Modification of LeFort I Osteotomy for Correction of Severe Maxillary Cant Associated With Fibrous Dysplasia.

Differential superior reposition of maxilla following LeFort I osteotomy in the correction of maxillary cant poses a greater challenge especially when associated with the pathology like fibrous dysplasia which completely obliterates the antrum. Purpose of this paper is to highlight the modification of LeFort I osteotomy and hypothesis is to assess its difficulty index in modifying the standard steps, in executing the maxillary separation at various to correct the gross facial asymmetry to achieve a favorable outcome. Multiphased management involved scrupulous clinical planning, advanced imaging by computed tomgraphy scans, stereolithographic models to debulk the lesion. The second phase included pre surgical orthodontic evaluation along with correction of severe maxillary cant adopting a modified LeFort 1 osteotomy technique and standard bilateral sagittal split osteotomy, thereby simultaneously attaining functional stability and esthetic harmony.

Unusual Gigantiform Angiomatosis of Jawbone.

ABSTRACT: The purpose of this paper is to highlight rare highly infiltrative massive Angiomatosis and depict surgical outcome of a rare case series of gigantic lesions in the maxillofacial region. Data were recorded from the medical records of patients. Predictor variables were drawn from demographics, age, gender, site, evaluation of surgical treatment. The outcome variables were the challenges encountered and related complications. Out of 6 patients, the youngest was 10 and the oldest was 26 years old. Soft tissue and jawbone involvement were seen in 3 patients each with a single massive lesion involving both maxilla and mandible. All 6 patients had wide excision of the lesion with one patient having 2 stage procedures. No complications or recurrence was seen at 1-year follow-up. Angiomatosis is a rare and benign lesion in the head and neck region. its diffuse infiltrating nature may give a false malignant picture. it clinically mimics Hemangioma or Arteriovenous (AV) malformation thus requires thorough evaluation and its surgical intervention is challenging as described in this case series because of its magnitude and infiltrative nature.

Role of Distraction Osteogenesis in the Management of Postankylotic Deformity.

INTRODUCTION: Distraction osteogenesis (DO) has evolved in maxillofacial surgery and gained popularity due to the limitations of orthognathic surgery in gross asymmetry cases. PURPOSE: The primary aim of the paper was to determine if the use of DO for the management of severe deformities of the mandible secondary to temporomandibular joint ankylosis can achieve optimal results, with or without genioplasty, based on cephalometric norms. The secondary aim of this study was to evaluate the complications associated with DO in this group of patients. MATERIALS AND METHODS: Six patients with postankylotic deformity were included. Both internal and external devices were used for an average mandibular corpus lengthening of 15 mm with adjunctive procedure genioplasty. RESULTS: All patients had excellent outcome in terms of profile, functional occlusion, and mouth opening without deviation. Two patients had primary genioplasty showed excellent compliance and 2 as secondary at the time of device removal. Complications noted were, difficulty in vector control during distraction, paresthesia, occlusal discrepancy, scarring, and relapse of 2 to 3 mm. Preorthodontics and postorthodontics were done in all patients to settle the occlusion, which was stable after 2-year follow-up. CONCLUSIONS: Case series shows such gross deformities pose a greater challenge due to undergrowth, gross midline shift, and discrepancy between soft and hard tissue growth pattern and the desired results can be achieved by precise planning. Genioplasty at the time of device placement has definitive positive effect on patient compliance. Though orthognathic surgery has a definitive role in minor deformity, whereas in gross deformities DO with precise planning using 3-dimensional model and vector controlled technique offers excellent outcome.

Occlusal Analysis Using T-Scan in Patients With Condylar Fractures When Managed by Closed Method.

The aim of the study is to assess the occlusion in mandibular condyle fractures using T-Scan and analyze the data obtained. Twenty patients underwent non-surgical management for condylar fractures were treated with Erich arch bar and guiding elastics, and periodically subjected to T-Scan III evaluations. The data obtained was analyzed with the clinical evaluation conducted. There were 18 males and 2 females. Mean age of the patients was 25.4 ±â€Š7.4 years. There were statistically no significant changes in Centre of Force values, in Bite Force at First Contact (P < 0.05) during the study period. There were significant differences in Maximum Bite Force between preoperative and postoperative values, preoperative and sixth-month values, postoperative and first-month values, first-month and sixth-month values. There were significant (P < 0.05) differences in Bite Force at Maximum Intercuspation between preoperative and third month, preoperative and sixth-month values, postoperative and sixth-month values, first-month and consequent follow-ups. Subjective evaluation of occlusion revealed significant differences (P < 0.05) between preoperative and 1-month, preoperative and postoperative, postoperative and 1-month values. All patients improved by the end of 6 months with regards to their mouth opening. The center of force does not alter significantly in post trauma period. Mouth opening improves significantly at the end of 6-month period post-operative. Improvement in maximum bite force and maximum intercuspation take place simultaneously. Mouth opening improved significantly. Subjective evaluation of occlusion does not change significantly after the third month evaluation. Longer follow-ups would help us in understanding when or if the bite forces equilibrate after a condylar trauma.

Are Facial Asymmetry and Condylar Displacement Associated With Ramal Height and Treatment Outcomes in Unilateral Condylar Fracture When Managed by the Closed Method?

PURPOSE: This study measured the mandibular ramal height in patients with unilateral condylar fractures managed by the closed method using elastic intermaxillary fixation. Its correlation with facial asymmetry and condylar displacement was assessed. This will determine whether the treatment outcome is in favor of the closed or open method. MATERIALS AND METHODS: A prospective cohort study was performed. The study included patients with unilateral condylar fractures who reported to SDM Craniofacial Surgery and Research Centre, Dharwad, India. All patients in the study were managed by the closed method (nonsurgically using arch bars and elastic intermaxillary fixation). Standardized panoramic radiographs were used to assess ramal height and condylar displacement in the sagittal plane. Posteroanterior mandible and reverse Towne radiographs were used to assess facial asymmetry and condylar displacement in the coronal plane before treatment; immediately after treatment; and at 3, 6, and 12 months of follow-up. Data were subjected to statistical analysis using the analysis-of-variance test and the Pearson correlation coefficient method. RESULTS: The study included 25 patients with unilateral condylar fractures managed by closed treatment; they showed a significant reduction in ramal height on the affected side by 1.15 mm (P = .0001) at 12 months' follow-up. The change in facial asymmetry was reported as 1.05 mm (P = .0016) at 12 months' follow-up. Its correlation with ramal height was noted to be insignificant (P = .07). The only significant correlation noted between facial asymmetry and condylar displacement was in the coronal plane at 12 months' follow-up (P = .04). CONCLUSIONS: A weak positive correlation was noted among the assessed values on radiographs obtained during the 12-month follow-up. Facial symmetry was not greatly affected when the ramal height at the time of injury on the fractured side was reduced by 3.25 ± 0.6 mm.

Incidence and Treatment Protocol for Maxillofacial Fungal Osteomyelitis: A 12-Year Study.

PURPOSE: The aim was to retrospectively determine the incidence of fungal osteomyelitis and outcome of the surgical protocol and complications. MATERIALS AND METHODS: Data were recorded from the medical records of patients treated from 2006 to 2018. Predictor variables were drawn from demographic characteristics (age and gender), etiology, most common site, associated comorbidities involved, and treatment protocol followed. The outcome variables were the success rate and associated complications. RESULTS: We identified 50 patients with fungal osteomyelitis out of 153 who were treated for various types of osteomyelitis for 12 years. The incidence was 32.6%; men were affected more than women, at a ratio of 2.5:1; and most common site was the maxilla (56%), followed by the mandible (32%) and other sites (12%). Treatment protocols were dependent on the nature of the lesion, site, and optimization of underlying comorbid conditions. The outcome of our protocol showed that 28 patients (56%) healed well. Patients with complications such as palatal fistula (13 [26%]) underwent revision surgery using a local advancement flap and the buccal fat pad. During the immediate postoperative period, 2 patients (4%) had wound dehiscence; 2 patients (4%) had nasal regurgitation; and 1 patient (2%) had a reduced mouth opening that was managed with a mouth-opening exercise regimen. In 1 patient (2%) with recurrence, secondary correction was performed after 6 months and postoperative antifungal therapy was administered for 3 months. CONCLUSIONS: The incidence of fungal osteomyelitis was high owing to associated comorbidities. The surgical outcome was markedly influenced by a prompt diagnosis based on the clinical presentation and histopathology, identification and optimization of comorbidities, correction of electrolyte imbalances, 2 doses of amphotericin B preoperatively under an intensive care unit setup, intraoperative collection of specimens for fungal culture by a microbiologist, curettage and debridement of the soft tissue and bone, closure of the defect with either a local or regional flap, and postoperative antifungal therapy.

Orbital Observation Chart: Significant in Orbital Fractures or Not?

PURPOSE: The study was conducted to assess the efficacy of orbital chart in detecting postoperative complications of orbital fractures. MATERIALS AND METHODS: A retrospective study was conducted in the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2011 to December 2016. It included all the patients with orbital fractures who underwent surgical intervention for reduction of the fracture in the study. We recorded data for the type of fracture, type of intervention, and orbital and ocular changes. Orbital changes measured and charted for 5 parameters which were: pain, proptosis, visual acuity, size of the pupil, and pupillary reaction to direct light reflex. RESULTS: Two hundred thirty-six patients with orbital fractures underwent surgical intervention during these 5 years. The prevailing type of fracture for which they required orbital intervention remains zygomatic complex fractures (69%). The treatment protocol depended on the pattern and displacement of fracture and age of the patient. Pain was the most common symptom among these parameters (15.7%). CONCLUSION: Orbital chart monitoring represents a straightforward and effective method to detect any complications after surgical management of orbital fractures.

Histological Assessment of the Carotid Sheath in Patients With Oral Squamous Cell Carcinoma.

PURPOSE: During surgical management of the neck using various types of neck dissection, the carotid sheath is removed, in particular, the part adjacent to the jugular lymph node chain, with the intention of preventing recurrence from the lymphatics present within it. The role of the carotid sheath as a potential origin for nodal recurrence has not been proved thus far. Working in a tissue plane between the carotid sheath and the neurovascular structures of the neck can lead to a greater chance of damage to these structures. Also, the carotid sheath is a strong fibroelastic tissue barrier that shields the internal jugular vein and carotid artery from saliva and local infection during the postoperative period. Thus, this study investigated the histopathology of the carotid sheath in patients with oral squamous cell carcinoma (OSCC) and assessed the pathologic infiltration of the carotid sheath when grossly uninvolved. PATIENTS AND METHODS: Pathologic infiltration and histopathologic characteristics of the entire length of the carotid sheath were assessed in 30 biopsy-proved cases of OSCC; these patients underwent surgical excision of the lesion in addition to neck dissection from 2013 to 2015 in the craniofacial unit of the authors' institution. RESULTS: The carotid sheath consisted of fibrofatty tissue and interspersed nerve bundles. Neutrophilic infiltration and dilated lymphatic channels were seen in all 30 cases. Miniature lymph nodes adherent to the carotid sheath were seen in 5 cases and some lymphoid aggregates were seen in 15 cases. The carotid sheath in all 30 cases (metastatic and nonmetastatic) was free from tumor deposit and lymphatic tumor emboli, which are indicators of tumor cell infiltration. CONCLUSION: Indicators of tumor cell infiltration were not found in any of the 30 cases. The result did not vary with the age or gender of the patient, tumor size, location, staging or grading of the tumor, or even when there were metastatic lymph nodes in the gross specimen. Hence, the role of the carotid sheath as a potential origin for nodal recurrence is questionable and its removal needs reconsideration.

Functional and Aesthetic Outcome of Macgregor and Z Plasty (Step Ladder) Approach for Lip Splitting in Oral Squamous Cell Carcinoma.

Purpose: The aim of the study is to compare the functional and esthetic results of two lip splitting approaches-McGregor incision and stepladder Z plasty for surgical resection of primary Oral Squamous cell carcinoma (OSCC). Method: Prospective study involved 24 patients who had modified radical neck dissection for OSCC between 2018 and 2020. Predictor variables were drawn from demographic characteristics (age and gender), primary site, extent of the primary lesion. Patients were divided into two groups randomly with group I McGregor lip splitting incision and group II step ladder Z plasty, with subjective and objective assessment. Results: In the overall comparison of the oral incontinence between the two groups, there was no statistically significant results. Z plasty group had better outcome with lesser degree of drooling and good cosmesis. There was no difference between the speech efficiency between the two groups. Subjective assessment of the appearance of lips and face was better in Z plasty group. Subjective assessment of inversion and eversion was better in McGregor group. Cosmesis was assessed objectively by Stony Brook Scar Evaluation Scale (SBSES). Group 1 had a mean score of 2.92 out of 5 and Group II mean score of 4.08 out of 5. Cosmesis was better in Z plasty group. Conclusion: Z plasty was found as a superior option when it comes to cosmesis due to its geometric nature which allows accurate approximation. McGregor offers better functional outcome in terms of lip movement and oral incontinence.

Comparative Study of the Efficacy of Low-Level Laser Therapy and Dexamethasone in Reducing the Severity of Post-Operative Inflammatory Response Following Surgical Extraction of Mandibular Third Molars.

Objectives: To assesses the efficacy of low-level laser therapy (LLLT) over dexamethasone in reducing postoperative edema and trismus following surgical removal of mandibular third molars. Study design: A single-center, parallel group, randomized, prospective, single-blind clinical trial on 50 patients between the age 18-40 years, requiring surgical extraction of mandibular third molars classified as mesioangular, class II and position B impactions, was selected for the study. The selected patients were randomly divided into two groups:Group 1, n = 25, Soft Tissue Diode laser was applied intra-orally and extra-orally at the insertion of the masseter.Group 2, n = 25, 8 mg of Dexamethasone was given intravenously preoperatively.Trismus and edema were calculated preoperatively and on the 1st and 5th postoperative day. The collected data were subjected to statistical analysis using student's t test. Results: Trismus (4.61 ± 0.26 cm [p = 0.0001]) in the LLLT group was significantly less than the dexamethasone group (trismus: 3.82 ± 0.73 cm). Edema at different anatomic locations in the LLLT group was also significantly less than the dexamethasone group (Angle-tragus [p = 0.0008], angle-canthus [p = 0.0021], angle-ala [p = 0.0258], angle-commissure [p = 0.0168], angle-mentus [p = 0.0227]). Conclusion: This study demonstrates that LLLT was beneficial in reduction in edema and trismus compared to dexamethasone following surgical extraction of third molars.

Single perforator-based anterolateral thigh flap, the workhorse flap, in oral cancer reconstruction: A tertiary care institution experience.

Background: Ablative procedures of the oral cavity require composite removal of tissues, which results in compromise of both functional activities and esthetic mutilation and proves to be a reconstructive challenge. This paper focuses on the reliability and versatility of a single perforator-based anterolateral thigh (ALT) flap in oral cancer reconstruction. Materials and Methods: All patients who underwent reconstruction with a single perforator-based ALT for oral cancer defects at our center were included in the study. Results: Forty-seven patients who underwent reconstruction with a single perforator-based ALT flap were included in our study. The average flap size in our series was 111 cm2, with the largest measuring 375 cm2. They was a complete loss of flap in two patients; both of them underwent salvage procedure and were reconstructed with pectoralis major myocutaneous flap. One had a partial loss that underwent re-exploration. Conclusion: We conclude that a single perforator-based ALT is a very safe, reliable, and versatile flap for head and neck reconstruction. The microvascular anastomosis may be expensive and technically a limitation; however, it has found a permanent place in our head and neck reconstructive toolkit and is the workhorse flap for head and neck reconstruction.

Incidence and Clinical Analysis of Complications of Neck Dissection.

The aim of the study was to assess and evaluate the incidence of complications related to type of neck dissection to different variables. Retrospective study was conducted on patients who reported to our craniofacial centre between 2010 and 2019 and underwent neck dissection for evaluation of complications related to it. Records of all patients were analysed for complications which were alienated into intra-operative, immediate post-operative (within 10 days) and post-operative complications. 256 patients, 141 male and 115 female aged between 25 and 70 years operated for squamous cell carcinoma were included. The overall incidence of complications was 32.8%. Intra-operative complications were haemorrhage 14%, nerve injury 5.4%, inadvertent internal jugular vein ligation 0.3%, chyle leak 0.3%. No incidence of carotid blow out. Immediate post-operative complications were hematoma formation 7%, salivary fistula in 2.3% and re-exploration was done in 1.5% cases. Post-operative complications noted were wound dehiscence in 22.6%, infection in 20.7%, hematoma in 2.7%, salivary fistula in 11.7% and nerve injury in 0.3% cases. Neck dissection is a challenging and therapeutic procedure. Prevention of major complications like carotid blow-out, injury to brachial plexus, vagus nerve or hypoglossal nerve requires thorough knowledge of neck anatomy.

Grossly Depressed Frontal Bone Fracture in a Paediatric Patient: A Case Report.

This study highlights the management of a grossly depressed frontal bone fracture with obvious deformity in a paediatric patient as facial fracture management is frequently intricate and challenging, particularly within the paediatric population as compared to adult. Paediatric fractures have a greater capacity to remodel, but the paediatric brain and craniofacial skeleton are still developing which puts the children at risk for unique complications, such as growing skull fractures.

Role of coronoidectomy and temporalis myotomy in surgical management of oral submucous fibrosis.

PURPOSE: The involvement of temporalis muscle fibers by oral submucous fibrosis (OSMF) and the procedure of coronoidectomy and temporalis myotomy in the surgical treatment protocol for the disease is a controversy. The primary objective of this study is to evaluate the histopathological changes in temporalis muscle fibers in patients undergoing surgical treatment for OSMF and to authenticate the importance of temporalis myotomy and coronoidectomy in surgical treatment protocol. METHOD: A 3-year prospective study was conducted to assess the histopathological changes in temporalis muscle in surgically treated OSMF cases. The predictor variables were drawn from demographic characteristics (age and gender) etiology, and mouth opening. The outcome variables were histopathological assessment of temporalis muscle fibers for parameters suggestive of degenerative changes and fibrosis changes at cellular level. RESULTS: Out of 56 patients, 30 patients were had surgical intervention. Twenty-eight (93.3%) were male and 2 (6.6%) were female with a ratio of 14:1. Histopathological examination of temporalis muscle fibers revealed hyalinization of muscle fibers in 80% of the patients followed by loss of striation (73.33%), fragmentation (60%), nucleus internalization (33.33%), infiltration of macrophages and other inflammatory cells (20.67%), multiple nuclei (20%), and swollen muscle fibers (6.67%). Mean preoperative mouth opening was 12.4 and post-operatively 41.3 mm on 1-year follow-up and this was stable on further follow-up. CONCLUSION: The results of this study suggest involvement of temporalis muscle with disease itself and the justification for coronoidectomy and temporalis myotomy in the surgical protocol was established.

Phosphaturic Mesenchymal Tumor in the Maxillofacial Region: A Diagnostic Dilemma.

Oncogenic osteomalacia is a rare paraneoplastic syndrome and is associated with the presence of phosphaturic mesenchymal tumor (PMT) which results in renal phosphate wasting with hypophosphatemia. In total, 95% of cases reported in upper and lower extremities and in head and neck are a rare site for these tumors. Besides osteomalacia, the clinical presentation includes bone pain and multiple bone fractures. Only fewer cases of PMT are reported in the oral cavity. The presentation of this rare case in a young patient was palatal swelling mimicking like an abscess which was clinically and by advanced imaging evaluated and histopathological findings confirmed the rare presentation. Following the surgical excision, the serum level of FGF23 rapidly decreased, hypophosphatemia improved, and the clinical symptoms greatly improved. The result suggests that the overexpressed FGF23 primary tumor in the palate was the cause of osteomalacia which is a rare entity.

Correction to: Phosphaturic Mesenchymal Tumor in the Maxillofacial Region: A Diagnostic Dilemma.

[This corrects the article DOI: 10.1007/s12663-020-01496-8.].

Does Pectoralis Major Myocutaneous Flap Cause the Shoulder Morbidity: A Clinical Comparative Study.

The aim was to compare the morbidity of shoulder function following modified radical neck dissection with and without Pectoralis Major Myocutaneous muscle flap (PMMC) harvest in head and neck cancer patient to determine the effect of PMMC flap harvest on shoulder function and also to determine the effect of physiotherapy. Materials and methods: Prospective study involving two groups study group of 20 patients with MRND, with PMMC flap reconstruction as part of head and neck cancer surgery and control group of 20 patients who had undergone MRND(IJV & SAN sparing) without PMMC flap in same period were included. All patients were assessed at 3rd and 6th month following completion of surgery using subjective (Shoulder Disability Questionnaire) and objective (goniometer and manual muscle testing) parameters. 40 patients were included in the study, 33 (82.5%) male and 7 (17.5%) female with a mean age of 49 years with stage III/IV carcinoma In Group-1 and Group-2 the shoulder disability decreased significantly after physiotherapy intervention and also at 6thmonth postoperatively both groups showed improvements in shoulder range of motion and muscle strength. Harvesting of PMMC flap does not intensify the morbidity of shoulder which is common in RND and during MRND. A regimen of home-based exercises and patient education are effective tools to reduce shoulder disability and improving shoulder function.

Cephalometric analysis of parents of patients with cleft lip and/or palate.

BACKGROUND: Cleft lip and/or palate (CL ± P) or isolated cleft palate (CP) are the most common congenital malformations of the face. Although there have been advances in prenatal diagnosis and the discovery of genetic markers, there has been no breakthrough in the identification of parents at risk of giving birth to a child with a cleft. AIMS: To determine a possible phenotypic difference in the craniofacial morphology of parents of children with CL ± P and to investigate whether cephalometric analysis can help identify parents at risk of giving birth to a child with a cleft. METHODS: Cephalometric data of 25 sets of parents having children with CL ± P were compared with that of 25 sets of parents of children without CL ± P. The study population was indigenous to North Karnataka. In all, 10 linear, 2 angular, and 5 triangular measurements were made on lateral cephalograms and compared using an unpaired t­test. RESULTS: The length of the posterior cranial base (S-Ba) in mothers was smaller in the study compared to the control group. Total facial height (N-Me) both in fathers and in the group with both parents, upper facial height in the group with both parents, and lower facial height (ANS-Me) in fathers was smaller in the study than in the control group. The area of the nasopharyngeal triangle (S-PNS-Ba) in mothers and that of the anterior maxillary triangle (S-N-A) in fathers was smaller in the study group than in the control group. CONCLUSION: Parents of children with CL ± P showed variations in craniofacial morphology. Future research correlating cephalometric findings with genetic studies may indicate whether cephalometric analysis can be an adjunct to genetic tests for risk prediction among susceptible parents.

Acantholytic variant of squamous cell carcinoma in the mandible: A rare entity and a brief review.

Acantholytic Squamous Cell Carcinoma (ASCC) is an uncommon histopathologic variant of Squamous Cell Carcinoma which occurs in the sun-exposed skin and rarely in the oral cavity. Although the World Health Organization (WHO) has defined ASCC as a unique entity, its occurrence in the oral cavity has been just about 60 cases in the literature. There have been cases reported in the lips, tongue, gingiva and maxillary alveolus but rarely in the mandible. Definitive diagnosis and treatment of such a rare condition is challenging as there are not much available data in the literature. We report a rare case of Acantholytic Squamous cell carcinoma with pathologic fracture of the mandible which was managed aptly considering its hostile clinical, radiological and histological presentation. The reconstruction was done using a vascularised free fibula graft which helped in achieving a functional and aesthetic rehabilitation for the patient thereby improving his quality of life.

Variations in the Anatomy of Spinal Accessory Nerve and its Landmarks for Identification in Neck Dissection: A Clinical Study.

PURPOSE: To assess the anatomy of the spinal accessory nerve (SAN), its variations and the landmark of level II B lymph nodes. METHODS: Prospective study included 50 patients from 2016 to 2018.The predictor variables were drawn from demographic details of the patients; SAN was analyzed intraoperatively with the parameters like the nerve relationship with the IJV, SCM muscle, contributions of cervical plexus and a new parameter of length from midpoint of clavicle to entry of nerve in the trapezius muscle in the lower part of neck which was studied for the first time and forms the prime identification landmark to preserve the nerve. Outcome variables were details of anatomic variations and branches and utility of these landmarks in prevention of nerve injury. RESULTS: Sample consisted of 38 (76%) male and 12 (24%) female patients. The SAN with respect to the IJV was dorsal in 42% patients and ventral in 58%. In 54% cases, SAN gave a branch to the SCM without penetrating the muscle and in 46% gave a branch to the SCM penetrating the muscle. SAN received contributions from the C2 root of the cervical plexus in 68%, both C2 and C3 in 54% and C3 in 50% cases. Mean length from measurements recorded between mid-line of clavicle to insertion of SAN to trapezius muscle and entry of SAN into trapezius muscle was 59 mm with variations recorded in gender and short/long neck. CONCLUSION: The result of this study suggests that parameters used are simple clinical tools for identification of the SAN and its variations resulting in no nerve injury. It is prudent for the surgeon to have knowledge of sound anatomical landmarks with the variations in the SAN course which avoids morbidity and improves the quality of life.