The beauty of parotid is the precise identification of facial nerve and preserving it with all of its branches, the nerve is usually identified at Stylomastoid Foramen(SF) where it leaves the temporal bone. A firm grip over the anatomical landmarks of this area is required for correct identification of nerve without any iatrogenic injury. At SF main trunk was identified which is then followed to dissect all of its main branches. The use of intra operative nerve monitoring is recently popularized in developed countries but we have demonstrated a comparable postoperative facial nerve preservation even without the use of nerve monitor. We have used the orthodox method of nerve identification by suing posterior belly of digastric and tympanomastoid suture as landmarks in all of our cases, additionally we have been using the Morrisons Mastoid Self retaining retractor between the parotid gland parenchyma and tragal cartilage to improve retraction and visualization, this helps us a lot especially when using magnification. We also recommend to use surgical blade no.12 to divide the parotid gland over branches of the facial nerve this aids is minimizing traction trauma to nerve. We have a series of 25 patients which were operated with this technique in last 3 years both total and superficial parotidectomy was done for different pathologies including benign and malignant and none have complete paralysis only 2 out of 25 patients developed paralysis of Marginal branch which recovered in few weeks with physiotherapy. One patient developed complete temporary paralysis and recovered in 6 weeks with physiotherapy. Only one patient with squamous cell carcinoma T4 developed recurrence. Hence we propose that even without the use of facial nerve monitor, nerve preservation can be achieved however this will only be applicable in primary parotid surgeries and revision surgeries might require nerve monitoring.
Basis technique of nerve identification
The most persistent surgical landmark
Novel technique for dissection of nerve branches
Post operative nerve functions