Preserving The Facial Nerve During the Orbitozygomatic Craniotomy: Surgical Anatomy Assessment and Stepwise Illustration.

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Preserving The Facial Nerve During the Orbitozygomatic Craniotomy: Surgical Anatomy Assessment and Stepwise Illustration.

World Neurosurg. 2017 May 30;:

Authors: Meybodi AT, Lawton MT, Yousef S, Sánchez JG, Benet A

Abstract
OBJECTIVE: Surgical safety and efficiency during an OZ osteotomy rely on thorough knowledge of the surgical anatomy of the facial nerve. Although the anatomy of the facial nerve and its relation to the pterional craniotomy are described, a thorough assessment of facial nerve preservation techniques during the OZ approach and its variations is lacking. We assessed the surgical anatomy of the facial nerve related to the OZ and provided a thorough stepwise description on how to preserve it.
METHODS: The OZ was performed bilaterally in 15 cadaveric heads. The interfascial and subfascial techniques were performed to study their nuances in preserving the facial nerve. We compared the the two techniques, and provided a thorough description on how to preserve the facial nerve during each step of the OZ approach.
RESULTS: At the zygomatic arch, the facial nerve was found between the galea and the superficial temporal fascia. A cut in the fascia at the posterior end of the zygomatic arch did not cross any facial nerve branches. The subfascial technique was simpler, more efficient and provided more structural protection of the facial nerve branches than the interfascial technique.
CONCLUSION: The frontal division of the facial nerve is directly related to dissection over the zygomatic bone, and may be injured during fascial dissection or osteotomies. Both interfascial and subfascial techniques are feasible to use during the OZ craniotomy and provide ample exposure of the OZ unit. Regarding the preservation of the facial nerve branches, we favor the subfascial method.

PMID: 28576712 [PubMed - as supplied by publisher]

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