Anatomical and Surgical Landmarks for Facial Nerve Identification During Parotidectomy: A Critical Narrative Review of Reliability, Clinical Utility, and Operative Decision-Making
7 affiliations
- 1Department of Clinical Anatomy, Mazovian University in Płock, 09-402 Płock, Poland
- 2“VARIA” Research Laboratory, Mazovian University in Płock, 09-402 Płock, Poland
- 3“VARIANTIS” Research Laboratory, Mazovian University in Płock, 09-402 Płock, Poland
- 4Department of Forensic Medicine, Pathology and Histology, Mazovian University in Płock, 09-402 Płock, Poland
- 5Faculty of Medicine, Collegium Medicum, Mazovian University in Płock, 09-402 Płock, Poland
- 6Faculty of Health Sciences, Collegium Medicum, Mazovian University in Płock, 09-402 Płock, Poland
- 7Facultad de Medicina, Universidad de Valparaíso, Campus San Felipe, San Felipe 2170000, Chile
Abstract
Background: Facial nerve identification during parotidectomy requires interpretation of complementary landmarks. This critical narrative review distinguishes anatomical proximity from operative accessibility and evidence of improved facial nerve preservation. Methods: PubMed/MEDLINE, Scopus and Web of Science were searched through 7 October 2026, with a further search during revision and records reconciled on 2 November 2026. Two authors screened the literature and evaluated study methods and clinical applicability. Screening of 7157 deduplicated November records added no studies. The final bibliography contains 80 distinct publications; 22 principal morphometric reports are tabulated with cadaveric and intraoperative measurements separated. Results: Reported landmark distances depend on reference points, neural endpoints and study setting. Mean tympanomastoid suture–trunk distances differed from 2.5 mm in one cadaveric series to 10.0 mm in another. In 32 operations for benign superficial-lobe masses, the tragal pointer, posterior belly of digastric and suture were exposed in 32, 26 and 25 cases, respectively. Comparative evidence on dissection direction predominantly concerns benign disease, limiting extrapolation to revision, malignant and irradiated fields. Conclusions: Complementary landmarks support anatomical orientation, but proximity and concordance do not establish a safe dissection plane or improved postoperative function. The proposed operative framework integrates landmark reassessment, alternative identification routes and adjunctive stimulation; it remains unvalidated and requires prospective evaluation against operative and functional outcomes.
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BibTeX
@article{szczerba2026anatomical,
title = {{Anatomical and Surgical Landmarks for Facial Nerve Identification During Parotidectomy: A Critical Narrative Review of Reliability, Clinical Utility, and Operative Decision-Making}},
author = {Nina Szczerba and Łukasz Olewnik and Piotr Łabętowicz and Jolanta Łuniewska-Bury and Magdalena Ciechanowska and Daniel Casanova-Martínez and Marta Pośnik and Ingrid C. Landfald},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218718},
url = {https://www.mdpi.com/2077-0383/15/21/8718},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Anatomical and Surgical Landmarks for Facial Nerve Identification During Parotidectomy: A Critical Narrative Review of Reliability, Clinical Utility, and Operative Decision-Making
AU - Nina Szczerba
AU - Łukasz Olewnik
AU - Piotr Łabętowicz
AU - Jolanta Łuniewska-Bury
AU - Magdalena Ciechanowska
AU - Daniel Casanova-Martínez
AU - Marta Pośnik
AU - Ingrid C. Landfald
PY - 2026
DA - 2026/11/08
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218718
UR - https://www.mdpi.com/2077-0383/15/21/8718
AB - Background: Facial nerve identification during parotidectomy requires interpretation of complementary landmarks. This critical narrative review distinguishes anatomical proximity from operative accessibility and evidence of improved facial nerve preservation. Methods: PubMed/MEDLINE, Scopus and Web of Science were searched through 7 October 2026, with a further search during revision and records reconciled on 2 November 2026. Two authors screened the literature and evaluated study methods and clinical applicability. Screening of 7157 deduplicated November records added no studies. The final bibliography contains 80 distinct publications; 22 principal morphometric reports are tabulated with cadaveric and intraoperative measurements separated. Results: Reported landmark distances depend on reference points, neural endpoints and study setting. Mean tympanomastoid suture–trunk distances differed from 2.5 mm in one cadaveric series to 10.0 mm in another. In 32 operations for benign superficial-lobe masses, the tragal pointer, posterior belly of digastric and suture were exposed in 32, 26 and 25 cases, respectively. Comparative evidence on dissection direction predominantly concerns benign disease, limiting extrapolation to revision, malignant and irradiated fields. Conclusions: Complementary landmarks support anatomical orientation, but proximity and concordance do not establish a safe dissection plane or improved postoperative function. The proposed operative framework integrates landmark reassessment, alternative identification routes and adjunctive stimulation; it remains unvalidated and requires prospective evaluation against operative and functional outcomes.
SN - 2077-0383
ER -