Variations in Facial Nerve Branches and Anatomical Landmarks for Its Trunk Identification: A Pilot Cadaveric Study in the Lithuanian Population

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Abstract
The purpose of this study was to evaluate facial nerve (FN) branching variations based on Davis and Kopuz classifications in the Lithuanian population and measure the shortest distance from the facial nerve trunk (FNT) to its anatomical landmarks. Twenty-two hemifaces of 11 cadavers were dissected. The preauricular skin cut was made and extended behind the ear lobe and along the inferior border of the mandible. The skin with subcutaneous tissue and superficial fascia were separated and medially retracted, and the parotid gland was dissected anterogradely. The FNT and its furcation type and branching pattern were disclosed and noted based on Davis and Kopuz classifications. Further, the shortest distance from the FNT to the anatomical landmarks of the tragal pointer (TP), the angle of mandible (AM), and the tip of mastoid process (TMP) was measured. The prevalence of branching patterns did not differ significantly compared to Davis classification. Based on Kopuz, type IVA pattern was the most common in six cases (27%). Eighteen (82%) trunks split as bifurcations and two (9%) trifurcations, while two (9%) had separate double trunks. The shortest distance (mm) from the FNT to the TP is 9.30 ± 0.93, AM 36.45 ± 4.14, and TMP 12.52 ± 2.30. The prevalence of FN variations in the Lithuanian population is similar to Davis classification. The AM and TMP are consistent superficial bony landmarks for trunk identification, while the distance from the TP highly varies among studies. Surgeons should be aware of double FNT during parotidectomy, which is described in Kopuz classification.

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