TRAGAL POINTER AS A SURGICAL LANDMARK FOR THE IDENTIFICATION OF FACIAL NERVE TRUNK IN PAROTIDECTOMY: OUR EXPERIENCE

Abstract

BACKGROUND: Facial nerve paralysis is a major complication of parotid surgery, widely reported. Knowledge of the key landmarks of the facial nerve trunk is essential for safe and effective surgical intervention in the region of the parotid gland. In current practice, wide ranges of landmarks are used to identify the facial nerve trunk; however, there is much debate in the literature about the safety and reliability of each of these landmarks. The present study aim was therefore to evaluate the tragal pointer as a surgical landmark for identification of facial nerve trunk.

OBJECTIVE: To evaluate the tragal pointer as a surgical landmark for identification of facial nerve trunk.

MATERIAL AND METHODS: This Cross sectional observational study was conducted in ENT Department, Saidu Teaching Hospital Saidu Sharif Swat, KPK Pakistan from January 2014 to July 2016. Thirty Patients having parotid lump, aged 10 to 70 years were admitted through OPD and operated after examination, relevant investigation and informed written consent. Tragal pointer was used as a sole landmark for the identification of facial nerve. Data was collected on a predesigned proforma and analyzed on SPSS version 19 for descriptive statistics.

RESULTS: Out of thirty patients, 80% (n=24) were female while 20 % (n=06) were male with the mean age of 34 ± 3 years. All were presented with a parotid lump mostly on the right side. Twenty eight 93.3% patients had benign pathology while two patients 6.6 % had malignancies. The most common postoperative complication was temporary facial nerve paresis in 3.3% patients. Marginal mandibular nerve was the most common branch involved in facial nerve paresis. Tragal pointer was used as a surgical land mark in twenty eight (93.3 %) while retrograde dissection was done in 6.6 % (n=2) cases in which tragal pointer identification was difficult due to fibrosis in the adjacent tissue. Tragal pointer was lying at a distance of 16.5 mm to 21.5 mm from the facial nerve trunk and was more consistent in position and direction.

CONCLUSION: Tragal pointer is an important, consistent and easily identifiable surgical land mark for the identification of facial nerve trunk in primary parotid surgery to minimize damage to facial nerve.