Facial nerve exploration

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Endoscopyassisted parotidectomy for benign parotid tumors. Facial nerve, Parotidectomy, Proximal, Distal. Overall 17 superficial parotidectomies were performed. Brodie and Thompson have reviewed 58 facial nerve injuries and reported that all patients with incomplete paralysis in the beginning recovered and 8 of 9 patients with delayed and 3 of 5 patients with sudden onset facial paralysis recovered after surgical decompression. The posterior belly of the digastric is traced upwards and backwards to its insertion onto the mastoid which lies immediately below the stylomastoid thus leading the operator to the facial nerve from below Fig. Nyberg and Fisch, and later on Graham and Kemink, described transmastoid and middle fossa combined total facial nerve exploration in patients with recurrent facial paralysis [ 16 ].

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J Maxillofac Oral Surg.

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Proximal and distal Facial nerve exploration during superficial parotidectomy

Facial nerve monitoring along with distal nerve exposure is well supported in literature [ 16 ]. 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. Indication and timing of the facial nerve decompression for facial paralysis and the anatomical extent of decompression has been a subject of controversy for years. Extensive fibrosis around facial nerve was evident in patients with transverse fracture. If the superficial parotidectomy is being performed for chronic infection, the duct is tied off as far ahead to prevent recurrent ascending infection from the oral cavity Fig. They have reported that of the 65 surgically treated patients 52 had immediate paralysis and at 2 years after surgery, Superficial parotidectomies were also performed for one case each of lymphoepithelial cysts and intraparotid facial nerve neurofibroma.

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