Facial nerve preservation in the region of the zygomatic arch

In order to preserve the frontotemporal branch of the facial nerve in frontotemporal and trans-zygomatic craniotomies, electromyographic responses from the facial muscles were recorded preoperatively. Incising the frontotemporal branch of the facial nerve could be avoided by identifying the crossing point of the frontotemporal branch of the facial nerve on the superior border of the zygomatic arch. The crossing points were investigated in 20 patients and in most cases they existed between 2 cm and 6 cm from the anterior border of the external auditory canal. Another important point to preserve the facial nerve is to conserve the layer in which the facial nerve is included. Therefore, the surgical anatomy in the region of the zygomatic arch and temporal area was reviewed in detail. This knowledge is crucial for neurosurgeons to dissect precisely in this region without causing postoperative facial palsy.