The Facial Nerve in Contemporary Surgery: Anatomical Variability, Pathology-Induced Distortion, and Functional Preservation

Objectives: The facial nerve (FN) possesses one of the most intricate anatomical courses in the head and neck, traversing the brainstem, temporal bone, and parotid gland before terminating within the muscles of facial expression. Owing to its complex anatomy, marked anatomical variability, and frequent distortion by adjacent pathology, preservation of FN integrity remains a fundamental challenge in skull base,...

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No actionable change for audiologists in routine practice; this review is directed at surgeons operating in the temporal bone and parotid region, though audiologists involved in peri-operative monitoring (intraoperative nerve monitoring) may find the anatomical variability data useful.

Facial nerve injury during ear and skull-base surgery remains a significant morbidity risk, and updated anatomical guidance supports safer surgical outcomes for patients undergoing these procedures.

1. 01The facial nerve shows notable anatomical variability across the brainstem, temporal bone, and parotid gland.
2. 02Pathological conditions (tumors, cholesteatoma, etc.) can distort the nerve from its expected course.
3. 03Functional preservation strategies during contemporary surgery are reviewed.
4. 04Relevant to skull-base, otologic, and parotid surgeons and to audiologists doing intraoperative monitoring.
5. 05No new clinical trial data; this is a narrative review of anatomy and surgical technique.

PMID

42513535

DOI

10.3390/jcm15145622.

Journal

Journal of Clinical Medicine

Publication type

review

Evidence level

5

Population

Surgical patients with conditions affecting the facial nerve in the brainstem, temporal bone, and parotid regions

Intervention

Surgical strategies for facial nerve functional preservation