Lateral approaches
Between 2015 and 2017, prestyloid surgery at our center was based on a
lateral approach. The transcervical approach involves a 4-cm transverse
skin incision; once the digastric posterior belly and the stylohyoid are
recognized, the stylomandibular ligament is cut to improve exposure. The
dissection continues toward the head and the inferior and posterior PPS
can be exposed.9 The trancervical-transparotid
approach identifies the facial nerve and reaches the deep parotid lobe
and the lateral prestyloid space.10 The
transcervical-transmandibular approach adds a mandibular osteotomy,
making it possible to reach the upper PPS. Facial nerve intraoperative
neuromonitoring using the AVALANCHE system (Dr. Langer Medical GmbH,
Waldkirch, Germany) with four channels was used with these lateral
approaches.