scholarly journals Do Benign Mass Lesions in the Superficial Lobe of Parotid Gland Influence Landmark-Based Search for Facial Nerve Trunk at Surgery?

2021 ◽  
Author(s):  
Subhadip Sardar ◽  
Mainak Dutta ◽  
Sirshak Dutta ◽  
Saumik Das ◽  
Ramanuj Sinha
Keyword(s):  
Observational Study ◽  
Facial Nerve ◽  
Correlation Coefficients ◽  
Nerve Trunk ◽  
Digastric Muscle ◽  
Superficial Parotidectomy ◽  
Anatomic Landmarks ◽  
Superficial Lobe ◽  
Mass Lesions ◽  
Benign Mass

Objective: To assess the influence of benign mass lesions in the superficial lobe of parotid on the known anatomic landmarks for identifying the facial nerve trunk. Method: Patients with unilateral biopsy-proven benign mass lesions in the superficial parotid were selected for this observational study. During superficial/partial superficial parotidectomy, distance of the facial nerve trunk from each landmark was assessed using spring calliper and correlated with the lesion’s volume (measured from the pre-operative imaging). At least two identifiers among tragal pointer (TP), posterior belly of digastric muscle (PBDM) and tympanomastoid suture (TMS) were considered. Results: The study involved 32 patients. The lesions mostly involved the parotid tail (50%) and pretragal region (34.3%), and constituted of pleomorphic adenoma (~66%) and Warthin’s tumor (~9%), the rest being various cysts and hamartomas. TP was universally uncovered, while PBDM and TMS were exposed in 26 and 25 patients, respectively. Average distances between the facial nerve trunk and TP, PBDM and TMS were 12.79 mm (SD=2.33), 9.78 mm (SD=1.21) and 7.58 mm (SD=1.33), respectively. Correlation coefficients between the lesion’s volume and the distance of facial nerve from a given landmark were -0.11, 0.04 and -0.16 for TP, PBDM and TMS, respectively. Conclusions: TP was the most easily available landmark on surgical dissection, while PBDM was the most consistent and the least variable when volumetric data of the benign mass lesions in the superficial lobe of parotid were considered as a factor influencing the distance from the facial nerve trunk.

IDENTIFICATION OF THE FACIAL NERVE TRUNK DURING SUPERFICIAL PAROTIDECTOMY BY TRIDENT LANDMARK

2019 ◽  
Vol 2 (1) ◽  
pp. 17-26
Author(s):  
Yasser Hatata ◽  
Mohamed Ibrahim ◽  
Reda Fawzy ◽  
Hazem Elgohary
Keyword(s):  
Facial Nerve ◽  
Nerve Trunk ◽  
Superficial Parotidectomy

scholarly journals The Role of the Parotid-Mastoid Fascia in Identification of the Facial Nerve Trunk During Parotidectomy

2019 ◽  
pp. 014556131987799
Author(s):  
Steven B. Micucci ◽  
Siri Sunderi Cheng ◽  
Tara Song ◽  
Barry Rasgon
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Nerve Trunk ◽  
Open Book ◽  
Parotid Glands ◽  
Medial Aspect ◽  
Anatomic Landmarks ◽  
Posterior Aspect ◽  
Inferior Aspect

Objective: We aim to describe the parotid fascia as a landmark that can help identify the immediately underlying facial nerve trunk. Methods: Dissection of the parotid fascia and identification of the facial nerve trunk were carried out on 8 fresh cadaveric parotid glands. The attachments and arrangement of the parotid gland and its fascia were evaluated and histologically assessed, with special attention to the fascia overlying the facial nerve trunk. Results: The parotid fascia envelops the posterior aspect of the parotid gland in an open-book fashion. Posteriorly, it connects to the anterior and medial aspect of the mastoid tip. Posterosuperiorly, it attaches to the inferior aspect of the tragal pointer. Directly medial to the fascia lies the facial nerve trunk. Conclusion: The parotid fascia, particularly the parotid–mastoid segment overlying the facial nerve trunk, can be utilized as an additional landmark of depth to help identify the facial nerve trunk during a parotidectomy in conjunction with other commonly used standard anatomic landmarks. The parotid fascia sling spans from the mastoid and tragal pointer to the parotid gland and can be easily palpated intraoperatively. Once the fascia is removed, the facial nerve trunk is identified.

scholarly journals Recurrent Multinodular Pleomorphic Adenoma of Parotid Gland- A Case Report

2021 ◽  
Author(s):  
Priya Kanagamuthu ◽  
Swetha Thirumurthi ◽  
S Rajasekaran ◽  
S Prabakaran ◽  
RB Namasivaya Navin
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Previous History ◽  
Significant Risk ◽  
Superficial Parotidectomy ◽  
Parotid Region ◽  
Superficial Lobe ◽  
History Of ◽  
The Right

Pleomorphic adenoma or benign salivary gland tumours predominantly affects the superficial lobe of parotid gland. It is a slow growing swelling with or without facial nerve involvement with female predilection in third and fifth decade of life. The origin of the tumour is both epithelial and connective tissue and hence it is of pleomorphic nature. After surgery, its recurrence rate varies considerably and seems to depend more on the surgical technique used. A 49-year-old male patient, presented with complaints of swelling in front of right ear and right parotid region for past eight years. He gave previous history of similar swelling in the right parotid region and history of previous surgery done elsewhere in 2009. Right superficial parotidectomy was done following which he was asymptomatic for two years. On examination of right parotid- a multilobulated irregular swelling was present in right parotid region and the swelling extended till the right ear lobule. The swelling hid previous surgical scar. Facial nerve was clinically intact. Fine Needle Aspiration Cytology (FNAC) was suggestive of Pleomorphic Adenoma. Magnetic Resonance Imaging (MRI) with contrast revealed that the lesions were arising from superficial lobe of the parotid gland. Right superficial parotidectomy was planned. Mass was excised and sent for histopathological examination and was reported to be Pleomorphic Adenoma. Patient is still on follow-up and no recurrence has been noted. The rate of recurrence depends on tumour spillage, intra-surgical rupture, or any histopathological feature. There is significant risk for local recurrence if the microscopic finger like formation (pseudopodia) of tumour tissue extends beyond the main mass.

scholarly journals Comparison of antegrade versus retrograde facial nerve dissection in cases of superficial parotidectomy for pleomorphic adenoma of parotid gland

2018 ◽  
Vol 5 (5) ◽  
pp. 1749
Author(s):  
Mundada Ashishkumar B. ◽  
Pradeep P. S.
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Pleomorphic Adenoma ◽  
Major Salivary Gland ◽  
Superficial Parotidectomy ◽  
Time Duration ◽  
Facial Nerve Injury ◽  
Common Benign Tumor ◽  
Superficial Lobe

Background: Pleomorphic adenoma being the most common benign tumor of the major salivary gland, parotid in particular, attracts attention. Facial nerve anatomically separates the superficial lobe from deeper lobe. Superficial Parotidectomy, commonly practiced surgical technique carries high risk of nerve injury causing long term functional and esthetic deficits. This prospective study was to designed to compare required time of  surgery and facial nerve injury in antegrade versus retrograde dissection.Methods: Total of 32 patients who underwent superficial parotidectomy between June 2010 to June 2013 included in this study in which 18 patients were in retrograde dissection group and 14 subjects were in antegrade facial nerve dissection group. Time from the incision till closure is noted along with post operative facial nerve palsy for statistical analysis.Results: This study shows that retrograde facial nerve dissection in superficial parotidectomy requires statistically significant lesser time duration with no difference in facial nerve injury when compared to antegrade nerve dissection.Conclusions: This study approves retrograde facial nerve dissection over antegrade nerve dissection in cases of superficial parotidectomy for betterment of the patient.

scholarly journals POSTERIOR AURICULAR NERVE – A NOVEL LANDMARK FOR IDENTIFICATION OF THE FACIAL NERVE IN SUPERFICIAL PAROTIDECTOMY

2021 ◽  
Vol Volume 9 (upjohns/volume9/Issue2) ◽  
pp. 10-14
Author(s):  
Arulalan Mathialagan
Keyword(s):  
Facial Nerve ◽  
Pleomorphic Adenoma ◽  
Nerve Trunk ◽  
Target Area ◽  
Superficial Parotidectomy ◽  
Tertiary Referral Center ◽  
Individual Variations ◽  
Parotid Surgery ◽  
Auricular Branch ◽  
Nerve Identification

ABSTRACT Background-Facial nerve identification and preservation is the most critical step in parotid surgery. Though there are described landmarks to locate the facial nerve trunk, they have individual variations. The posterior auricular nerve (PAN) is a branch of the facial nerve and is always present, it can be followed to reach the facial nerve trunk. MATERIALS AND METHODS A retrospective cohort study in which analysis of parotidectomy performed from January 2017 to November 2018 at our tertiary referral center was done. RESULTS A total of 23 parotidectomies were performed, of which 18 cases were pleomorphic adenoma. In four cases of pleomorphic adenoma we could clearly identify and preserve the PAN. Using PAN as the landmark the facial nerve trunk was located, all its peripheral branches were dissected and preserved. PAN identification narrows down the target area of dissection to identify the facial nerve trunk. CONCLUSION The posterior auricular branch of the facial nerve can be used as a standard landmark in parotid surgeries, that almost always leads to the facial nerve trunk. CLINICAL SIGNIFICANCE Though identification of PAN may be difficult in all cases, effort must be made to identify it under magnification. If done meticulously PAN can be an ideal landmark to identify facial nerve in parotid surgery. KEYWORDS Parotid surgery, Superficial Parotidectomy, Posterior auricular nerve, Facial nerve.

Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

2021 ◽  
Author(s):  
Aldo Eguiluz-Melendez ◽  
Sergio Torres-Bayona ◽  
María Belen Vega ◽  
Vanessa Hernández-Hernández ◽  
Erik W. Wang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Parapharyngeal Space ◽  
Jugular Bulb ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
The Novel ◽  
Main Trunk ◽  
Transcervical Approach ◽  
Semiquantitative Evaluation ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to describe the anatomical nuances, feasibility, limitations, and surgical exposure of the parapharyngeal space (PPS) through a novel minimally invasive keyhole endoscopic-assisted transcervical approach (MIKET). Design Descriptive cadaveric study. Setting Microscopic and endoscopic high-quality images were taken comparing the MIKET approach with a conventional combined transmastoid infralabyrinthine transcervical approach. Participants Five colored latex-injected specimens (10 sides). Main Outcome Measures Qualitative anatomical descriptions in four surgical stages; quantitative and semiquantitative evaluation of relevant landmarks. Results A 5 cm long inverted hockey stick incision was designed to access a corridor posterior to the parotid gland after independent mobilization of nuchal and cervical muscles to expose the retrostyloid PPS. The digastric branch of the facial nerve, which runs 16.5 mm over the anteromedial part of the posterior belly of the digastric muscle before piercing the parotid fascia, was used as a landmark to identify the main trunk of the facial nerve. MIKET corridor was superior to the crossing of the accessory nerve over the internal jugular vein within 17.3 mm from the jugular process. Further exposure of the occipital condyle, vertebral artery, and the jugular bulb was achieved. Conclusion The novel MIKET approach provides in the cadaver straightforward access to the upper and middle retrostyloid PPS through a natural corridor without injuring important neurovascular structures. Our work sets the anatomical nuances and limitations that should guide future clinical studies to prove its efficacy and safety either as a stand-alone procedure or as an adjunct to other approaches, such as the endonasal endoscopic approach.

Deep Lobe Parotid Tumors: A Systematic Review and Meta-analysis

2021 ◽  
pp. 019459982110092
Author(s):  
Margaret H. Aasen ◽  
Michael J. Hutz ◽  
Brian T. Yuhan ◽  
Christopher J. Britt
Keyword(s):  
Facial Nerve ◽  
Imaging Modality ◽  
Meta Analysis ◽  
Needle Aspiration ◽  
Computed Tomography Scan ◽  
Fine Needle ◽  
Deep Lobe ◽  
Parotid Tumors ◽  
Superficial Lobe ◽  
Tomography Scan

Objective We performed a systematic review and meta-analysis of deep lobe parotid tumors to evaluate their unique characteristics. Data Sources PubMed/Medline, Embase, Web of Sciences, and Cochrane Library databases were queried for relevant literature. Review Methods Studies were individually assessed by 2 independent reviewers. Risk of bias was assessed with the Cochrane bias tool, GRADE criteria, and MINORS criteria. Results were reported according to the PRISMA guidelines. Statistical analysis was performed by comparing rates of malignancy between deep and superficial lobe tumors. Results In total, 8 studies including 379 deep lobe parotid tumors met inclusion criteria. Mean age at diagnosis was 44.9 years. Computed tomography scan was the most common imaging modality. Preoperative diagnostic fine-needle aspiration was utilized in 39.4% of patients and demonstrated high sensitivity for malignant disease. The most common approach was subtotal parotidectomy with facial nerve preservation (58.9%). The rate of malignancy was 26.6%, which was significantly higher than that of the superficial lobe tumors in this study (risk ratio, 1.25; 95% CI, 1.01-1.56). The rate of temporary postoperative facial nerve weakness between deep and superficial lobe tumors was 32.5% and 11.7%, respectively. Conclusion Deep lobe parotid tumors had a 26.6% rate of malignancy. On meta-analysis, deep lobe tumors appeared to have higher rates of malignancy than superficial lobe tumors. Surgical excision of deep lobe tumors showed increased rates of temporary facial nerve paresis as compared with superficial lobe tumors. Computed tomography scan was the most common imaging modality. There were limited data regarding the utility of fine-needle aspiration.

Surgical Anatomy of the Parotid Gland

2021 ◽  
pp. 13-23
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
External Auditory Meatus ◽  
Styloid Process ◽  
Terminal Segment ◽  
External Carotid Artery ◽  
Surgical Anatomy ◽  
Mastoid Process ◽  
External Carotid ◽  
Superficial Lobe

The parotid gland consists of two lobes: superficial and deep with regard to its relation with the facial nerve. It is wrapped around the mandibular ramus and secretes saliva through the parotid (Stensen's) duct. It is a paired organ, weighing 15-30g each. Its superficial lobe overlies the lateral surface of the masseter muscle and is bounded superiorly by the zygomatic arch, while its deep lobe is located in the pre-styloid compartment of the parapharyngeal space between the mastoid process posteriorly, ramus of mandible anteriorly, and external auditory meatus superiorly. Medially, the gland reaches to the styloid process. Inferiorly, the parotid tail extends down to the anteromedial margin of sternocleido-mastoid muscle. Several structures run through the parotid gland, namely, terminal segment of external carotid artery, retro-mandibular vein, parotid lymph nodes, and facial nerve, which soon gives two divisions (temporo-facial and cervico-facial) that give off five branches inside the gland radiating forwards. This chapter explores the surgical anatomy of the parotid gland.

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