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Penetration of the facial nerve by the posterior auricular artery: case report, comprehensive review and clinical–surgical applications

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Abstract

Anatomical variations between the facial nerve and adjacent arteries are rare. However, knowledge of such anatomical variations is important to the surgeon who operates on or near the facial nerve. Herein, we report an unusual finding between the extracranial part of the facial nerve and a nearby artery. During routine dissection of the right facial nerve trunk, the posterior auricular artery was found to pierce the nerve effectively forming a nerve loop. The nerve was pierced by the artery soon after its exit from the stylomastoid foramen. This case is detailed and a review on this topic presented, specifically identifying previously reported studies describing this or similar variations, and the relationship between the posterior auricular artery and facial nerve trunk in general. Piercing of the facial nerve trunk by the posterior auricular artery appears to be rare. However, such a relationship should be known by the clinician who treats patients with pathologies of the facial nerve trunk. To our knowledge, this is the first report of this variation in an adult. Due to such rarity, this case is of archival value for those who might describe it or similar cases in the future.

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Data availability

Please contact authors for data requests (Juan Jose Osorio Cardona MD—email address: jcardona2@tulane.edu).

References

  • Babiker HE, Eltohami Y, Sulaiman A (2021) The pattern of facial nerve branching: a cadaveric and clinical study. FACE 2:468–474

    Article  Google Scholar 

  • Bhatjiwale M, Bhatjiwale M (2020) Migrainous facial palsy (MFP): the introduction of a new concept of neurovascular conflict and its preliminary clinical evidence. Neurol Sci 41:2547–2552

    Article  PubMed  Google Scholar 

  • Blau I, Vaisbuch Y, Marom A (2019) A new method for tracing the facial nerve trunk using the posterior auricular nerve. Clin Anat 32:453–457

    PubMed  Google Scholar 

  • Borle RM, Jadhav A, Bhola N, Hingnikar P, Gaikwad P (2019) Borle’s triangle: a reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy. J Oral Biol Craniofac Res 9:33–36

    Article  PubMed  Google Scholar 

  • Bushey A, Quereshy F, Boice JG, Landers MA, Baur DA (2011) Utilization of the tympanomastoid fissure for intraoperative identification of the facial nerve: a cadaver study. J Oral Maxillofac Surg 69:2473–2476

    Article  PubMed  Google Scholar 

  • Carwardine T (1907) Excision of the parotid gland with preservation of the facial nerve; its possibility. The Lancet 170:892

    Article  Google Scholar 

  • Cvetko E (2013) A case of unilateral fenestration of the external jugular vein, through which the cervical branch of the facial nerve passes. Anat Sci Int 88:151–152

    Article  PubMed  Google Scholar 

  • Davis RA, Anson BJ, Budinger JM, Kurth LR (1956) Surgical anatomy of the facial nerve and parotid gland based upon a study of 350 cervicofacial halves. Surg Ginecol Obstet 102:385–412

    CAS  Google Scholar 

  • Elvan Ö, Bobuş A, Erdoğan S, Aktekin M, Olgunus ZK (2019) Fetal anatomy of the facial nerve trunk and its relationship with posterior auricular artery. Surg Radiol Anat 41:153–159

    Article  PubMed  Google Scholar 

  • Furnas DW (1965) Landmarks for the trunk and the temporofacial division of the facial nerve. Br J Surg 52:694–696

    Article  CAS  PubMed  Google Scholar 

  • Ivashchuk G, Andrea A, Saker E, Loukas M, Tubbs RS (2016) Penetration of cranial nerves by intracranial arteries and veins: a comprehensive review. Anatomy 10:143–147

    Article  Google Scholar 

  • Iwanaga J, Singh V, Ohtsuka A et al (2021) Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat 34:2–4

    Article  PubMed  Google Scholar 

  • Iwanaga J, Singh V, Takeda S et al (2022) Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: recommendations from anatomical journal editors-in-chief. Clin Anat 35:526–528

    Article  PubMed  Google Scholar 

  • Katz AD, Catalano P (1987) The clinical significance of the various anastomotic branches of the facial nerve. Report of 100 patients. Arch Otolaryngol Head Neck Surg 113:959–962

    Article  CAS  PubMed  Google Scholar 

  • Kopuz C, Turgut S, Yavuz S, Ilgi S (1994) Distribution of facial nerve in parotid gland: analysis of 50 cases. Okajimas Folia Anat Jpn 70:295–299

    Article  CAS  PubMed  Google Scholar 

  • Liu R, Fagan P (2001) Unusual course of the anterior inferior cerebellar artery through the facial nerve in the cerebellopontine angle. Otolaryngol Head Neck Surg 124:479

    Article  CAS  PubMed  Google Scholar 

  • Liu M, Wang SJ, Benet A, Meybodi AT, Tabani H, Ei-Sayed IH (2018) Posterior auricular artery as a novel anatomic landmark for identification of the facial nerve: a cadaveric study. Head Neck 40:1461–1465

    Article  PubMed  Google Scholar 

  • Liu M, Tong L, Xu M et al (2022) Posterior auricular artery as a novel anatomic landmark for identification of the facial nerve: a clinical study. Laryngoscope Investig Otolaryngol 7:1441–1447

    Article  PubMed  PubMed Central  Google Scholar 

  • Meybodi AT, Moreira LB, Lawton MT, Preul MC (2019) Anatomical assessment of the digastric branch of the facial nerve as a landmark to localize the extratemporal facial nerve trunk. Surg Radiol Anat 41:657–662

    Article  Google Scholar 

  • Micucci SB, Cheng SS, Song T, Rasgon B (2021) The role of the parotid-mastoid fascia in identification of the facial nerve trunk during parotidectomy. Ear Nose Throat J 100:504–508

    Article  PubMed  Google Scholar 

  • Moreau S, Bourdon N, Salame E et al (2000) Facial nerve: vascular-related anatomy at the stylomastoid foramen. Ann Otol Rhinol Laryngol 109:849–852

    Article  CAS  PubMed  Google Scholar 

  • O’Brien JX, Rozen WM, Ting JW, Leung M (2012) A simplified landmark for the facial nerve trunk in parotidectomy: the sternocleidomastoid origin. J Plast Reconstr Aesthet Surg 65:832–833

    Article  PubMed  Google Scholar 

  • Oh CH, Shim YS, Park H, Kim EY (2015) A case of hemifacial spasm caused by an artery passing through the facial nerve. J Korean Neurosurg Soc 57:221–224

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71

    Article  PubMed  PubMed Central  Google Scholar 

  • Poutoglidis A, Paraskevas GK, Lazaridis N et al (2022) Extratemporal facial nerve branching patterns: systematic review of 1497 cases. J Laryngol Otol 136:1170–1176

    Article  CAS  PubMed  Google Scholar 

  • Reddy GGSS, Verma RK, Devarapalli NSP, Sahni D, Bakshi J, Panda NK (2021) Feasibility of using posterior auricular artery as landmark for identification of facial nerve trunk in parotid surgery: a cadaver study. J Craniofac Surg 32:1832–1835

    PubMed  Google Scholar 

  • Stankevicius D, Suchomlinov A (2019) Variations in facial nerve branches and anatomical landmarks for its trunk identification: a pilot cadaveric study in the lithuanian population. Cureus 11:e6100

    PubMed  PubMed Central  Google Scholar 

  • Upile T, Jerjes W, Nouraei SA et al (2009) The stylomastoid artery as an anatomical landmark to the facial nerve during parotid surgery: a clinico-anatomic study. World J Surg Oncol 7:71

    Article  PubMed  PubMed Central  Google Scholar 

  • Verma R, Reddy GGSS, Prakash DNS, Sahni D (2022) Simple technique using an additional landmark to reliably identify the trunk of facial nerve during parotidectomy: a cadaveric and clinical correlation study. Indian J Surg Oncol 13:647–651

    Article  PubMed  Google Scholar 

  • Walker NR, Mistry RK, Mazzoni T (2022) Facial nerve palsy. StatPearls, Treasure Island

    Google Scholar 

Download references

Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude (Iwanaga et al. 2021).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, 70112, USA

    Juan J. Cardona, Joe Iwanaga & R. Shane Tubbs

  2. Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Arada Chaiyamoon

  3. Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain

    Ana Carrera & Francisco Reina

  4. Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Joe Iwanaga

  5. Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  6. Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  7. Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  8. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    R. Shane Tubbs

  9. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  10. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA

    R. Shane Tubbs

  11. University of Queensland, Brisbane, QLD, Australia

    R. Shane Tubbs

Authors
  1. Juan J. Cardona
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  2. Arada Chaiyamoon
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  3. Ana Carrera
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  4. Francisco Reina
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  5. Joe Iwanaga
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  6. R. Shane Tubbs
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Contributions

Conceptualization: RST, JI. Data acquisition: AC, AC, FR. Data analysis or interpretation: JJC, FR. Drafting of the manuscript: JJC. Critical revision of the manuscript: FR, JI, RST. Approval of the final version of the manuscript: all authors.

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Correspondence to Juan J. Cardona.

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Cardona, J.J., Chaiyamoon, A., Carrera, A. et al. Penetration of the facial nerve by the posterior auricular artery: case report, comprehensive review and clinical–surgical applications. Anat Sci Int 98, 604–610 (2023). https://doi.org/10.1007/s12565-023-00708-8

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  • DOI: https://doi.org/10.1007/s12565-023-00708-8

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