SURGICAL ANATOMY OF THE FACIAL NERVE: With reference to the technique of orbicularis block (palpebral akinesia)

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Abstract
With reference to the technique of orbicularis block (palpebral akinesia) the course of the facial nerve was investigated. The following features were discovered which differ from the usual descriptions. The facial nerve lies sandwiched in the parotid gland and divides it into a large superficial and a small deep part which are connected by a slender isthmus. The isthmus passes between the 2 diverging portions of the nerve, the temporo-facial and the cervico-facial divisions. The point of bifurcation of the facial nerve into its 2 divisions, and the main trunk of the temporo-facial division lie at the same level, namely, at the junction of the upper and middle thirds of the distance between the angle of the mandible and the palpable condyloid process, at a point about 1.5-2.5 cm. below the lower margin of the zygomatic arch. The temporo-facial division supplies the orbicularis muscle. In 7 of 11 dissections it received rami from the cervico-facial division. Clinical application of these anatomic features will produce palpebral akinesia in 90-95% of cases.

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