A Simple Method for Safe Identification of the Facial Nerve Using Palpable Landmarks

Abstract

Setting: University department of human anatomy and university hospital. Methods: A total of 40 human cadaver heads (79 facial nerves) were dissected by 2 prosectors, a surgeon with experience in the anatomy of the parotid region (J.A.P.; n = 39) and a medical student with experience in anatomical dissection and basic knowledge of the facial nerve disposition (A.M.; n=40). A 3-cm skin incision was made in the center of the triangle formed by the temporomandibular joint, the mastoid process, and the angle of the mandible, and dissection was continued deep until the main facial nerve trunk was identified. Main Outcome Measures: The time taken from the skin incision to the identification of the nerve was monitored with a chronometer by an independent observer. The distance between the predicted and actual position of the facial nerve was measured. Results: In all cases, the facial nerve was identified and there were no significant differences in the dissection time between the 2 prosectors (144 vs 148 seconds). The mean distance between the predicted and the actual position of the nerve was 1.42 mm. Conclusion: The proposed localization landmarks allowed a fast and safe identification of the facial nerve and may be of significant help during surgery around the parotid region.

The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study

“…Pereira et al [ 5 ] suggested that external palpable landmarks can be used to identify the facial nerve trunk quickly and safely. In a study that involved 40 human cadavers, they proposed that a centre of a triangle formed by the temporomandibular joint, the mastoid process and the angle of the mandible allowed a fast and safe identification of the facial nerve and may be of significant help during surgery around the parotid region.…”

Easy and Safe Method for Facial Nerve Identification in Parotid Surgery

“…In a cadaveric study, Pereira et al suggested external palpable landmarks to identify the facial nerve and proposed that the facial nerve can be identified in the center of a triangle formed by the temporomandibular joint, the mastoid process, and the angle of the mandible. 15 Bony landmarks to identify the facial nerve were proposed in another cadaveric study. 16 The usefulness of these approaches in live surgery has not been tested.…”

Anatomical Dissection and Modified Sihler Stain of the Lower Branches of the Facial Nerve

“…A preauricular vertical skin incision was made over the center of the triangle formed by the temporomandibular joint, mastoid process, and angle of the mandible, which have been described as palpable landmarks used to accurately locate the facial nerve trunk. 28 The incision was curved behind the ear, similar to a modified Blair approach, and continued inferiorly along the sternocleidomastoid muscle to a level horizontal with the inferior edge of the thyroid cartilage. A horizontal incision was carried to the midline and the skin was reflected.…”