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Heilingoetter AL, See GB, Brookes J, Campisi P, Cervantes SS, Chadha NK, Chelius D, Chen D, Chun B, Cunningham MJ, D'Souza JN, Din T, Dzongodza T, Francom C, Gallagher TQ, Gerber ME, Gorelik M, Goudy S, Graham ME, Hartley B, Hazkani I, Hong P, Hsu WC, Isaac A, Jatana KR, Johnston DR, Kabagenyi F, Kazahaya K, Koempel J, Leboulanger N, Luscan R, Maurrasse SE, Mercier E, Peer S, Preciado D, Rahbar R, Rastatter J, Richter G, Rosenblatt SD, Shay SG, Sheyn A, Tassew Y, Walz PC, Whigham AS, Wiedermann JP, Yeung J, Maddalozzo J. Comprehensive management and classification of first branchial cleft anomalies: An International Pediatric Otolaryngology Group (IPOG) consensus statement. Int J Pediatr Otorhinolaryngol 2024; 186:112095. [PMID: 39278130 DOI: 10.1016/j.ijporl.2024.112095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/01/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE First branchial cleft anomalies are rare congenital head and neck lesions. Literature pertaining to classification, work up and surgical treatment of these lesions is limited and, in some instances, contradictory. The goal of this work is to provide refinement of the classification system of these lesions and to provide guidance for clinicians to aid in the comprehensive management of children with first branchial cleft anomalies. MATERIALS AND METHODS Delphi method survey of expert opinion under the direction of the International Pediatric Otolaryngology Group (IPOG) was conducted to generate recommendations for the definition and management of first branchial cleft anomalies. The recommendations are the result of expert consensus and critical review of the literature. RESULTS Consensus recommendations include evaluation and diagnostic considerations for children with first branchial cleft anomalies as well as recommendations for surgical management. The current Work classification system was reviewed, and modifications were made to it to provide a more cogent categorization of these lesions. CONCLUSION The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations based on review of the literature for the management of pediatric otolaryngologic disorders. These consensus recommendations are aimed at improving care of children presenting with first branchial cleft anomalies. Here we present a revised classification system based on parotid gland involvement, with a focus on avoiding stratification based on germ layer, in addition to guidelines for management.
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Affiliation(s)
| | - Goh Bee See
- National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | | | - Paolo Campisi
- The Hospital for Sick Children (SikKids), Ontario, Canada
| | | | - Neil K Chadha
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Diane Chen
- Riley Children's Hospital, Indianapolis, IN, USA
| | - Bob Chun
- Children's Wisconsin, Milwaukee, WI, USA
| | - Michael J Cunningham
- Harvard Medical School, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA
| | - Jill N D'Souza
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Taseer Din
- Sidra/Weill Cornell Medicine, Ar-Rayyan, Qatar
| | | | - Christian Francom
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Thomas Q Gallagher
- Children's Hospital of the King's Daughters, Norfolk, VA, USA; Eastern Virginia Medical School, Norfolk, VA, USA
| | | | | | - Steven Goudy
- Emory University, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Inbal Hazkani
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Paul Hong
- IWK Health Centre, Nova Scotia, Canada
| | - Wei-Chung Hsu
- National Taiwan University Hospital Children's Hospital, Taipei, Taiwan
| | - Andre Isaac
- Stollery Children's Hospital, Alberta, Canada
| | - Kris R Jatana
- Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA
| | | | | | - Ken Kazahaya
- University of Pennsylvania, Philadelphia, PA, USA; Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeff Koempel
- Children's Hospital of Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, Los Angeles, CA, USA
| | | | - Romain Luscan
- Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | | | | | - Shazia Peer
- University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | | | | | | | | | | | - Anthony Sheyn
- LeBonheur Children's Hospital, Memphis, TN, USA; University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yilkal Tassew
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Patrick C Walz
- The Ohio State University, Columbus, OH, USA; Makerere University, Kampala, Uganda
| | - Amy S Whigham
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | - Jeffrey Yeung
- Montreal Children's Hospital, Quebec, Canada; McGill University Health Centre, Quebec, Canada
| | - John Maddalozzo
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
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Lee HS, Park K. Penetrating Offenders in Hemifacial Spasm: Surgical Tactics and Prognosis. Life (Basel) 2023; 13:2021. [PMID: 37895403 PMCID: PMC10608199 DOI: 10.3390/life13102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: In cases of hemifacial spasm (HFS), there are various patterns related to the vascular compression of the facial nerve, including a very rare form that is seen when the offending vessel penetrates the facial nerve. However, there have been few reports in the literature regarding the associated surgical techniques and postoperative prognosis. (2) Methods: A retrospective review was conducted of 4755 patients who underwent microvascular decompression (MVD) surgery from April 1997 to June 2023. In total, 8 out of the 4755 patients (0.2%) exhibited a penetrating offending vessel; the medical and surgical records of these 8 patients were then analyzed. Surgery was then attempted to maximally decompress the penetrating offender. (3) Results: Seven out of the eight patients (87.5%) were spasm-free immediately after surgery, and one had only 10% residual spasm compared to their preoperative condition. That patient was also spasm-free one year later. Postoperative facial palsy occurred in one patient (12.5%) who was assessed as grade II in the House-Brackmann grading system. In another patient, the resection of a small facial nerve bundle did not result in facial palsy. There were no cases of hearing loss or other complications. (4) Conclusions: Decompressing the penetrating offender did not increase the incidence of facial palsy, and the prognosis for hemifacial spasms was good. Therefore, when a penetrating pattern was encountered during MVD surgery, decompression between the penetrating offender and the facial nerve may offer good results.
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Affiliation(s)
- Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Pupić-Bakrač J, Skitarelić N, Novaković J, Lasić V. Patho-Anatomic Spectrum of Branchial Cleft Anomalies: Proposal of Novel Classification System. J Oral Maxillofac Surg 2021; 80:341-348. [PMID: 34648755 DOI: 10.1016/j.joms.2021.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Histogenesis, nomenclature, and classification of branchial cleft anomalies (BCAs) have been subjects of controversy for decades. The purpose of this study was to investigate the accuracy of current developmental theories (congenital, lymph node, and hybrid branchial inclusion theories) in defining the anatomic and histopathological characteristics of BCAs. METHODS Ninety consecutive patients with BCAs who underwent surgical excision were enrolled in this 2-center retrospective cohort study. RESULTS The present study included 90 patients: 46 (51.11%) women and 44 (48.89%) men (P > .05). The mean age at presentation was 31.89±17.31 years. Altogether, 92 BCAs were identified within the study population including 49 (53.26%) on the left side and 43 (46.74%) on the right side (P > .05). The BCAs included 79 (85.87%) branchial cleft cysts, 11 (11.96%) branchial cleft sinuses, and 2 (2.17%) branchial cleft fistulae. Three (3.26%) BCAs were distributed in the head regions, 88 (95.65%) in the neck regions, and 1 (1.09%) in the thoracic cavity. Following surgery, lymphoepithelial tissue was detected in the histopathological examination in 83 (90.22%) BCAs. The hybrid branchial inclusion theory exhibited significantly higher accuracy in defining patho-anatomic characteristics of BCAs than the branchial apparatus, precervical sinus, thymopharyngeal, and inclusion theories (90.22, 9.78, 2.17, 0.00, and 0.00%; respectively) (P < .05). CONCLUSION The novel branchial node (BN) classification system based on the hybrid branchial inclusion theory appears to be superior to other classification systems in determining the patho-anatomy of BCAs.
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Affiliation(s)
- Jure Pupić-Bakrač
- Resident, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia
| | - Neven Skitarelić
- Resident, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia; Professor, Department of Health Studies, University of Zadar, Zadar, Croatia; Professor, Faculty of Medicine, University of Rijeka, Rijeka, Croatia; Department Head, Department of Otorhinolaryngology and Maxillofacial Surgery, General Hospital Zadar, Zadar, Croatia.
| | - Josip Novaković
- Physician Associate, Department of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Valentina Lasić
- Resident, Department of Pediatric Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Zhang CL, Li CL, Chen HQ, Sun Q, Liu ZH. First branchial cleft cyst accompanied by external auditory canal atresia and middle ear malformation: A case report. World J Clin Cases 2020; 8:3616-3620. [PMID: 32913872 PMCID: PMC7457106 DOI: 10.12998/wjcc.v8.i16.3616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We report a rare case of first branchial cleft anomaly (FBCA) accompanied by bony atresia of the external auditory canal, middle ear malformation, and location malformation of the facial nerve according to the intraoperative findings.
CASE SUMMARY A 19-year-old male patient presented to our department with a mass behind the right earlobe and recurrent postauricular swelling and pain since childhood, he also had severe hearing loss in the right ear since birth. The patient underwent surgery including mass removal, mastoidectomy, and simultaneous meatoplasty and ossiculoplasty under microscopy. No facial palsy or recurrence was noted during postoperative follow-up.
CONCLUSION FBCAs are rare, and to our knowledge, this is the first report of FBCA accompanied by external auditory canal bony atresia, middle ear malformation, and location malformation of the facial nerve. An effective postauricular approach under microscopy facilitated complete lesion removal and simultaneous otologic reconstruction.
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Affiliation(s)
- Chun-Lin Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Chun-Lei Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Hang-Qi Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
- Postgraduate College of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Qiang Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
- Postgraduate College of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Zhao-Hui Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Congenital External Auditory Canal Cholesteatoma Resected by a Transcanal Endoscopic Approach. Otol Neurotol 2020; 41:715-717. [PMID: 32221107 DOI: 10.1097/mao.0000000000002631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the first case of congenital external auditory canal cholesteatoma resected via a transcanal endoscopic approach and describe the possible pathologenesis of cholesteatoma. PATIENT A 2-year-old female patient presented with a cholesteatoma that extended from the floor of the external auditory bony canal to the inferior quadrant of her right tympanic membrane. INTERVENTION Otological examinations and computed tomography were performed. The cholesteatoma was resected using a transcanal endoscopic approach. RESULTS Pathologic examination confirmed the diagnosis of external auditory canal cholesteatoma. The patient's postoperative hearing was observed to be normal. Cholesteatoma did not recur during the 2-year follow-up period. Computed tomography scan revealed an isodense mass, partly surrounded by bony tissue, on the floor of the external auditory canal, outside of the inferior quadrant of an intact tympanic membrane. A minor malformation of the bony tissue, covering the inferiolateral surface of the cholesteatoma, was observed. The proposed mechanisms of pathogenesis are: 1) the embryonic developmental deficits of the meatal plug, during its differentiation into squamous epithelium, cause the arrest of ectodermal tissues, 2) a remnant of the squamous epithelium becomes trapped in the niche of the foramen tympanicum. CONCLUSION A rare case of congenital external auditory canal cholesteatoma, located on the inferior external auditory canal, was diagnosed and resected using a transcanal endoscopic approach. It was possibly caused by a minor anomaly of the first branchial cleft or by a remnant of the squamous epithelium trapped in the foramen tympanicum.
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Maddalozzo J, Johnston DR, Isaac A, Bhushan B, Rastatter JC. Displacement of the Facial Nerve by Deep Parotid Lobe Lesions in the Pediatric Population. Laryngoscope Investig Otolaryngol 2019; 4:550-553. [PMID: 31637300 PMCID: PMC6793612 DOI: 10.1002/lio2.302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To describe and investigate facial nerve displacement in deep lobe parotid lesions in children and to determine clinical and radiographic predictors of abnormal facial nerve position. Methods Retrospective case review of children who underwent total parotidectomy for deep lobe parotid lesions at a tertiary care center between January 2014 and December 2017. Aberrant facial nerve trajectory was defined as ascension of the nerve at an angle of 45° or greater. Elongation was defined as the main trunk >2 cm in length. Patient demographics, radiographic, pathologic results, postoperative nerve weakness, and intraoperative nerve findings were collected. Wilcoxon rank‐sum test and Fisher's exact test were used to assess the associations between variables of interest and facial nerve position. Results A total of 20 patients were included. The mean age was 7.7 ± 5 years. The most common pathologies were lymphatic malformation, pleomorphic adenoma, and first branchial cleft cyst. Twelve out of twenty (60.0%) patients had abnormal intraoperative facial nerve position. There was no significant difference in distribution of pathologies between those with or without an abnormal intraoperative nerve position (P = .41). Neither radiographic lesion size nor distance between the lesion and proximal portion of the facial nerve (mastoid tip) were associated with abnormal facial nerve position intraoperatively. Conclusion Pediatric deep lobe parotid lesions can displace the facial nerve and distort its anatomy in a posterior lateral direction, in approximately 60% of patients. Statistical analysis of increased numbers of patients to further define predictors of aberrant nerve course is warranted. Level of Evidence 4.
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Affiliation(s)
- John Maddalozzo
- Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Luire Children's Hospital of Chicago Chicago Illinois U.S.A
| | - Douglas R Johnston
- Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Luire Children's Hospital of Chicago Chicago Illinois U.S.A
| | - Andre Isaac
- Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Luire Children's Hospital of Chicago Chicago Illinois U.S.A
| | - Bharat Bhushan
- Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Luire Children's Hospital of Chicago Chicago Illinois U.S.A
| | - Jeffrey C Rastatter
- Division of Pediatric Otolaryngology-Head and Neck Surgery Ann & Robert H. Luire Children's Hospital of Chicago Chicago Illinois U.S.A
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Eide J, Isaac A, Maddalozzo J. Facial Nerve Duplication and First Branchial Cleft Cysts: An Association in an Uncommon Pathology. Otolaryngol Head Neck Surg 2019; 161:904-905. [PMID: 31262223 DOI: 10.1177/0194599819861341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacob Eide
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - André Isaac
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - John Maddalozzo
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Castellanos A, Scangas GA, Naunheim MR, Raol N, Cohen MS. Avoiding surgical pitfalls during resection of a "hybrid" first and second branchial cleft cyst - A case report. Int J Pediatr Otorhinolaryngol 2016; 87:91-3. [PMID: 27368450 DOI: 10.1016/j.ijporl.2016.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Angela Castellanos
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096, United States; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States.
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Bifid Facial Nerve Trunk: Anatomic and Surgical Considerations. J Craniofac Surg 2016; 27:e541-3. [PMID: 27428907 DOI: 10.1097/scs.0000000000002858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The segment of the facial nerve (FN) between its emergence from the skull through the stylomastoid foramen and its bifurcation at the parotid area is referred to as the FN trunk (FNT). Injury to the facial nerve trunk is among the most undesirable outcomes following different otologic, plastic, maxillofacial, and neurosurgical procedures. These procedures frequently involve manipulation and isolation of this segment, and meticulous dissection should be practiced to avoid iatrogenic damage to the nerve. Identification and exposure of the FN trunk, however, may be difficult because it is surrounded by dense connective tissue. This dissection becomes even more difficult and risky when the normal anatomy is distorted.During a routine left conservative superficial parotidectomy of a Pleomorphic Adenoma in the superficial lobe of the left parotid gland, duplication of the FNT was encountered. The FNT after its exit through the stylomastoid foramen, split into 2 main divisions, which rejoined before its penetration into the parotid gland. To the best of our knowledge, this variation has not been previously reported.
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