Prediction of the position of the intraparotid portion of the facial nerve on MRI and CT

Despite developments in imaging technology, visualisation of the intraparotid portion of the facial nerve is not possible. Three separate radiological techniques have been described to predict the position of the facial nerve: Connʹs are; a plane extending posteriorly from the outer surface of the mandibular ramus; and soft-tissue structures, including the posterior belly of the digastric muscle, the retromandibular vein and the lateral border of the masseter muscle. We investigated the reliability of these techniques in predicting the relationship of tumours to the facial nerve. Cross-sectional imaging of the parotid glands was performed prior to the removal of a parotid mass in 26 patients. Twenty patients underwent MRI, and six had CT scans. We removed 14 malignant neoplasms, nine benign lesions and three non-neoplastic lesions. The relationship of the tumour to the facial nerve was assessed radiologically by each of the three techniques, and compared with the findings at surgery. In 18 patients the tumour involved the parotid gland deep to the facial nerve. The above techniques predicted the position of the facial nerve in 69%, 58% and 46% of cases, respectively. When planning parotid surgery, it is important that the surgeon understands the advantages and limitations of the radiological assessment of the position of parotid tumours in relation to the facial nerve.