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Surgical Anatomy of the Neck
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
The facial nerve's main function is motor innervation to the muscles of facial expression. It also provides motor supply to the posterior belly of digastric and the stylohyoid. The trunk of the nerve exits the temporal bone via the stylomastoid foramen. It traverses the parotid gland, dividing into five main branches. Known as the ‘pes anserinus’, these branches are the temporal, zygomatic, buccal, marginal mandibular and cervical.
Medical Negligence in Otorhinolaryngology
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Where a tumour is located hard up against the skull base at the stylomastoid foramen it is substandard to try and locate the main trunk of the facial, as the tumour will for sure have moved the nerve to an abnormal anatomical position. The nerve should always be located in an area of normal anatomy. If the tumour is known to be benign then it best to identify a peripheral branch such as the marginal mandibular branch of the facial nerve and trace it back towards the main trunk and the tumour. This will usually effect a successful excision without a nerve palsy. Where the tumour is malignant then it is best to open the mastoid and identify the descending facial nerve and follow it towards the tumour. This has the advantage that in a low-grade malignancy the nerve can usually be kept intact but if that is not possible grafting is permitted.
Neurology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Motor loss alone (i.e. weakness of the facial muscles alone):1 Lesion is after the nerve exits from the stylomastoid foramen.
Facial nerve paralysis in malignant otitis externa: comparison of the clinical and paraclinical findings
Published in Acta Oto-Laryngologica, 2020
Sasan Dabiri, Narges Karrabi, Nasrin Yazdani, Ahmad Rahimian, Azita Kheiltash, Mehrdad Hasibi, Elham Saedi
The facial nerve involvement is usually assigned to the inflammation at the stylomastoid foramen, which leads to sooner involvement than other cranial nerves. The inflammatory process interferes with the conduction power of the facial nerve [6] and in severe cases, nerve integrity may be affected [7]. However, the stylomastoid area involvement on imaging has been seen in all patients in the current study and it could not be useful for prediction of the facial nerve risk of dysfunction. On the other hand, as mentioned earlier, the facial nerve canal erosion is of utmost importance to determine the risk. This point might be critical for surgical decisions as the decompression of the facial nerve might be useful in patients with facial palsy. Further research could evaluate this hypothesis.
Intraparotid facial nerve schwannoma: a 17-year, single-institution experience of diagnosis and management
Published in Acta Oto-Laryngologica, 2019
Shijun Li, Xuguang Lu, Shang Xie, Zimeng Li, Xiaofeng Shan, Zhigang Cai
Based on available literature, the incidence of preoperative facial nerve paralysis ranges 10.5–20% [4,12], in our study, this incidence was 7.1% (3/42). Preoperative facial nerve paralysis happened in reportedly 61.4% of patients with intratemporal facial nerve schwannoma [3]. The marked difference in these incidence rates indicates the importance of surrounding tissue structure. Zhang et al. [4] believed the intratemporal involvement of IFNS was the major cause of facial paralysis; however, in our study, only 1 of 3 patients who experienced facial paralysis showed involvement into the stylomastoid foramen. Since IFNSs are benign tumors, we believed that the pressure exerted on the axons by such tumors, and the lack of internal blood supply of such tumors, was the primary reasons for fiber degeneration; tumor involvement of the fallopian canal could possibly be a high-risk factor.
Percutaneous Threshold of Facial Nerve Stimulation Predicts Facial Canal Dehiscence
Published in The Neurodiagnostic Journal, 2019
Patricia Johnson, Taha Mur, Richard Vogel, Pamela C. Roehm
Preoperative FN stimulation was accomplished using a monopolar stimulating probe (Neurosign Surgical, Carmarthenshire, United Kingdom). Stimulation was performed prior to sterile skin prep and draping of the patient. The stylomastoid foramen was localized by palpation of the inferior tip of the mastoid and styloid process and initial placement of the probe tip between these sites. Subsequently, the stylomastoid foramen was identified by moving the tip to the site within a 1 cm area of these landmarks with the lowest initial stimulation thresholds. Electrical stimulation of the FN consisted of a 200 µsec square-wave, constant-current, cathodal pulse delivered with a frequency of 3.1 Hz. The stimulus return (anode) electrode was placed in the deltoid muscle contralateral to the operated ear. The tip of the stimulating probe was positioned at the approximate location of the stylomastoid foramen. With the tip in place, the stimulus intensity was gradually increased from 0 to 40 mA in 0.10 mA steps.