title: Direct coaptation of extensive facial nerve defects after removal of the superficial part of the parotid gland: an anatomic study.
abstract: BACKGROUND
  In the surgical repair of facial nerve paralysis, a tension-free end-to-end coaptation of the trunk or its branches with or without rerouting is functionally superior to grafting. Assuming that a lengthening of all branches of the parotid plexus can be attained by removal of the superficial part of the parotid gland and mobilization of the branches, we performed an anatomic study.
  
  
  METHODS
  The parotid regions of 10 cadavers were dissected to investigate the length gained for the branches of the parotid plexus by this technique. Every branch at the upper and ventral border of the gland was marked by a surgical suture. After removing the superficial part of the parotid gland, the branches were cut at the suture, and the proximal stump was drawn toward the distal stump. The distance of the overlapping stumps was measured by means of an electronic gliding caliper. In addition, in five specimens only the trunk of the facial nerve was dissected by the same method, and the distance of the overlapping stumps was measured.
  
  
  CONCLUSIONS
  The results demonstrate that removing the superficial part of the parotid gland may be sufficient to enable direct coaptation without nerve grafting. Cut temporal or zygomatic branches with a gap of up to 15 mm and cut buccal or marginal mandibular branches with a gap of up to 23 mm can be bridged by mobilization of just the proximal stumps. This technique may also be used to bridge a 17-mm gap of the trunk of the facial nerve.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Innsbruck and Ludwig-Boltzmann-Institute for Quality Control in Plastic Surgery, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. alexander.gardetto@uibk.ac.at
authors.forename: Alexander
authors.initials: A
authors.lastname: Gardetto
authors.forename: Peter
authors.initials: P
authors.lastname: Kovacs
authors.forename: Johannes
authors.initials: J
authors.lastname: Piegger
authors.forename: Christian
authors.initials: C
authors.lastname: Rainer
authors.forename: Romed
authors.initials: R
authors.lastname: Meirer
authors.forename: Hildegunde
authors.initials: H
authors.lastname: Piza-Katzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D002102:Cadaver; D005154:Facial Nerve / Q000033:anatomy & histology* / Q000601:surgery*; D020220:Facial Nerve Injuries / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010306:Parotid Gland / Q000033:anatomy & histology / Q000294:innervation* / Q000601:surgery