A 40-year-old with a large parotid pleomorphic adenoma undergoes parotidectomy. The nerve most at risk of injury during superficial parotidectomy is the facial nerve. At what anatomical landmark is the facial nerve trunk most reliably found?

• A Immediately posterior to the styloid process, lateral to the carotid sheath
• B At the angle of the mandible, where the marginal mandibular branch first becomes superficial
• C 1 cm medial and inferior to the tragal pointer (tragal cartilage), at the level of the digastric muscle insertion on the mastoid process ✓
• D Deep to the posterior belly of the digastric at the jugular foramen

Explanation

The facial nerve trunk is identified by the 'tragal pointer' landmark: the nerve lies approximately 1 cm deep and inferior to the tip of the tragal cartilage. Additionally, the facial nerve is found at the level where the posterior belly of the digastric meets the mastoid process. The nerve exits the stylomastoid foramen and enters the parotid gland, dividing into temporofacial and cervicofacial divisions. The styloid process and digastric posterior belly are secondary landmarks used in conjunction. Marginal mandibular branch identification comes late in the dissection.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.