Anatomical Variations of the Intrapetrous Portion of the Facial Nerve

A rare facial nerve anomaly was incidentally discovered whilst performing a tympanoplasty and ossicular reconstruction on a patient with an acquired unilateral conductive hearing loss. The nerve was seen to bifurcate and straddle a normal stapes superstructure as it ran posteriorly through the middle ear, a unique and as yet unreported combination. This case highlights the importance of vigilance regarding facial nerve anatomical variations encountered during middle-ear surgery thus avoiding inadvertent damage. The purported embryological mechanism responsible for such anomalies of the intra-tympanic facial nerve is discussed.

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Avoiding Facial Nerve Injuries in Rhytidectomy Anatomical Variations and Pitfalls

Plastic & Reconstructive Surgery ◽

10.1097/00006534-197912000-00005 ◽

1979 ◽

Vol 64 (6) ◽

pp. 781-795 ◽

Cited By ~ 195

Author(s):

Daniel C. Baker ◽

John Conley

Keyword(s):

Facial Nerve ◽

Anatomical Variations ◽

Nerve Injuries ◽

Facial Nerve Injuries

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Anatomical Variations of the Facial Nerve in First Branchial Cleft Anomalies

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.129.3.351 ◽

2003 ◽

Vol 129 (3) ◽

pp. 351 ◽

Cited By ~ 26

Author(s):

C. Arturo Solares ◽

James Chan ◽

Peter J. Koltai

Keyword(s):

Facial Nerve ◽

Anatomical Variations ◽

Branchial Cleft Anomalies ◽

Branchial Cleft

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R435 – Stapedius Muscle Relations to the Facial Canal

Otolaryngology ◽

10.1016/j.otohns.2008.05.591 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P190-P190

Author(s):

Alaa A. Abou-Bieh ◽

Thomas J Haberkamp ◽

Jarah Ali Al-Tubaikh

Keyword(s):

Facial Nerve ◽

Temporal Bone ◽

Anatomical Variations ◽

Surgical Anatomy ◽

Facial Canal ◽

Sinus Tympani ◽

Stapedius Muscle ◽

Facial Nerve Canal ◽

Tendon Insertion ◽

Temporal Bones

Problem The gross anatomical variations of the stapedius muscle and its relations to the facial nerve canal. Methods Thirty-five temporal bones were dissected, and the anatomic details were studied utilizing an operating microscope and otoendoscopes with 0o, 30o and 70o angles and 2.7 and 3 mm diameters. The muscle origin, its course in its bony sulcus with its relation to the facial nerve canal, the tendon and its insertion were studied. Results Marked variations in the origin, size, and course of the muscle in its bony sulcus were detected. The shape of the sulcus itself and its relation to the facial nerve canal varied also, both mainly influenced by the sinus tympani development. These variations affected the shape and length of the tendon and the pyramidal eminence. In addition, they influenced the site of tendon insertion into the stapes. The presence of ectopic muscle bundles was confirmed in one specimen. Conclusion The stapedius muscle anatomy can vary significantly from one temporal bone to another. In some situations these variations can be of surgical importance worse enough to be recognized. Significance To add important unrecognized data to the surgical anatomy of the temporal bone.

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Discerning a Smile -- The Intricacies of Analysis of Post-Neck dissection Asymmetr

10.22541/au.161347823.30287514/v1 ◽

2021 ◽

Author(s):

Rachael Thomas ◽

Joshua Whittaker ◽

Jonathan Pollock

Keyword(s):

Facial Nerve ◽

Anatomical Variations ◽

Surgical Anatomy ◽

Tumour Resection ◽

Cervical Nerve ◽

Simple Method ◽

Marginal Mandibular Nerve ◽

High Incidence ◽

Mandibular Branch ◽

Made In

Introduction Iatrogenic facial nerve palsy is distressing to the patient and clinician. The deformity is aesthetically displeasing, and can be functionality problematic for oral competence, dental lip trauma and speech. Furthermore such injuries have litigation implications. Marginal mandibular nerve (MMN) palsy causes an obvious asymmetrical smile. MMN is at particular risk during procedures such as rhytidoplasties, mandibular fracture, tumour resection and neck dissections. Cited causes for the high incidence are large anatomical variations, unreliable landmarks, an exposed course and tumour grade or nodal involvement dictating requisite nerve sacrifice. An alternative cause for post-operative asymmetry is damage to the cervical branch of the facial nerve or platysmal dysfunction. This tends to have a transient course and recovers. Distinction between MMN palsy and palsy of the cervical branch of the facial nerve should therefore be made. In 1979 Ellenbogen differentiated between MMN palsy and “Pseudo-paralysis of the mandibular branch of the facial nerve”. Despite this, there is paucity in the literature & confusion amongst clinicians in distinguishing between these palsies, and there is little regarding these post-operative sequelae and neck dissections. Method This article reflects on the surgical anatomy of the MMN and cervical nerve in relation to danger zones during lymphadenectomy. The authors review the anatomy of the smile. Finally, we utilise case studies to evaluate the differences between MMN palsy and its pseudo-palsy to allow clinical differentiation. Conclusion Here we present a simple method for clinical differentiation between these two prognostically different injuries, allowing appropriate reassurance, therapy & management.

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Variable relationship of retro-mandibular vein to the facial nerve, a finding during parotid surgery: a rare case report

International Surgery Journal ◽

10.18203/2349-2902.isj20173909 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3166

Author(s):

V. Jayapala Reddy ◽

T. Hemachandra ◽

S. Nagesh Kumar ◽

P. V. Ramasubba Reddy

Keyword(s):

Facial Nerve ◽

Anatomical Variations ◽

Needle Aspiration ◽

Classical Text ◽

Parotid Region ◽

First Case ◽

Parotid Surgery ◽

Rare Case Report ◽

History Of ◽

Needle Aspiration Cytology

Studies describing the anatomical relation and variability of facial nerve and retro-mandibular vein were mostly on cadavers. Intraoperative encounter of variable anatomy in parotid surgery is rarely reported in literature. The usual location of retro-mandibular vein is medial to facial nerve as described in many classical text books is around 88%. Here we present a case with variable anatomy of retromandibular vein. A 55-year-old Indian gentleman presented with history of painless swelling in left parotid region for 5 months. On clinical examination, a 3×3 cm swelling probably arising from left parotid gland was felt. Preoperative ultrasonography described it as parotid cyst arising from inferior pole. Fine needle aspiration cytology described it as benign parotid cyst. A superficial parotidectomy was planned and executed. During surgery, the retro-mandibular vein was found crossing the two trunks of the facial nerve laterally (superficial to facial nerve) in between the division of facial nerve trunk and origin of ramifications. Usually retro-mandibular vein runs medial (deep) to the facial nerve trunks. Anatomical variations between facial nerve and retro-mandibular vein are underreported and not given due importance during training. With this article, we want to emphasize the importance of having awareness regarding anatomical variations related to facial nerve and retro-mandibular vein and be prepared to encounter during surgery there by preventing complications. We are reporting the first case from India.

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