Our experience with surgical dissection of the facial nerve in parotid gland tumours. (A preliminary report).

Conservative parotidectomy is a primary method in the surgical treatment of parotid gland tumours. The classic parotid gland surgery uses the styloid process as a landmark for dissection of the facial nerve. The anatomical variations of the styloid process, however, prevent it from being always used as a reference landmark in this operative approach. This requires finding reliable invariable anatomical landmarks to be applied in the facial nerve dissection. The author presents his experience from the surgical treatment of 37 patients (25 females and 12 males) with tumours of the parotid gland. Adenoma was verified in 31 patients and 6 patients had a low malignancy carcinoma stage I. The mean age of the patients was 52 +/- 2.4 years. Conservative parotidectomy was performed in 28 patients (75.67%) and lateral parotidectomy in 9 patients (24.32%). The insertion of the posterior belly of digastric muscle on the mastoid process and tympanomastoid fissure were the primary landmarks used in the conservative parotidectomy. The proposed surgical technique was assessed as more reliable and less traumatic. Transient paralysis of the facial nerve occurred in 7 patients (18.9%) and subsided without treatment within 6-8 months. Based on his experience the author finds these anatomical landmarks easily recognizable and reliable start-points in facial nerve dissection that reduce the risk of traumatic injury of the facial nerve.