The Role of the Parotid Fascia in Identification of the Facial Nerve during Parotidectomy

Abstract

Objectives: At the conclusion of the presentation, participants should be able to appreciate that performing a safe parotidectomy requires identification and preservation of the facial nerve. Participants will demonstrate understanding of the relationship between the parotid fascia and the location of the facial nerve trunk. Multiple standard anatomic landmarks have been used to help the surgeon identify the general location of the facial nerve trunk. To our knowledge, no study has evaluated the use of the parotid fascia that immediately overlies the trunk as a landmark. Methods: Prospective cadaver study. Dissection of the parotid fascia and identification of the facial nerve trunk was carried out in 8 fresh cadaveric parotid glands. The attachments of the parotid gland were evaluated, with special attention to the fascia overlying the facial nerve trunk. Results: The parotid fascia envelops the posterior aspect of the gland in an open book fashion. Posteriorly, it connects to the anterior and medial aspect of the mastoid tip. Postero-superiorly it attaches to the inferior aspect of the tragal pointer. Directly medial to the fascia lies the facial nerve trunk. Conclusions: The parotid fascia can be used as an additional landmark, in conjunction with other commonly used standard anatomic landmarks to identify the facial nerve trunk. It is useful as a landmark of depth of the facial nerve trunk. It can be palpated from the mastoid to the parotid gland. Deep to this sling of fascia, the facial nerve trunk is identified.