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

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.

Prospective study to evaluate the value of Identification of nerves crossing inguinal canal during inguinal mesh hernioplasty

Background Long-term morbidity associated with open inguinal hernia repair mainly consists of postoperative chronic pain. The mechanism responsible for the development of this postoperative pain is thought to be the entrapment, inflammation, and fibrotic reactions of the nerve around the mesh. Aim of the Work To analyse and provide comprehensive data on their incidence (identification rates), anatomical characteristics, and possible sources of heterogenecity, to decrease the risk of iatrogenic injury/ entrapment to these nerves during inguinal hernioplasty. Patients and Methods This study identified 40 patients who underwent inguinal hernia repairs with either routine repair or nerve identification and preservation. As several studies point out, a nerve-recognizing procedure is a logical step for minimizing postoperative groin pain. Such an approach can be advocated for two reasons: identification of the nerves for preservation or for performing standard neurectomy in case of interference with the position of the mesh. Results In the present study, there was no difference in pain scorings at one or 3-months after repair between different surgical techniques in patients undergoing open repair of a primary inguinal hernia. In present work, in addition to identifying and preserving all neural structures, specific maneuvers have been adopted for preventing postherniorrhaphy inguinodynia Conclusion The results indicated that routine nerve identification and preservation was associated with a significantly lower incidence of postoperative neuralgia compared with no nerve identification.