The deep lobe of the parotid gland lies medial to the stylomandibular ligament and the facial nerve divides it from the superficial lobe. During parotidectomy, identifying the main trunk of the facial nerve is performed by locating it at which landmark?

• A Anterior to the tragal pointer, at the junction of the tympanomastoid suture and the mastoid process
• B At the posterior border of the mandible, below the angle
• C At the exit of the stylomastoid foramen, 1 cm medial to the tragal pointer (pointer technique) ✓
• D At the stylomandibular ligament, medial to the gland

Explanation

The facial nerve exits the stylomastoid foramen and enters the substance of the parotid approximately 1 cm medial and slightly inferior to the tragal pointer (the cartilaginous tip of the tragus). This is the most reliable intraoperative landmark (the tragal pointer technique). Additional landmarks include the tympanomastoid suture (the nerve lies at its inferior end), the posterior belly of digastric (the nerve runs parallel to it, just superficial), and the mastoid process (nerve lies medial). Identification at the posterior mandibular border would risk more distal branches. The stylomastoid foramen is deep and not easily visible directly.

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

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Written and medically reviewed by the StethoPrep medical team.