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Anatomical assessment of the digastric branch of the facial nerve as a landmark to localize the extratemporal facial nerve trunk

  • Ali Tayebi Meybodi
  • Leandro Borba Moreira
  • Michael T. Lawton
  • Mark C. PreulEmail author
Original Article
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Abstract

Purpose

Localization of the facial nerve trunk (FNT) [i.e., the portion of the facial nerve between the stylomastoid foramen (SMF) and pes anserinus] may be required during various surgical interventions such as parotidectomy and hypoglossal-facial anastomosis. Several landmarks have been proposed for efficient identification of the FNT. We sought to assess the anatomical features of the digastric branch of the facial nerve (DBFN) and its potential as a landmark to identify FNT.

Methods

Fifteen sides of eight cadaveric heads were dissected to find the DBFN. Anatomic features of DBFN including its point of origin relative to SMF, length, and important relationships, as well as the distance between the insertion point on the digastric muscle and mastoid tip were recorded.

Results

DBFN was found in all specimens originating from the FNT outside the SMF with an average length (± standard deviation) of 15.4 ± 3.4 mm. In all specimens, the DBFN inserted on the superomedial aspect of the posterior belly of the digastric muscle (PBD). In 8/15 specimens, DBFN was accompanied by the stylomastoid artery on its anteromedial side. Average distance (± standard deviation) between the mastoid tip and the nerve insertion point on PBD was 13.6 ± 2.0 mm (range 10–17).

Conclusions

The DBFN is a reliable landmark for identifying the FNT. It could be consistently identified within 15–20 mm of the mastoid tip on the superomedial aspect of the PBD. The DBFN may be used as a supplementary landmark for efficient localization of the FNT.

Level of evidence

Not applicable (anatomic study).

Keywords

Digastric Muscle Hypoglossal-facial anastomosis Parotidectomy 

Notes

Author contributions

ATM: Project Development, Data Collection, Data Analysis, Manuscript Writing. LBM: Data Collection, Data Analysis, Critically Revising the Article. MTL: Critically Revising the Article. MCP: Project Development, Critically Revising the Article, Study Supervision, Technical and Administrative Support.

Funding

This study was funded by the Barrow Neurological Foundation and the Newsome Chair in Neurosurgery Research held by Dr. Preul. Dr. Tayebi Meybodi is supported by fellowship funds from the Barrow Neurological Foundation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bergman RA, Tubbs RS, Shoja MM, Loukas M (2016) Bergman’s comprehensive encyclopedia of human anatomic variation. Wiley, HobokenGoogle Scholar
  2. 2.
    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.  https://doi.org/10.1016/j.joms.2010.11.044 CrossRefGoogle Scholar
  3. 3.
    Cannon CR, Replogle WH, Schenk MP (2004) Facial nerve in parotidectomy: a topographical analysis. Laryngoscope 114:2034–2037.  https://doi.org/10.1097/01.mlg.0000147943.13052.62 CrossRefGoogle Scholar
  4. 4.
    Coleman CC (1940) Results of facio-hypoglossal anastomosis in the treatment of facial paralysis. Ann Surg 111:958–970CrossRefGoogle Scholar
  5. 5.
    Conley J (1978) Search for and identification of the facial nerve. Laryngoscope 88:172–175CrossRefGoogle Scholar
  6. 6.
    de Ru JA, Bleys RL, van Benthem PP, Hordijk GJ (2001) Preoperative determination of the location of parotid gland tumors by analysis of the position of the facial nerve. J Oral Maxillofac Surg 59:525–528.  https://doi.org/10.1053/joms.2001.22682 (discussion 529–530) CrossRefGoogle Scholar
  7. 7.
    de Ru JA, van Benthem PP, Bleys RL, Lubsen H, Hordijk GJ (2001) Landmarks for parotid gland surgery. J Laryngol Otol 115:122–125Google Scholar
  8. 8.
    Djindjian R, Merland JJ, Théron J (1978) Super-selective arteriography of the external carotid artery. Springer, BerlinCrossRefGoogle Scholar
  9. 9.
    Farahvash MR, Yaghoobi A, Farahvash B, Farahvash Y, Hadadi Abiyaneh S (2013) The extratemporal facial nerve and its branches: analysis of 42 hemifacial dissections in fresh Persian (Iranian) cadavers. Aesthet Surg J 33:201–208.  https://doi.org/10.1177/1090820X12473104 CrossRefGoogle Scholar
  10. 10.
    Gray H, Williams PL (1989) Gray’s anatomy, 37th edn. C. Livingstone, EdinburghGoogle Scholar
  11. 11.
    Greyling LM, Glanvill R, Boon JM, Schabort D, Meiring JH, Pretorius JP, van Schoor A (2007) Bony landmarks as an aid for intraoperative facial nerve identification. Clin Anat 20:739–744.  https://doi.org/10.1002/ca.20508 CrossRefGoogle Scholar
  12. 12.
    Holt JJ (1996) The stylomastoid area: anatomic-histologic study and surgical approach. Laryngoscope 106:396–400CrossRefGoogle Scholar
  13. 13.
    Ji YD, Donoff RB, Peacock ZS, Carlson ER (2018) Surgical landmarks to locating the main trunk of the facial nerve in parotid surgery: a systematic review. J Oral Maxillofac Surg 76:438–443.  https://doi.org/10.1016/j.joms.2017.06.039 CrossRefGoogle Scholar
  14. 14.
    Kanatas AN, McCaul JA (2011) Use of digastric branch of the facial nerve for identification of the facial nerve itself in parotidectomy: technical note. Br J Oral Maxillofac Surg 49:493–494.  https://doi.org/10.1016/j.bjoms.2010.10.019 CrossRefGoogle Scholar
  15. 15.
    Kawakami S, Tsukada S, Taniguchi W (1994) The superficial temporal and retromandibular veins as guides to expose the facial nerve branches. Ann Plast Surg 32:295–299CrossRefGoogle Scholar
  16. 16.
    Keefe MA, Castro JR, Keefe MS (2009) Identification of the facial nerve main trunk by retrograde dissection of the postauricular branch. Otolaryngol Head Neck Surg 140:126–127.  https://doi.org/10.1016/j.otohns.2008.10.014 CrossRefGoogle Scholar
  17. 17.
    Lawson HH (1988) Value of the tympanomastoid fissure in the exposure of the facial nerve. Br J Surg 75:309CrossRefGoogle Scholar
  18. 18.
    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.  https://doi.org/10.1002/hed.25127 Google Scholar
  19. 19.
    May M, Sobol SM, Mester SJ (1991) Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Otolaryngol Head Neck Surg 104:818–825.  https://doi.org/10.1177/019459989110400609 CrossRefGoogle Scholar
  20. 20.
    Moreau S, Bourdon N, Salame E, Goullet de Rugy M, Babin E, Valdazo A, Delmas P (2000) Facial nerve: vascular-related anatomy at the stylomastoid foramen. Ann Otol Rhinol Laryngol 109:849–852.  https://doi.org/10.1177/000348940010900912 CrossRefGoogle Scholar
  21. 21.
    Nishida M, Matsuura H (1993) A landmark for facial nerve identification during parotid surgery. J Oral Maxillofac Surg 51:451–453CrossRefGoogle Scholar
  22. 22.
    Pather N, Osman M (2006) Landmarks of the facial nerve: implications for parotidectomy. Surg Radiol Anat 28:170–175.  https://doi.org/10.1007/s00276-005-0070-z CrossRefGoogle Scholar
  23. 23.
    Pia F, Policarpo M, Dosdegani R, Olina M, Brovelli F, Aluffi P (2003) Centripetal approach to the facial nerve in parotid surgery: personal experience. Acta Otorhinolaryngol Ital 23:111–115Google Scholar
  24. 24.
    Pitty LF, Tator CH (1992) Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors. J Neurosurg 77:724–731.  https://doi.org/10.3171/jns.1992.77.5.0724 CrossRefGoogle Scholar
  25. 25.
    Rea PM, McGarry G, Shaw-Dunn J (2010) The precision of four commonly used surgical landmarks for locating the facial nerve in anterograde parotidectomy in humans. Ann Anat 192:27–32.  https://doi.org/10.1016/j.aanat.2009.09.005 CrossRefGoogle Scholar
  26. 26.
    Reid AP (1989) Surgical approach to the parotid gland. Ear Nose Throat J 68:151–154Google Scholar
  27. 27.
    Robertson MS, Blake P (1984) A method of using the tympanomastoid fissure to find the facial nerve at parotidectomy. Aust N Z J Surg 54:369–373CrossRefGoogle Scholar
  28. 28.
    Saha S, Pal S, Sengupta M, Chowdhury K, Saha VP, Mondal L (2014) Identification of facial nerve during parotidectomy: a combined anatomical & surgical study. Indian J Otolaryngol Head Neck Surg 66:63–68.  https://doi.org/10.1007/s12070-013-0669-z CrossRefGoogle Scholar
  29. 29.
    Salame K, Ouaknine GE, Arensburg B, Rochkind S (2002) Microsurgical anatomy of the facial nerve trunk. Clin Anat 15:93–99.  https://doi.org/10.1002/ca.1102 CrossRefGoogle Scholar
  30. 30.
    Sharma R, Sirohi D (2010) Proximal and distal Facial nerve exploration during superficial parotidectomy. J Maxillofac Oral Surg 9:150–154.  https://doi.org/10.1007/s12663-010-0040-9 CrossRefGoogle Scholar
  31. 31.
    Slattery WH (2014) The facial nerve. Thieme, New YorkCrossRefGoogle Scholar
  32. 32.
    Smith OJ, Ross GL (2012) Variations in the anatomy of the posterior auricular nerve and its potential as a landmark for identification of the facial nerve trunk: a cadaveric study. Anat Sci Int 87:101–105.  https://doi.org/10.1007/s12565-011-0125-7 CrossRefGoogle Scholar
  33. 33.
    Tabb HG, Scalco AN, Fraser SF (1970) Exposure of the facial nerve in parotid surgery. (Use of the tympanomastoid fissure as a guide). Laryngoscope 80:559–567.  https://doi.org/10.1288/00005537-197004000-00004 CrossRefGoogle Scholar
  34. 34.
    Upile T, Jerjes W, Nouraei SA, Singh SU, Kafas P, Sandison A, Sudhoff H, Hopper C (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.  https://doi.org/10.1186/1477-7819-7-71 CrossRefGoogle Scholar
  35. 35.
    Wong DS (2001) Surface landmarks of the facial nerve trunk: a prospective measurement study. ANZ J Surg 71:753–756CrossRefGoogle Scholar
  36. 36.
    Yoshioka N, Rhoton AL (2015) Atlas of the facial nerve and related structures. Thieme, New YorkCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Ali Tayebi Meybodi
    • 1
  • Leandro Borba Moreira
    • 1
  • Michael T. Lawton
    • 1
  • Mark C. Preul
    • 1
    Email author
  1. 1.Department of Neurosurgery, Barrow Neurological InstituteSt. Joseph’s Hospital and Medical CenterPhoenixUSA

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