• Xu Wang, Ge Chen, Gang Song, Jiantao Liang, Yuhai Bao, and Mingchu Li.
• Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China; Samii Clinical Neuroanatomy Research and Education Center of Xuanwu Hospital, Beijing, China.
• World Neurosurg. 2023 Apr 1; 172: e599e604e599-e604.

ObjectiveTo establish a new method for fast exposure of the facial nerve and hypoglossal nerve during facial nerve anastomosis surgery.MethodsDissection of 12 formalin-fixed cadaveric specimens was performed to explore the positional relationship between the posterior belly of digastric muscle (PBD) and the facial nerve and hypoglossal nerve. We retrospectively reviewed patients who underwent facial nerve reconstruction surgery between 2015 and 2020 at Xuanwu Hospital, Capital Medical University, and the optimized surgical strategy based on the PBD was proposed.ResultsThe trunk of the hypoglossal nerve runs across the external carotid artery after giving off the descendens hypoglossi located within the 1-cm scope deep to the junction of the tendon and belly of the PBD. The mean depth difference between the hypoglossal nerve and the junction of the tendon and belly of the PBD was 5.48 ± 2.24 mm (range, 1.88-9.27 mm). The stylomastoid foramen segment of the facial nerve was revealed after the parotid gland was dissected within the angle between the anterior margin of the mastoid tip and the inferior margin of the cartilage of the external acoustic meatus.ConclusionsThe facial nerve and hypoglossal nerve can be rapidly identified using the PBD as an anatomical landmark. The end-to-end facial-descendens hypoglossi anastomosis is a reliable facial nerve reconstruction method for patients whose facial nerve was damaged during operation.Copyright © 2023. Published by Elsevier Inc.

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