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tragal pointer

Yisi D Ji, R Bruce Donoff, Zachary S Peacock, Eric R Carlson
PURPOSE: The purpose of this study was to describe distances from commonly used anatomic landmarks to the main trunk of the facial nerve during parotid surgery. MATERIALS AND METHODS: A systematic search of the published literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies from January 1, 1990 to January 1, 2017 that measured distances to the main trunk of the facial nerve from common anatomic landmarks were eligible...
February 2018: Journal of Oral and Maxillofacial Surgery
Bilge Kagan Aysal, Abdulkerim Yapici, Yalcin Bayram, Fatih Zor
Facial nerve is the main cranial nerve for the innervation of facial expression muscles. Main trunk of facial nerve passes approximately 1 to 2 cm deep to tragal pointer. In some patients, where a patient has multiple operations, fibrosis due to previous operations may change the natural anatomy and direction of the branches of facial nerve. A 22-year-old male patient had 2 operations for mandibular reconstruction after gunshot wound. During the second operation, there was a possible injury to the marginal mandibular nerve and a nerve stimulator was used intraoperatively to monitor the nerve at the tragal pointer because the excitability of the distal segments remains intact for 24 to 48 hours after nerve injuries...
October 2016: Journal of Craniofacial Surgery
Somnath Saha, Sudipta Pal, Moushumi Sengupta, Kanishka Chowdhury, Vedula Padmini Saha, Lopamudra Mondal
To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Cadaveric dissection was performed in the Department of Anatomy and the surgeries were done in the Department of ENT and Head and Neck surgery of R. G. Kar Medical College of Kolkata. The distance of the facial nerve trunk from three most commonly used landmarks (viz...
January 2014: Indian Journal of Otolaryngology and Head and Neck Surgery
M A Muhleman, C T Wartmann, R Hage, P Matusz, M M Shoja, R S Tubbs, M Loukas
The tragal pointer has long been used as a surgical landmark for the identification of the facial nerve trunk and the maxillary artery in such procedures as parotidectomy, internal fixation of subcondylar and condylar fractures, mandibular osteotomy, temporomandibular joint arthroplasty, and percutaneous blocks of branches of the trigeminal nerve and pterygopalatine ganglion. Aside from its use as an external landmark, it has also been implicated as a contributor to crease formation in the presence of peripheral arterial disease...
May 2012: Folia Morphologica (Warsz)
David T Pointer, Paul L Friedlander, Ronald G Amedee, Perry H Liu, Ernest S Chiu
Reconstruction following oncologic resection in the head and neck is complex due to large surgical defects left after removal of skin, subcutaneous, and skeletal structures. It is essential to adequately fill the defect as well as provide an acceptable tissue match in terms of tone, texture, thickness and contour. A 55-year-old male presented with an advanced melanoma in the right pre-tragal area. Surgical resection was performed including a total auriculectomy. A tunnelled right supraclavicular artery island (SAI) flap was used to repair the surgical defect...
August 2010: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Paul M Rea, Gerry McGarry, John Shaw-Dunn
In addition to using intra-operative facial nerve monitoring in helping to locate the position of the facial nerve in anterograde parotidectomy, numerous soft tissue and bony landmarks have been proposed to assist the surgeon in the early identification of this nerve. There is still dispute within the literature as to the most effective method, if any, of locating the nerve. The purpose of this study was to measure the distance (in twenty-six embalmed cadavers) from four of the most commonly used surgical landmarks to the main trunk of the facial nerve-the posterior belly of digastric muscle (PBDM), the tragal pointer (TP), the junction between the bony and cartilaginous ear canal (EAM) and the tympanomastoid suture (TMS)...
February 20, 2010: Annals of Anatomy, Anatomischer Anzeiger: Official Organ of the Anatomische Gesellschaft
Hakan Orbay, Metin Kerem, Ramazan Erkin Unlü, Ayhan Cömert, Eray Tüccar, Omer Sensöz
BACKGROUND: The maxillary artery can be injured during procedures in the subcondylar portion of the mandible. Thorough knowledge of this region is mandatory to avoid accidental puncture of the maxillary artery, which can lead to profuse bleeding that is hard to control. METHODS: In 16 halves of eight embalmed cadaver heads, the maxillary artery was dissected from the branching point to the entrance point to the maxillary sinus. Its anatomical relationships with certain landmarks were recorded numerically...
December 2007: Plastic and Reconstructive Surgery
N Pather, M Osman
Facial nerve paralysis is a daunting potential complication of parotid surgery and is widely reported. Knowledge of the key landmarks of the facial nerve trunk is essential for safe and effective surgical intervention in the region of the parotid gland. In current practice, wide ranges of landmarks are used to identify the facial nerve trunk, however, there is much debate in the literature about the safety and reliability of each of these landmarks. The aim of this study, therefore, was to evaluate the relation of the surrounding anatomical structures and surgical landmarks to the facial nerve trunk...
May 2006: Surgical and Radiologic Anatomy: SRA
C Ron Cannon, William H Replogle, Michael P Schenk
OBJECTIVE: Establish normative data concerning parotidectomy and facial nerve dissection and determine the relationship between the length of the facial nerve dissected during parotidectomy and subsequent facial nerve paresis. STUDY DESIGN: Prospective mapping of facial nerve during parotidectomy and comparison with postoperative facial nerve function. METHODS: A prospective observational study of 78 patients who underwent 79 parotidectomy procedures...
November 2004: Laryngoscope
Hamdy El-Hakim, Rodney Mountain, Lachlan Carter, Erik L K Nilssen, Peter Wardrop, Malcolm Nimmo
OBJECTIVES: To determine the accuracy of using surrogate anatomic structures radiologically to predict the relation of parotid lesions to the intraparotid facial nerve. SETTING: Tertiary centre. DESIGN: Retrospective. PATIENTS AND METHODS: All patients with parotid masses over a 5-year period who undertook parotidectomy were considered. A radiologist and an otolaryngologist reviewed the images. Their decision regarding the location of the lesions using four surrogate structures was compared with intraoperative documentation...
October 2003: Journal of Otolaryngology
P Tolsdorff
"Plastipore" prostheses (TORP, PORP) in the middle ear have established themselves in recent years for the restoration of optimal transformation of air pressure in partial or total loss of the ossicular chain, provided that certain conditions are observed. A good protector between the tympanic membrane or the tympanic membrane graft, and a prosthetic screen is essential. For this we use a transplant composed of perichondrium and cartilage from the tragal cartilage cut in a certain manner, which also functions ideally as a tympanic membrane graft...
December 1983: HNO
S J Wetmore
A number of different approaches can be used to expose the facial nerve. The route taken will depend on the pathology and the portion of the nerve that requires exposure. When performing a parotidectomy approach to the extratemporal portion of the facial nerve, the tragal pointer is a key landmark, but other landmarks also should be used to identify the facial nerve safely. The lateral semicircular canal, the chorda tympani nerve, the digastric ridge, and the cochleariform process are some of the useful landmarks in the mastoid and middle ear...
June 1991: Otolaryngologic Clinics of North America
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