Proximal and distal Facial nerve exploration during superficial parotidectomy

One of the most technique sensitive surgeries in the maxillofacial region is the parotid gland surgery owing to the close relation between the gland and the extra-cranial course of facial nerve. Facial nerve is generally located by means of a proximal surgical identification technique aimed at identifying the facial nerve at its point of exit from the stylomastoid foramen to its entry into the posteromedial surface of parotid gland. There are reports in the literature on distal nerve identification techniques, either as a choice or in cases where proximal nerve identification is difficult. The present report deals with personal clinical experience, describing both the techniques for detection of the facial nerve in 17 cases reported. The technique mainly chosen was conventional proximal nerve identification technique in 16 cases. Distal exploration of the buccal branch was undertaken only in one case, on account of difficulty in locating the main trunk intraoperatively, due to the presence of a post inflammatory fibrosis. The decision to resort to the identification of the buccal nerve is supported by the regular course and adequate size of this branch of facial nerve in its peripheral area co-located with stenson’s duct, which enable it to be easily identified during surgery.