Retrograde approach to the facial nerve in parotid surgery

ABSTRACT

The temporal branch of the facial nerve was examined in eight cadaver dissections. Number of rami crossing the zygomatic arch and their location with respect to bone and soft-tissue landmarks were estimated. The temporal branch travelled in a constant plane along the under surface of the temporoparietal fascia and was superficial as it crossed the zygomatic arch. Based on these relationships, a safe method of dissection within the temporal region was formulated. In five cases with retromandibular parotid neoplasms, the seventh cranial nerve was located through retrograde exploration of its temporal branch. The decision to resort to the identification of the temporal branch is supported by its adequate calibre in its peripheral area, short course, and multiple rami crossing the zygomatic arch, which enable it to be easily located. Retrograde or centripetal approach to facial nerve has been found to be anatomically sound, simple to use and safe. It must be indicated when anterograde exploration is difficult