This clinical photograph illustrates an intraoperative view of an open parotidectomy surgical field. The image highlights the identification and measurement of surgical landmarks within the parotid bed. Castroviejo calipers are utilized to measure the shortest distance between the tragal pointer (TP), indicated by blue dotted lines, and the main trunk of the facial nerve (FN), denoted by a blue arrow. The surgical field displays exposed soft tissues, including the posterior belly of the digastric muscle and the sternocleidomastoid muscle, following glandular resection. Self-retaining or manual retractors are visible, providing exposure of the deep neck anatomy and the facial nerve's exit from the stylomastoid foramen. This visual demonstrates critical surgical steps in head and neck surgery, emphasizing the importance of anatomical landmarks for the preservation of the facial nerve during parotid gland procedures. The clinical focus is on surgical anatomy, nerve monitoring, and precise measurement for surgical outcomes.

Clinical intraoperative photograph of a right quadrant parotidectomy, presented in two panels (1A and 1B). Panel 1A provides a wide surgical field view showing the post-excision anatomy of the upper quadrant. A blue arrow identifies the skeletonized zygomatic branch of the facial nerve, while a double asterisk marks the rough, nodular transected surface of the lower parotid gland quadrant. Panel 1B is a high-magnification close-up view identifying key neurovascular and glandular landmarks: (1) the zygomatic branch of the upper trunk of the facial nerve, appearing as a thin, white fiber; (2) the origin of the lower trunk of the facial nerve; (3) the yellowish, lobulated parenchyma of the transected lower quadrant; and (4) the great auricular nerve located inferior to the primary surgical site. The images demonstrate the surgical preservation of the facial nerve trunk and its branches during selective salivary gland resection. This material is suited for teaching surgical anatomy, parotid surgery techniques, and nerve-sparing protocols in otolaryngology or surgical oncology.

Clinical intraoperative photograph of the left parotid region during a parotidectomy. The surgical field demonstrates the relationship between a focal mass and the facial nerve. A red arrowhead indicates the retracted superficial lobe of the parotid gland, revealing granular glandular tissue. Centrally, a well-circumscribed, smooth-walled mass is visible. A black arrow points to the superior division of the facial nerve, which appears as a thin, white, fibrous strand directly coursing over and becoming encased within the mass. A metal surgical dissector is shown at the superior aspect of the lesion to facilitate exposure. This visual demonstrates the surgical anatomy of a facial nerve neurofibroma and the technical challenge of nerve preservation when a neoplasm incorporates nerve fascicles. Key landmarks include the auricle (left) and the dissected surgical bed with associated soft tissue and vascularity.

This clinical photograph shows an intraoperative surgical field during a parotidectomy, focusing on the identification of the facial nerve trunk (FNT). The image illustrates key anatomical landmarks used to localize the nerve as it exits the stylomastoid foramen. The FNT is centrally located and annotated in the dissection field. Superior to the nerve is the 'Tragal pointer', a cartilaginous landmark. Inferior and slightly posterior to the FNT is the 'Tip of mastoid' process. Additional visible muscular landmarks include the posterior belly of the digastric muscle, which lies deep and inferior to the nerve trunk, and the sternocleidomastoid muscle, visible at the inferior-most aspect of the surgical site. The photograph demonstrates the spatial relationship between these soft tissue and bony structures, which serve as essential surgical guides for preventing iatrogenic facial nerve injury during head and neck surgery. The educational focus is on the surgical anatomy of the parotid region and the safe identification of the extra-temporal facial nerve.

This clinical photograph displays a surgical dissection of the preauricular and parotid regions, illustrating the surgical anatomy and morphometric relationships of the facial nerve. The image is divided into two panels (a and b) showing the same field with anatomical labels and measurements. Key landmarks identified include the tragus (T), the lateral pole of the mandibular condyle (C), the pes anserinus (P) of the facial nerve, and the temporozygomatic division of the facial nerve (FN). Panel (b) specifically quantifies the distances from the posterior apex of the tragus to these landmarks: 2.20 cm to the lateral pole of the condyle (T-C), 2.31 cm to the point where the facial nerve crosses the posterior border of the condylar neck (T-FN), and 2.25 cm to the pes anserinus (T-P). This anatomical diagram serves as a guide for identifying and preserving the facial nerve during preauricular surgical approaches, such as those used in parotidectomy or temporomandibular joint surgery, by providing standardized reference measurements from the tragus.

A clinical intraoperative photograph showing the anatomical arrangement of the facial nerve branches in a surgical dissection, following parotidectomy. The image provides a lateral view of the cervicofacial region where the parotid gland has been removed to expose the extratemporal facial nerve plexus. Labeled branches include the temporal branch extending superiorly, the zygomatic and buccal branches traveling toward the mid-face, and the marginal mandibular and cervical branches descending inferiorly. The cervical branch is depicted in close proximity to the jugular vein, which is visible in the lower surgical field. Surgical instruments (retractors) are positioned to maintain exposure of the deep tissues. A 5mm grid scale is included for anatomical measurement. This visual serves as an educational guide for surgical anatomy, identifying key landmarks for nerve preservation during parotid gland surgery or facial nerve decompression.