Parotidectomy is basically an anatomical dissection. Identification of the facial nerve trunk is essential during surgery of the parotid gland because facial nerve injury is the most daunting potential complication of parotid gland surgery owing to the close relation between the gland and the extratemporal course of facial nerve.
There are two approaches to identify the facial nerve trunk during parotidectomy—conventional antegrade dissection of the facial nerve, and retrograde dissection. Numerous soft tissue and bony landmarks have been proposed to assist the surgeon in the early identification of this nerve. Most commonly used anatomical landmarks to identify facial nerve trunk are stylomastoid foramen, tympanomastoid suture (TMS), posterior belly of digastric (PBD), tragal pointer (TP), mastoid process and peripheral branches of the facial nerve.
I found posterior belly of digastric muscle and tragal pointer as the most easily identifiable and a very consistent landmark for facial nerve dissection during parotidectomy. For incision I use modified Blair incision. I raise the skin flap subplatysmally, anterior extension up to the masseter muscle. I always preserve the posterior branch of the great auricular nerve. The whole procedure I will demonstrate with a short video clip.
Abdul Matin1
1 Department of Otorhinolaryngology, University Hospital Limerick, Limerick