Styloid Process Is the Robust Landmark for Identification of the Facial Nerve during Parotid Surgery

Objective: To identify the facial nerve trunk (FNT) very easily. quickly and accurately considering the styloid process as the robust anatomically consistent landmark during parotid surgery. Patients and Methods: This prospective study was conducted between January 2010 to December 2022 at a Tertiary care hospital. It included 130 patients: 84 (65%) males and 46 (35%) females with a mean age of 43.52 ± 15.63 years. Patients presented with pleomorphic adenoma (90), chronic sialectasis (05), parotid cyst (03), parotid sinus (01), mucoepidermoid carcinoma (28), adenoid cystic carcinoma (02) and squamous cell carcinoma (01) were subjected to superficial parotidectomy and total parotidectomy. The outcome was evaluated regarding the clinical success of facial nerve function that considered the location of the styloid process in the triangle technique for identification of the FNT during parotid surgery. Results: All 130 patients underwent superficial and total parotidectomy. The facial nerve trunk was successfully identified as the location of the styloid process in the triangle technique in all the patients with no intra-operative complications. Operative time ranged from 50 to 180 minutes with a mean time 90.70 ± 15.68 minutes. Dysfunction of the angle of the mouth due to the deficit of the marginal mandibular nerve (MMN) was noted in 5 patients (3.8%), 02 had difficulty in eye closure (1.5%). No patient reported surgical site infection, skin flap necrosis and hematoma in this series. Conclusion: Styloid process is the prominent robust landmark in the triangle technique for the identification of facial nerve trunk with relative ease, safety and accuracy in the parotid surgical procedure. This can be a very useful method to locate the FNT and minimize facial nerve injury during parotid surgery.

Rectal biopsy for Hirschsprung's disease:a review of techniques,pathology,and complications

Background:Hirschsprung's disease(HD)is one of the most common congenital anomalies of colorectal function,affecting approximately 1 in 5000 live births,with a 4:1 male predominance.HD is characterized by aganglionosis that is most often limited to the rectosigmoid,but can extend proximally along the colon and,in rare instances,reach into the small intestine.A clinical history of delayed passage of meconium beyond 48 hours after birth,physical exam findings of abdominal distention and vomiting,and a contrast enema demonstrating a transition zone are highly suggestive of HD.Data sources:We searched databases including PubMed,Google Scholar,and Scopus for the following key words:Hirschsprung's disease,rectal biopsy,pathology,ganglion cell,nerve trunk hypertrophy,pediatric constipation,and selected publications written in English that were relevant to the scope of this review.Results:Based on the data presented in the literature,we reviewed 1)biopsy techniques for the diagnosis of Hirschsprung's disease,addressed inadequate biopsies,and complications from rectal biopsy,and 2)pathologic and histologic interpretation of biopsy specimens for the diagnosis of Hirschsprung's disease.Conclusion:A well-executed rectal biopsy with expert pathologic evaluation of the specimen remains the gold standard for the diagnosis of Hirschsprung's disease and is the subject of this review.