Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy

Purpose: An accurate understanding of the anatomy, identification and preservation of facial nerve is critical in performing successful functional parotidectomies. The current literature is replete with inconsistencies of various landmarks when used alone for identification of facial nerve trunk (FN...

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Main Authors: Rajiv M. Borle, Anendd Jadhav, Nitin Bhola, Pawan Hingnikar, Prafulla Gaikwad
Format: Article
Language:English
Published: Elsevier 2019-01-01
Series:Journal of Oral Biology and Craniofacial Research
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Online Access:http://www.sciencedirect.com/science/article/pii/S2212426818300344
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author Rajiv M. Borle
Anendd Jadhav
Nitin Bhola
Pawan Hingnikar
Prafulla Gaikwad
author_facet Rajiv M. Borle
Anendd Jadhav
Nitin Bhola
Pawan Hingnikar
Prafulla Gaikwad
author_sort Rajiv M. Borle
collection DOAJ
description Purpose: An accurate understanding of the anatomy, identification and preservation of facial nerve is critical in performing successful functional parotidectomies. The current literature is replete with inconsistencies of various landmarks when used alone for identification of facial nerve trunk (FNT). The purpose of the paper is to introduce a new anatomical triangle, Borle's triangle (BT) for safer and reliable operative identification of FNT during parotodectomies. Patients and methods: Between Aug 2014 and Dec 2017, twelve patients who reported with unilateral disease of the parotid gland with intact facial nerve function who underwent superficial or complete parotidecomies were included in the study. BT was conceptualized by intersection of three imaginary lines drawn along anatomical structures and forming a triangle comprising of angles a, b and c. Results: Introperatively, BT helped reliably identify the FNT and its branches successfully in all the cases. The mean distance of FNT from angle b was found to be 12.18 ± 1.7 mm. Transient neurological deficits with one or more branches were seen in four cases whilst, one case had transient deficit with all the five peripheral branches. All of them spontaneously resolved completely by the end of three months post operatively. Conclusions: When used in isolation, substantial variations exist in distances measured from anatomic landmarks to the main FNT in the literature. The BT utilizes three commonly used anatomical landmarks. It predictably helps in proper anatomic orientation, identification and preservation of FNT and branches with ease in parotidectomies.
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spelling doaj-art-7bafda87b94d4fd89d7e2a37a13f8e732025-08-20T02:01:55ZengElsevierJournal of Oral Biology and Craniofacial Research2212-42682019-01-0191333610.1016/j.jobcr.2018.08.004Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomyRajiv M. Borle0Anendd Jadhav1Nitin Bhola2Pawan Hingnikar3Prafulla Gaikwad4Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharshtra, 442004, IndiaCorresponding author.; Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharshtra, 442004, IndiaDepartment of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharshtra, 442004, IndiaDepartment of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharshtra, 442004, IndiaDepartment of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharshtra, 442004, IndiaPurpose: An accurate understanding of the anatomy, identification and preservation of facial nerve is critical in performing successful functional parotidectomies. The current literature is replete with inconsistencies of various landmarks when used alone for identification of facial nerve trunk (FNT). The purpose of the paper is to introduce a new anatomical triangle, Borle's triangle (BT) for safer and reliable operative identification of FNT during parotodectomies. Patients and methods: Between Aug 2014 and Dec 2017, twelve patients who reported with unilateral disease of the parotid gland with intact facial nerve function who underwent superficial or complete parotidecomies were included in the study. BT was conceptualized by intersection of three imaginary lines drawn along anatomical structures and forming a triangle comprising of angles a, b and c. Results: Introperatively, BT helped reliably identify the FNT and its branches successfully in all the cases. The mean distance of FNT from angle b was found to be 12.18 ± 1.7 mm. Transient neurological deficits with one or more branches were seen in four cases whilst, one case had transient deficit with all the five peripheral branches. All of them spontaneously resolved completely by the end of three months post operatively. Conclusions: When used in isolation, substantial variations exist in distances measured from anatomic landmarks to the main FNT in the literature. The BT utilizes three commonly used anatomical landmarks. It predictably helps in proper anatomic orientation, identification and preservation of FNT and branches with ease in parotidectomies.http://www.sciencedirect.com/science/article/pii/S2212426818300344Borle's triangleFacial nerve trunkParotidectomiesAnterograde dissection
spellingShingle Rajiv M. Borle
Anendd Jadhav
Nitin Bhola
Pawan Hingnikar
Prafulla Gaikwad
Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy
Journal of Oral Biology and Craniofacial Research
Borle's triangle
Facial nerve trunk
Parotidectomies
Anterograde dissection
title Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy
title_full Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy
title_fullStr Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy
title_full_unstemmed Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy
title_short Borle's triangle: A reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy
title_sort borle s triangle a reliable anatomical landmark for ease of identification of facial nerve trunk during parotidectomy
topic Borle's triangle
Facial nerve trunk
Parotidectomies
Anterograde dissection
url http://www.sciencedirect.com/science/article/pii/S2212426818300344
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