Branch Of Facial Nerve Research Articles

Evidence-based Considerations on Donor Nerve Selection and Ideal Muscle Weight in Long-standing Facial Paralysis – The Freiburg Algorithm

Introduction: Free functional muscle transfer (FMT) is the standard for smile reconstruction in long-standing facial paralysis. Using the contralateral NVII for innervation of the transferred muscle frequently produces satisfying results. However, axon counts of facial nerve branches used as donor nerves for cross-face nerve grafts (CFNG) generally decrease with age resulting in insufficient muscle contraction. Also, the volume of the transferred muscle segment necessary for symmetric oral excursion depends on the donor nerve. This study presents our algorithm for donor nerve selection and ideal muscle weight in long-standing facial paralysis. Materials and Methods: In a prospective cohort study, we evaluated facial palsy patients scheduled for dynamic smile reanimation preoperatively via EMG for involuntary masseter muscle activation upon smiling. Six months after noting the first muscle contraction, we assessed smile synchronicity and correlated the results with the EMG results. Furthermore, we correlated oral commissure amplitude with the weight of the muscle segment and the donor nerve used. Results: We recruited 30 patients for the prospective study and included 22 patients in the retrospective analysis. Postoperatively, all patients demonstrated a voluntary smile. The preoperative coactivation of the masseter muscle predicted the outcome regarding synchronicity of the smile with high sensitivity and specificity. Also, we observed a significant increase in oral commissure excursion with increasing muscle weight when using the NV. Conclusion: The lack of masseter coactivation upon smiling predicts the absence of a synchronous, involuntary smile after FMT using the masseteric nerve. The ideal muscle weight depends on the donor nerve and should be smaller for the NV.

Protection of the marginal mandibular branches of the facial nerves by different surgical procedures in comprehensive cervical lymphadenectomy for locally advanced oral and oropharyngeal cancer: a multicenter experience

ObjectiveAccording to the different characteristics of patients and cervical lymph node metastasis of oral and oropharyngeal cancer, the marginal mandibular branches of facial nerves were treated by different surgical procedures, and the safety and protective effects of different surgical procedures were investigated.MethodsOne hundred ninety-seven patients with oral and oropharyngeal cancer satisfying the inclusion criteria were selected. According to the different characteristics of patients and cervical metastatic lymph nodes, three different surgical procedures were used to treat the marginal mandibular branches of the facial nerve: finding and exposing the marginal mandibular branches of the facial nerves at the mandibular angles of the platysma flaps, finding and exposing the marginal mandibular branches of facial nerves at the intersections of the distal ends of facial arteries and veins with the mandible, and not exposing the marginal mandibular branches of the facial nerves. The anatomical position, injury, and complications of the marginal mandibular branches of the facial nerves were observed.ResultsThe marginal mandibular branches of the facial nerves were found and exposed at the mandibular angles of the platysma flaps in 102 patients; the marginal mandibular branches of facial nerves were found and exposed at the intersections of the distal ends of the facial arteries and veins with the mandibles in 64 patients; the marginal mandibular branches of facial nerves were not exposed in 31 patients; among them, four patients had permanent injury of the marginal mandibular branches of the facial nerves, and temporary injury occurred in seven patients. There were statistically significant differences in the protection of the mandibular marginal branch of the facial nerve among the three different surgical methods (P = 0.0184). The best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap, and the injury rate was only 2.94%.ConclusionThe three different surgical procedures were all safe and effective in treating the marginal mandibular branches of the facial nerves, the best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap.

349 - Injury of motor branch of facial nerve after carotid endarterectomy

349 - Injury of motor branch of facial nerve after carotid endarterectomy

Mandibular Fossa Approach to Petroclival and Anterior Pontine Lesions.

Objective To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine lesions. Design Five dry skulls were examined for surgical approach. Three adult cadaveric heads underwent bilateral dissection. One cadaveric head was evaluated with computed tomography after dissection. Setting This study was performed in an academic medical center. Participants Neurosurgical anatomy researchers performed this study using dry skulls and cadaveric heads. Main Outcome Measurements This was a proof-of-concept anatomical study. Results The mandibular fossa approach uses a vertical preauricular incision above the facial nerve branches. Removal of the temporomandibular joint exposes the mandibular fossa. The anterior boundary is the mandibular nerve at the foramen ovale, and the posterior boundary is the jugular foramen. The chorda tympani, eustachian tube, and tensor tympani muscle are sectioned. The carotid artery is transposed out of the petrous canal, and a petrosectomy is performed from Meckel's cave to the foramen magnum and anterior occipital condyle. Dural opening exposes the anterior pons, vertebrobasilar junction, bilateral vertebral arteries, and the ipsilateral anterior and posterior inferior cerebellar arteries. At completion, the temporomandibular joint is reconstructed with a prosthetic joint utilizing a second incision along the mandible. Conclusions The mandibular fossa approach is a new trajectory to the petroclival region and the anterior pons. It combines the more anterior angle of endoscopic approaches along with the enhanced control of open approaches. Further study is necessary before this approach is used clinically.

Deep Subfascial Approach in the Management of Zygomatic Arch Fracture: A Case Report

Even for the most skilled maxillofacial surgeon, gaining access to the zygomatic arch for surgical procedures can be difficult due to the potential obstruction caused by a depressed zygomatic arch fracture, leading to restricted mouth opening. There are various treatment options available for zygomatic arch fractures. This article discusses the deep subfascial technique as a means to access the Temporomandibular Joint (TMJ) and zygomatic arch. This surgical procedure ensures a secure operative field while minimizing the risk to facial nerve branches. Here, the authors present the case of a 62-year-old male patient who sustained a right zygomatic arch fracture in a road traffic accident. The fractured segments were treated surgically through open reduction and internal fixation using the deep subfascial approach. The procedure resulted in minimal post-operative discomfort, no functional impairment, successful reduction of the fracture, and restoration of function.

The sternocleidomastoid-parotid space (Diancan’s space)

Parotid gland tumors are common and mostly benign. The main treatment is surgical excision. The conventional surgical procedure, progressing from shallow to deep tissue, usually comprises three steps: first, exposing of superficial gland surface by raising a skin flap; second, approaching the tumor via destruction of the overlying gland tissue; third, tumor removal (e.g., by extracapsular dissection [ECD]). The surgical complications may include iatrogenic sialocele or fistula secondary to extensive injury of gland tissue, or facial palsy caused by contact with the facial nerve branches intraoperatively. To avoid surgical complications, we use an innovative procedure, progressing from deep to shallow tissue using ECD via the sternocleidomastoid-parotid space approach (ECD-SPSA). The sternocleidomastoid-parotid space (SPS; “Diancan’s space”) is a potential fascial space between the sternocleidomastoid muscle and the inferolateral parotid. This procedure comprises two steps; the first is a direct approach to the tumor through the SPS with simultaneous adenocutaneous flap establishment; and the second is ECD of the parotid tumor through the exposed SPS. The indications for this approach are clinically benign parotid tumors plunging into the SPS, which can be distinguished on computed tomography or magnetic resonance imaging by a “shot-put” sign in the axial plane and a “dolphin lift ball” sign in the coronal plane.1Yang R. Guo Y. Mao C. et al.Extracapsular dissection via sternocleidomastoid muscle–parotid space approach—a new operative technique for treating clinically benign tumor in the parotid tail.Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2020; 129: 109-114Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Exposing the inferoposterior edge of the parotid gland and elevating an adenocutaneous flap allows the SPS to be used for safe removal of some tumors in the deep lobe of the parotid gland.2Wang D.C. Sun Z.P. Peng X. et al.Surgical resection of clinically benign tumours in the maxillomandibular deep lobe of the parotid gland via sternocleidomastoid muscle–parotid space approach.Int. J. Oral Maxillofac. Surg. 2021; 50: 1012-1018Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ECD-SPSA is simple because the sternocleidomastoid muscle is easily identifiable. Moreover, ECD-SPSA is less invasive because the gland covering the tumor is preserved; skin covering the gland is not separated. Consequently, surgical complications, postoperative sialocele, and salivary fistulas can generally be avoided without using any specific intraoperative and/or postoperative measures to prevent or treat sialocele/fistula (e.g., medication sealant, pressure dressing, and dietary restrictions).3Lan L. Wang D. Ma R. et al.Extracapsular dissection by the sternocleidomastoid muscle–parotid space approach reduces the risks of postparotidectomy sialocele and salivary fistula.Head Neck. 2022; 44: 2522-2527Crossref PubMed Scopus (1) Google Scholar We thank Ryan Chastain-Gross, Ph.D., from Liwen Bianji (Edanz) for editing the English text of a draft of this article. The authors declare no competing interests.

Delineation and histological examination of the intramuscular innervation of the platysma: Application to botulinum neurotoxin injection.

This study aimed to identify the whole innervation pattern of the platysma using the Sihler's staining, and the axonal composition profile of the sensory-motor anastomosis identified by immunofluorescence assays. The findings provide a comprehensive understanding of the neural anatomy of the platysma and facilitate efficient and safe manipulation for neurotoxin injection. Ten fixed and two fresh hemifaces were included in this study. Sihler's staining was used to the study 10 fixed hemifaces and two fresh hemifaces were used for immunofluorescence assays. In all cases, the cervical branch of facial nerve (Cbr) broadly innervated the platysma, and the marginal mandibular branch of facial nerve (MMbr) provided supplementary innervation to the uppermost part of the platysma. The transverse cervical nerve (TCN), great auricular nerve (GAN), and supraclavicular nerve (SCN) were observed in the lower half of the platysma. In 30% of all cases, there was a communicating loop between the Cbr and TCN. In 20% of all the cases, a communicating branch joined between the Cbr and GAN. For successful esthetic rejuvenation procedures, a clinician should consider the Cbr distribution to the overall platysma and additionally innervation by individual nerves (MMbr, GAN, TCN, and SCN) to the middle and lower portions of the platysma muscle.

Connections between postparotid terminal branches of the facial nerve: An immunohistochemistry study.

It has been assumed that connections between the postparotid terminal branches of the facial nerve are purely motor. However, the nature of their fibers remains unexplored. The aim of this study is to determine whether these connections comprise motor fibers exclusively. In total 17 connections between terminal facial nerve branches were obtained from 13 different facial nerves. Choline acetyltransferase antibody (ChAT) was used to stain the fibers in the connections and determine whether or not all of them were motor. All connections contained ChAT positive and negative fibers. The average number of fibers overall was 287 (84-587) and the average proportion of positive fibers was 63% (37.7%-91.5%). In 29% of the nerves, >75% of the fibers were ChAT+ (strongly positive); in 52.94%, 50%-75% were ChAT+ (intermediately positive); and in 17.65%, <50% were ChAT+ (weakly positive). Fibers traveling inside the postparotid terminal cranial nerve VII branch connections are not exclusively motor.

The Deep Fascia of the Infraorbital Region, Deep Plane, and Suprafibromuscular Facelift: New Anatomy for Safer Facelifting.

Deep-plane rhytidectomy, first described by Skoog, has had a resurgence in popularity and is in high demand today. We describe anatomical findings that establish the presence of a true deep fascia in the midface, we named as Chiara's fascia, like the first author's first name, which helps to form the facial ligaments and is contiguous with the superficial layer of the deep temporal fascia. This fascia inserts on the periosteum of the inferior orbital rim at the arcus marginalis and separates the suborbicularis oculi fat (SOOF) from the preperiosteal fat. This distinct fascial layer lies under the superficial fascia or superficial musculoaponeurotic system (SMAS) and represents the floor of what is commonly termed the "deep plane." When this fascial highway is identified intraoperatively, blunt dissection immediately superficial to this layer will protect facial nerve branches overlying the muscles lifting the upper lip such as the zygomaticus. Subsequent dissection over the middle and lower face can usually be performed bluntly. Over a 10-year period, a total of 100 hemifaces were dissected with a 100% success rate of identifying this fascia in all specimens. This work was further validated by examining histologic specimens that clearly demonstrate this unique fibrofatty fascial layer. These dissections and new anatomical findings were then correlated to over 300 intraoperative deep-plane facelift cases by the primary and senior authors. We term this operative technique as the suprafibromuscular facelift. Dissection in this plane allows for safe release of facial retaining ligaments with protection of facial nerve branches.

CT-guided radiofrequency ablation of the extracranial cranial nerve for the treatment of Meige's syndrome.

BackgroundMeige’ s syndrome, a rare form of dystonia, lacks effective treatment. The purpose of this study was to determine the effects of CT-guided percutaneous extracranial radiofrequency ablation of the facial and/or trigeminal nerves in the treatment of Meige’s syndrome.MethodsA total of 10 patients were enrolled in this study, with the numbers of blepharospasm dystonia syndrome (BDS), oromandibular dystonia syndrome (ODS), and blepharospasm combined with oromandibular dystonia syndrome (B-ODS) being 7, 1, and 2, respectively. BDS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve; ODS patients underwent radiofrequency ablation of the bilateral foramen oval trigeminal mandibular branch, and B-ODS patients underwent radiofrequency ablation of the bilateral stylomastoid foramen facial nerve and foramen oval trigeminal mandibular branch. The therapeutic effects and complications were observed.ResultsAll 10 patients in this series experienced improved Meige’s syndrome-related symptoms after extracranial radiofrequency ablation of the cranial and/or mandibular branches of the extracranial trigeminal nerve. Adverse events included class II–III facial paralysis and/or mandibular skin numbness. Two patients had recurrences at the 18th and 22nd months postoperatively, respectively; the other patients were being followed up.ConclusionThese results shown that CT-guided radiofrequency ablation of bilateral stylomastoid foramen facial nerve and/or oval foramen trigeminal mandibular branch can effectively treat the corresponding types of Meige’s syndrome. According to preliminary observations, the therapeutic effect may last more than 18 months.

Proposals for Standardization of Intraoperative Facial Nerve Monitoring during Parotid Surgery.

Intraoperative facial nerve monitoring (FNM) has been widely accepted as an adjunct during parotid surgery to facilitate identification of the facial nerve (FN) main trunk, dissection of FN branches, confirmation of FN function integrity, detection of FN injury and prognostication of facial expression after tumor resection. Although the use of FNM in parotidectomy is increasing, little uniformity exists in its application from the literature. Thus, not only are the results of many studies difficult to compare but the value of FNM technology is also limited. The article reviews the current literature and proposes our standardized FNM procedures during parotid surgery, such as standards in FNM setup, standards in general anesthesia, standards in FNM procedures and application of stimulus currents, interpretation of electrophysiologic signals and prediction of the facial expression outcome and pre-/post-operative assessment of facial expressions. We hope that the FNM standardized procedures will provide greater uniformity, improve the quality of applications and contribute to future research.

Lateral branches of the facial artery and its clinical implications.

The facial artery is the main artery supplying blood to the face and is known to have facial branches of the inferior labial, superior labial, lateral nasal and angular arteries. These known major branches of facial artery run medially, however, there are sometimes branches of the facial artery heading laterally. The purpose of the present study was to investigate the lateral branches of the facial artery in face. We dissected facial branches of the facial artery in 74 cadaveric hemifaces. We investigated the presence of the lateral branches of the facial artery. Following parameters were investigated: lateral branch presence, the location of its origin, and the lateral branch diameter. Among the lateral branches, we evaluated the prevalence and diameter of the premasseteric branch. Lateral branches were observed in 48 of the 74 hemifaces (64.9%). The total number was 81 in the 48 hemifaces. The most common origin was between the inferior border of the mandible and inferior labial artery origin (42 of 81, 51.9%). The mean diameter of all lateral branches of the facial artery was 0.7 mm. Among the lateral branches, the premasseteric branches were present in 38 of 74 specimen (51.4%) and the mean diameter was 0.8 mm. The lateral branches of the facial artery may be registered in Terminologia Anatomica based on their prevalence. Accurate knowledge of the anatomy of the lateral branches of the facial artery is helpful for clinicians to avoid complications during facial procedures or maxillofacial surgeries.

Temporal Branch Ablation for the Treatment of Facial Rhytids: A New Surgical Technique.

Frontal wrinkles are a cause of distress for many people as they age. Traditionally, these have been treated with botulinum toxin injections. However, this procedure is not free from complications and has a temporary result. This report describes a procedure involving temporal branch of facial nerve ablation, a novel and simple technique for the treatment and prevention of rhytids. The objective of this study was to introduce this new technique of ablation for the treatment of frontal wrinkles after analyzing 3 options of approach based on the number of ablation lines. Fifty-one patients with a mean age of 49 years underwent nerve ablation. The temporal nerve branches were located through electrostimulation. Through a skin puncture in the temporal region, an Abbocath, with part of the plastic coating removed at its base, was introduced. The nerve branches were cauterized in oblique lines with a monopolar electric scalpel. Patients were divided into 3 groups, depending on the number of ablation lines. The median follow-up period was 20 months (range, 1-50 months). Only 3 (5.7%) patients developed unilateral relapse of muscle activity in the frontal region. Group 6 was statistically superior to Group 1. There was no statistically significant difference between Group 4 and the other 2 groups. More than 70% of patients were satisfied or very satisfied with the results. Facial nerve branch ablation is a simple surgical technique for the treatment of forehead rhytids that produces less postoperative pain, features rapid recovery, and, above all, offers long-lasting results.

P-61069874-222 - Antero-Parotid trans-massetric approach for reduction of mandibular subcondylar fractures; clinical tricks.

Sub-condylar fractures of mandible are a common occurrence in the trauma of the maxillofacial region both in children and adults. These fractures are treated by open reduction and internal fixation or by closed reduction according to the patient's age, his general condition and the facilities available in a particular healthcare setting. Use of the antero-parotid trans-massetric approach for treating mandibular subcondylar fractures has the least postoperative complications among other approaches for treating mandibular subcondylar fractures. Data was collected over seven years with a total of 245 fractures operated on 205 patients. Only minor complications were noticed during the 10 day post operative period, with mild temporary weakness of the buccal branches of facial nerve in 3.4% of cases while post operative unusual edema and trismus in 8.7% which resolved during the first ten days. No parotid leak/sialocele was found in any of these cases. Our aim is to give some clinical tricks after seven years experience in using this approach to treat subcondylar fractures and to achieve the best results with the least complications. The tricks include: the type of fractures which can be treated with this approach, to identify the access site, to deal with facial nerve branches in surgical site, the needfor perfect retraction and how to aid in reduction of fractures. We recommend this approach as it is rapid,easy, safe and effective for treating low subcondylar fractures.We suggest consideration of those clinical tricks to achieve the least complications and minimize surgical time.

Single incision-plus approach for gasless endoscopic parotidectomy: a seven-step procedure.

Endoscopic parotidectomy has the potential to become a reliable procedure for benign and low-grade malignant parotid gland tumors. Based on the previous literature review and our own clinical experience, we introduced in detail the surgical procedure of single incision-plus approach for gasless endoscopic parotidectomy. This method contributes a logical approach to achieving endoscopic resection of parotid gland tumor and preservation of facial nerve, which can be summarized into the following seven-step method: preoperative preparation; design of retroauricular-hairline incision and plus-incision; surgical cavities creation and coalescence; separation of surgical boundaries; separation and protection of the facial nerve trunk; processing of the branches of facial nerve; en bloc resection of the superficial parotid gland and tumor. Endoscopic parotidectomy is a more difficult procedure than conventional parotid surgery, requiring more precision as well as more experience and equipment. The learning curve of time and frequency is influenced by many factors, like anatomy, instruments, procedures and patience. We contribute our clinical exploration of anatomical precautions, feasible instruments, and surgical procedures and summarize precautions under single incision-plus in gasless endoscopic parotidectomy. Given the growing interest in the aesthetic process of the parotid region, the seven-step method may have the potential to be a method for teaching gasless endoscopic parotidectomy.

Surgical Treatment for Postparalytic Facial Synkinesis: A 35-Year Experience.

Surgical intervention with combined myectomy and neurectomy followed by functioning free muscle transplantation has been proposed to effectively resolve the problem of postparalytic facial synkinesis since 1985, and it continues to be the authors' standard of care. The authors aim to provide evidence that this surgical strategy is effective for treatment of synkinesis and smile quality. One hundred three patients with postparalytic facial synkinesis were investigated (1985 to 2020). They all underwent extensive removal of the synkinetic muscles and triggered facial nerve branches in the cheek, nose, and neck regions, followed by gracilis functioning free muscle transplantation for facial reanimation. Ninety-four patients (50 with type II and 44 with type III postparalytic facial synkinesis), all of whom had at least 1 year of postoperative follow-up, were included in the study. Patient demographics and functional and aesthetic evaluations before and after surgery were collected. In the yearly distribution of the facial paralysis reconstruction, the incidence of surgical intervention increased from 15 percent before 2012 up to 24 percent in the years after. Young adults (79 percent) and female patients (63 percent) were the dominant population. Results showed a significant improvement of the facial smile quality, with more teeth visible while smiling, and a long-lasting decrease of facial synkinesis. Ninety-six percent of patients did not require botulinum toxin type A injection after surgery. Revision surgery for secondary deformity was 53 percent. Combined myectomy and neurectomy followed by functioning free muscle transplantation for type II and III synkinetic patients leads to promising and long-lasting results despite high revision rates. Refined techniques to decrease the revision rates are needed in the future. Therapeutic, IV.

Studies on Nanomaterial Coated Stents on High Grade Ruptured Intracranial Aneurysms and Analysis of the Effect of Ultra-Early Clipping Operation

With the prolongation of the onset time after the rupture of highly distinct intracranial aneurysms, serious complications such as re-rupture hemorrhage, cerebral vasospasm and hydrocephalus often occur, which may lead to the death of the patient. Based on the above background, the purpose of this study is to analyze the curative effect of super early clipping for ruptured intracranial aneurysms with high grade. This paper mainly introduces the operation points and techniques of the pterional approach and the supracrubral lateral orbital approach, and then collects the clinical data of patients with intracranial ruptured aneurysm treated by craniotomy clip-clip-on in shenbei New District Central Hospital from June 2015 to July 2018. The results show that the supraorbital lateral approach is a minimally invasive, relatively safe approach with satisfactory field exposure. The superior lateral orbital approach is suitable for the treatment of high grade intracranial ruptured aneurysms as well as anterior circulation aneurysms. Compared with the pterional approach, it has the advantages of avoiding the injury of facial nerve branch, short operation time, small operation trauma, short average length of hospital stay, fewer complications, quick postoperative recovery and so on.

Reverse Facial-submental Artery Island Flap with Reinnervation of the Anterior Belly of the Digastric Muscle.

Reconstruction of the upper lateral lip subunit is challenging, and use of several classical local flaps have been previously reported. However, these methods have drawbacks such as visible scarring, anatomic distortion, and functional disability. To obtain satisfactory results, preservation of perioral function is important. We report a case of functional upper lip reconstruction after tumor resection using a reverse facial-submental artery island flap with a reinnervated anterior belly of the digastric muscle (ABDM) without sacrificing the perioral structure. A 73-year-old man presented with basal cell carcinoma on the left upper lip which was widely excised, including the orbicularis oris muscle. The remaining 4 cm × 3.5 cm defect was reconstructed using a reverse facial-submental artery island flap with ipsilateral ABDM. The motor nerve of the ABDM was sutured with the stump of the buccal branch of the ipsilateral facial nerve. The postoperative course was uneventful, and good functional and esthetic recovery were observed at 12-month follow-up. This procedure may be an alternative option for reconstruction of lateral upper lip defects.

Variations of facial nerve distribution in the parotid gland.

Objective: To study anatomical variations of facial nerve encountered during parotid gland surgery. Study Design: Observational Study. Setting: Anatomy Department with the Collaboration of General Surgery Department at Dow University of Health Sciences and Dow Hospital (Ojha Campus Karachi). Period: December 2020 to May 2021. Material &amp; Methods: Dissection of parotid gland was done in 50 cases including 10 cadavers (20 parotid glands) in anatomy department and 40 patients (40 parotid glands) admitted in general surgery ward undergoing parotid gland surgery for any pathology of the gland. Total 60 parotid glands were studied. Mean age of the cases was 31.6 ± 2.14 years with age range of 20-60 years. There were 10 female and 40 male cases. Results: In this study 60 parotid glands were dissected in 50 cases and facial nerve configuration was studied. In 46(92%) cases facial nerve pattern could be classified into main five types of the nerve pattern but in 04(08%) cases facial nerve pattern did not fit into any category of the classification. Type-III pattern of facial nerve distribution was commonly seen in 21(35%) glands. Conclusion: It is very important to keep knowledge of anatomical variations in facial nerve branching pattern in parotid gland to avoid its Injury during surgery.

ANATOMIC VARIATION OF RETROMANDIBULAR VEIN AND THE FACIAL NERVE DURING SUPERFICIAL PAROTIDECTOMY – A CASE REPORT

Knowledge of anatomic variations occurring in the head and neck region is very important for surgeons performing surgeries in these regions. Identification of facial nerve and its branches is the most important step while performing parotidectomy.During the parotid surgery, retromandibular vein is used as a guide to expose the facial nerve inside the parotid gland.The vein is also used as a landmark to identify facial nerve preoperatively,during computed tomography, magnetic resonance imaging and sonography.In our report we describe the anomalous relationship of retromandibular vein and facial nerve during left superficial parotidectomy in a 27year old female. In normal anatomical relation the retromandibular vein passes medial to the branches of facial nerve, in our case the retromandibular vein was found to pass lateral to the cervicofacial trunk of facial nerve and medial to the temporofacial trunk of facial nerve.These kinds of anomalous relation between these two structures are very important to be known to the surgeons while performing parotid surgeries.