title: Identification of facial nerve during parotidectomy: a combined anatomical & surgical study.
abstract: To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Cadaveric dissection was performed in the Department of Anatomy and the surgeries were done in the Department of ENT and Head and Neck surgery of R. G. Kar Medical College of Kolkata. The distance of the facial nerve trunk from three most commonly used landmarks (viz., tympanomastoid suture, tragal pointer and posterior belly of digastric muscle) was measured in both cadaver and live patients. The ease of identification of the nerve trunk using each of the landmarks, particularly during live surgery was also assessed. The mean distance of the tympanomastoid suture from the facial nerve trunk was 3.5 mm (cadaver) and 3.87 mm (live surgery), the tragal pointer was found to be at a mean distance of 16.61 mm (cadaver) and 16.36 mm (live surgery) and in case of the posterior belly of digastric muscle it was 7.41 mm (cadaver) and 8.03 mm (live surgery). During live surgery the posterior belly of digastric was found to be the most easily identifiable landmark with a consistent anatomical relationship with the nerve trunk. The posterior belly of digastric muscle is the most easily identifiable and a very consistent landmark for facial nerve dissection during parotidectomy. When supplemented with the tragal pointer, accuracy in identifying the facial nerve trunk is very high, thereby avoiding inadvertent injury to the nerve trunk.
authors.affiliation: Department of ENT, Head and Neck Surgery, R. G. Kar Medical College & Hospital, Kolkata, India ; Sundaram Apartments, 91, Sarat Chatterjee Road, Barat, Lake Town, Kolkata, 700089 India.
authors.forename: Somnath
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of ENT, Head and Neck Surgery, R. G. Kar Medical College & Hospital, Kolkata, India.
authors.forename: Sudipta
authors.initials: S
authors.lastname: Pal
authors.affiliation: Department of ENT, Head and Neck Surgery, R. G. Kar Medical College & Hospital, Kolkata, India.
authors.forename: Moushumi
authors.initials: M
authors.lastname: Sengupta
authors.affiliation: Department of ENT, Head and Neck Surgery, R. G. Kar Medical College & Hospital, Kolkata, India.
authors.forename: Kanishka
authors.initials: K
authors.lastname: Chowdhury
authors.affiliation: Department of Plastic Surgery, R. G. Kar Medical College, Kolkata, India.
authors.forename: Vedula Padmini
authors.initials: VP
authors.lastname: Saha
authors.affiliation: Department of Anatomy, Calcutta National Medical College, Kolkata, India.
authors.forename: Lopamudra
authors.initials: L
authors.lastname: Mondal
keywords: Facial nerve; Parotidectomy; Posterior belly of digastric; Tragal pointer