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

Tahwinder Upile,Ann Sandison,Colin Hopper,Holger Sudhoff,Waseem Jerjes,Panagiotis Kafas,Seyed Ahmad Reza Nouraei,Sandeep U Singh

doi:10.1186/1477-7819-7-71

Abstract

BackgroundThe identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; hence anatomical landmarks and adequate operative exposure can aid such identification and preservation.In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically.MethodsThe clinical component of the study included prospective reviewing of 100 consecutive routine parotidectomies; while, the anatomical component of the study involved dissecting 50 cadaveric hemifaces.ResultsWe could consistently identify a supplying vessel, stylomastoid artery, which tends to vary less in position than the facial nerve. Following this vessel, a few millimetres inferiorly and medially, we have gone on to identify the facial nerve trunk, which it supplies, with relative ease. The origin of the stylomastoid artery, in our study, was either from the occipital artery or the posterior auricular artery.ConclusionThis anatomical aid, the stylomastoid artery, when supplemented by the other more commonly known anatomical landmarks and intra-operative facial nerve monitoring further reduces the risk of iatrogenic facial nerve damage and operative time.

Highlights

The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; anatomical landmarks and adequate operative exposure can aid such identification and preservation.In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically
Since on an embryological basis the facial nerve grows into the developing parotid gland and is subject to many different anatomical variations that are not paralleled in branchial artery development
The standard approach is via a cervico-mastoid-facial incision, which provides good exposure and is relatively easy to perform [3]. In this clinico-anatomic study, we looked at the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified in cadavers and its arterial nature was confirmed histologically

Summary

Introduction

The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; anatomical landmarks and adequate operative exposure can aid such identification and preservation.In this clinico-anatomic study, we examined the stylomastoid artery (SMA) and its relation to the facial nerve trunk; the origin of the artery was identified on cadavers and its nature was confirmed histologically. The identification of the facial nerve can be difficult in a bloody operative field or by an incision that limits exposure; anatomical landmarks and adequate operative exposure can aid such identification and preservation. Since on an embryological basis the facial nerve grows into the developing parotid gland and is subject to many different anatomical variations that are not paralleled in branchial artery development. This is an extension of evolutionary principles whereby a reliable blood supply is required and assured for other structures to develop around them. One may argue that arteries or supplying vessels tend to vary in position less than nerves [2]

Methods

Results

Conclusion