Preserving The Facial Nerve During the Orbitozygomatic Craniotomy: Surgical Anatomy Assessment and Stepwise Illustration

• Published in: World neurosurgery Vol. 105; pp. 359 - 368
• Main Authors: Meybodi, Ali Tayebi, MD, Lawton, Michael T., MD, Yousef, Sonia, Sánchez, JJ González, MD, Benet, Arnau, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Cadaver; Craniotomy - methods; Facial nerve; Facial Nerve - surgery; Female; Head - anatomy & histology; Head - surgery; Humans; Interfascial; Male; Neurosurgery; Osteotomy - methods; Subfascial; Surgical Anatomy; Temporal fascia; Zygoma - anatomy & histology; Zygoma - surgery; Zygomatic arch; STA; Superior temporal line; Zygomatic Arch; Subfascial; Facial nerve; SMAS; STL; OZ; Superficial temporal artery; Superficial musculo-aponeurotic system; Temporal Fascia; Orbitozygomatic; Interfascial; Surgical Anatomy; Zygomatic arch; Temporal fascia
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.05.124

Abstract Objective Surgical safety and efficiency during an OZ osteotomy rely on thorough knowledge of the surgical anatomy of the facial nerve. Although the anatomy of the facial nerve and its relation to the pterional craniotomy are described, a thorough assessment of facial nerve preservation techniques during the OZ approach and its variations is lacking. We assessed the surgical anatomy of the facial nerve related to the OZ and provided a thorough stepwise description on how to preserve it. Methods The OZ was performed bilaterally in 15 cadaveric heads. The interfascial and subfascial techniques were performed to study their nuances in preserving the facial nerve. We compared the the two techniques, and provided a thorough description on how to preserve the facial nerve during each step of the OZ approach. Results At the zygomatic arch, the facial nerve was found between the galea and the superficial temporal fascia. A cut in the fascia at the posterior end of the zygomatic arch did not cross any facial nerve branches. The subfascial technique was simpler, more efficient and provided more structural protection of the facial nerve branches than the interfascial technique. Conclusion The frontal division of the facial nerve is directly related to dissection over the zygomatic bone, and may be injured during fascial dissection or osteotomies. Both interfascial and subfascial techniques are feasible to use during the OZ craniotomy and provide ample exposure of the OZ unit. Regarding the preservation of the facial nerve branches, we favor the subfascial method.