 114:2034-2037.
• 14. Wong DS. Surface landmarks of the facial nerve trunk: a prospective measurement study. ANZ J Surg 2001; 71:753-756.
• 15. De Ru JA, Van Benthem PP, Bleys RL, Lubsen H, Hordijk GJ. Landmarks for parotid gland surgery. J Laryngol Otol 2001; 15(2):122-125.
• 16. 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 2010; 192:27–32.
• 17. Ullah I, Khan SA, Iqbal M, Hussain G. Tragal pointer as a surgical landmark for the identification of facial nerve trunk in parotidectomy: our experience. JSMC 2018; 7:4-7.
• 18. Stankevicius D, Suchomlinov A. Variations in facial nerve branches and anatomical landmarks for ıts trunk ıdentification: a pilot cadaveric study in the lithuanian population. Cureus 2019; 11(11): e6100.
• 19. De Ru JA, Bleys RL, Van Benthem PP, Hordijk GJ. Preoperative determination of the location of parotid gland tumors by analysis of the position of the facial nerve. J Oral Maxillofac Surg 2001; 59(5):525–528.
• 20. Trible WM. Symposium: management of tumors of the parotid gland. III. Management of the facial nerve. Laryngoscope 1976; 86(1):25–27.
• 21. Greyling LM, Glanvill R, Boon JM, Schabort D, Meiring JH, Pretorius JP, van Schoor A. Bony landmarks as an aid for intraoperative facial nerve identification. Clin Anat 2007; 20:739-744.
• 22. Upile T, Jerjes W, Nouraei SA, et al. The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study. World J Surg Oncol 2009; 7:71.
• 23. Smith OJ, Ross GL. Variations in the anatomy of the posterior auricular nerve and its potential as a landmark for identification of the facial nerve trunk: a cadaveric study. Anat Sci Int 2012; 87:101–105.
• 24. Kopuz C, Ilgi S, Yavuz S, Onderoglu S. Morphology of the retromandibular vein in relation to the facial nerve in the parotid gland. Acta Anat (Basel) 1995; 152(1):66–68.
• 25. Witt RL, Weinstein GS, Rejto LK. Tympanomastoid suture and digastric muscle in cadaver and live parotidectomy. Laryngoscope 2005; 115:574-577.
• 26. Conley J. Salivary Glands and the Facial Nerve. Stuttgart: George Thieme Publishers, 1975.
• 27. Keefe MA, Castro JR, Keefe MS. Identification of the facial nerve main trunk by retrograde dissection of the postauricular branch. Otolaryngol Head Neck Surg 2009; 140:126–127.
• 28. Meybodi AT, Moreira LB, Lawton MT, Preul MC. Anatomical assessment of the digastric branch of the facial nerve as a landmark to localize the extratemporal facial nerve trunk. Surg Radiol Anat 2019; 41:657-662.
• 29. Liu M, Wang SJ, Benet A, Meybodi AT, Tabani H, Ei-Sayed IH. Posterior auricular artery as a novel anatomic landmark for identifcation of the facial nerve: A cadaveric study. Head Neck. 2018; 40(7):1461-1465.