Triangulation applied to facial nerve localization during parotidectomy--is math the answer?

OBJECTIVES To offer a novel framework that provides residents and practitioners with a reliable and surgically relevant method for identifying the facial nerve trunk (CNVII) after exiting the skull base during parotidectomy. METHODS The currently available literature and textbooks do not completely address the challenges trainees encounter in learning how to identify CNVII during parotidectomy. In response to this gap in the literature and potential associated deficits in surgical training, we developed an approach that integrates multiplanar intersections (based on mathematical principles) with surgical anatomy to create a reliable method for CNVII identification during parotidectomy. RESULTS The multiplanar intersections shown via our medical illustrations and surgical photography demonstrate the application of the triangulation concept to improve the accuracy and efficiency in surgical localization of CNVII. CONCLUSIONS The integration of multiplanar localization with surgical anatomy provides a reliable method for a surgeon to consistently and rapidly identify the CNVII, which inherently reduces the risk for inadvertent injury to the CNVII.