Intra-parotid Course and Variations in the Branching Pattern of Facial Nerve: Our Experience

Facial nerve is responsible for the facial expressions and its preservation during parotidectomy is an important aspect for the operating surgeon. The nerve has a long course and the terminal part traverses through the parotid gland. The branching pattern of the nerve within the gland is highly complex and variable, making parotidectomy a challenging surgery. A cross-sectional record based study was conducted in a tertiary care hospital of a medical college in north India between November 2020 and December 2021 with an aim to describe the branching pattern of the facial nerve within the parotid gland. Patients of all age groups and both genders who underwent superficial parotidectomy for benign parotid gland tumors were taken into consideration. The branching pattern of the nerve was observed and recorded. Twenty patients were included in the study. In seventy percent cases the nerve divided into two main branches whereas in the rest, three branches emerged. In sixty five percent cases, the upper division (temporofacial) further divided into two branches whereas in rest it divided into three. The lower division (cervicofacial) divided into two subdivisions in majority of the cases. Multiple communications were found in the branches given off from the upper division and buccal branch had the most variable origin. A knowledge of branching pattern and the communications between the branches of facial nerve helps in avoiding an iatrogenic injury during parotidectomy and preserving the nerve function.