Kaushal Darwin, Gugliani Abhishek, Sharma Vidhu, Goyal Amit, Choudhury Bikram, Soni Kapil
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
Iran J Otorhinolaryngol. 2021 Mar;33(115):93-96. doi: 10.22038/ijorl.2020.43760.2446.
The facial nerve is an important structure related to parotid gland surgery. Its identification at the time of surgery is critical. Multiple anatomical landmarks have been described to aid in its identification. The objective of this study is to assess whether the tympanomastoid suture is a better surgical landmark than the tragal pointer for identifying the facial nerve while performing parotidectomy.
Sixty patients presenting over a period of 3 years from 2016 to 2018 with a parotid swelling without pre-operative facial weakness were included in the study. The average distances between the facial nerve (FN) and the tragal pointer (TP), and the facial nerve (FN) and tympanomastoid suture (TMS) were calculated intra-operatively and compared.
Out of the 60 patients operated, 54 underwent superficial parotidectomy and 6 underwent total conservative parotidectomy. The mean distance between the FN (main trunk) and TP was found to be 18.38 ± 6.85 mm and that between FN and TMS was found to be 2.92 ± 0.6 mm (P<0.0001).
Tympanomastoid suture is a fairly constant and consistent bony landmark to locate the facial nerve during parotid surgeries as compared to the more commonly used cartilaginous tragal pointer. The results of this study can guide surgeons during parotidectomy, to correctly and promptly identify the facial nerve thereby reducing the risk of injury.
面神经是与腮腺手术相关的重要结构。手术中对其进行识别至关重要。已描述了多个解剖标志以辅助其识别。本研究的目的是评估在进行腮腺切除术时，鼓乳缝作为识别面神经的手术标志是否比外耳道软骨指针更好。
纳入2016年至2018年3年间出现腮腺肿大且术前无面部无力症状的60例患者。术中计算面神经（FN）与外耳道软骨指针（TP）之间以及面神经（FN）与鼓乳缝（TMS）之间的平均距离并进行比较。
在接受手术的60例患者中，54例行浅叶腮腺切除术，6例行全腮腺保留切除术。发现FN（主干）与TP之间的平均距离为18.38±6.85mm，FN与TMS之间的平均距离为2.92±0.6mm（P<0.0001）。
与更常用的软骨性外耳道软骨指针相比，鼓乳缝是腮腺手术中定位面神经相当恒定且一致的骨性标志。本研究结果可在腮腺切除术期间指导外科医生正确、迅速地识别面神经，从而降低损伤风险。
