Consistency of tragal pointer and tympanomastoid suture as surgical landmarks of facial nerve in parotid surgery: An institutional experience

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Darwin Kaushal, R K Verma and Vidhu Sharma

All India Institute of Medical Sciences, India
Postgraduate Institute of Medical Education and Research, India

: J Otol Rhinol

Abstract

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Statement of the Problem: Identification of facial nerve is the major challenge during parotid surgery. Tragal pointer commonly used landmark is prone to displacement due to bulk of the tumour. This study has focussed on the consistency of tympanomastoid suture as a surgical landmark thus avoiding complications. Purpose of the Study: To compare the reliability of tragal pointer and tympanomastoid suture for identification of facial nerve. Methodology: This is a retrospective study on 60 patients, who have been operated for parotid tumours. Distance of the primary facial nerve trunk from tragal pointer and mastoid tip was calculated. Parameters of every patient such as sex, fine needle aspiration, tumour extent, surgery performed, distance of the facial nerve from tragal pointer and tympanomastoid suture line at its lateral end, postoperative facial nerve status, final histopathology and seroma any other complications were documented. Findings: Out of 60 patients, final histopathology was pleomorphic adenoma in 50, mucoepidermoid carcinoma in 5, adenoid cystic carcinoma in 3 and oncocytoma and parotid tuberculosis 1 in each. 6 patients underwent total conservative parotidectomy whereas rest all 54 patients underwent superficial parotidectomy. 3 patients developed temporary facial paresis which improved with conservative management however one patient developed permanent marginal mandibular palsy. 45 patients developed postoperative seroma during second week of surgery which resolved with pressure dressing. The mean distance of the tympanomastoid suture from the facial nerve trunk was 2.92 mm and the tragal pointer was found to be at a mean distance of 18.38 mm. Conclusion & Significance: Parotidectomy is aesthetically concerned. Our study showed tympanomastoid suture to be the consistent landmark to identify facial nerve. Tragal pointer is a difficult guide often because of tumour related facial nerve displacement. Early identification of facial nerve is the key to reduce complications significantly Recent Publications 1. Panda N K, Kaushal D and Verma R (2016) Do we need to modify the parotidectomy incision? Indian J Otolaryngol Head Neck Surg. 68(4):487-489. 2. Verma R K, Kaushal D and Panda N K (2013) External jugular vein aneurysm with thrombus presenting as painful neck mass: a case report. Oman Med J 28(4):278-280. 3. Gupta N, Panda N K, Bakshi J, Verma R K and Kaushal D (2014) Piston diameter in stapes surgery. Does it have a bearing? Indian J Otol. 20(1):33-36. 4. Verma D R K, Kaushal D D, Bal A and Panda P N K (2013) Primary parotid tuberculosis mimicking parotid neoplasm: a rare case report. The Southeast Asian Journal of Case Report and Review 2(6):455-462. 5. Kaushal D, Gupta K, Gupta A K and Kakkar N (2013) Concomitant Oral and laryngeal tuberculosis mimicking carcinoma: a rare case report. 4. Current Research in Microbiology and Biotechnology 1(3):89-

Biography

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Darwin Kaushal has completed his MBBS degree at IGMC Shimla in 2007 and Postgraduation in Otorhinolaryngology at AIIMS, New Delhi. Further to refine his skills, he has completed his Senior Residency at Postgraduate Institute of Medical Research, Chandigarh. He is well experienced in all Head and Neck Surgeries, Paediatric Otorhinolaryngology cases and management of difficult airway cases. He is interested in thyroid, parotid and oropharyngeal oncology, clinical researches, organizing workshops and conferences. He has delivered several lectures and presented papers in various conferences. He is working as an Assistant Professor in the Department of Otorhinolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, Jodhpur (Rajasthan), India.

E-mail: drdarwin.aiims@gmail.com