Anatomical and Surgical Landmarks for Facial Nerve Identification During Parotidectomy: A Critical Narrative Review of Reliability, Clinical Utility, and Operative Decision-Making

Background: Facial nerve identification during parotidectomy requires interpretation of complementary landmarks. This critical narrative review distinguishes anatomical proximity from operative accessibility and evidence of improved facial nerve preservation. Methods: PubMed/MEDLINE, Scopus and Web of Science were searched through 7 October 2026, with a further search during revision and records reconciled on 2 November 2026. Two authors screened the literature and evaluated study methods and clinical applicability. Screening of 7157 deduplicated November records added no studies. The final bibliography contains 80 distinct publications; 22 principal morphometric reports are tabulated with cadaveric and intraoperative measurements separated. Results: Reported landmark distances depend on reference points, neural endpoints and study setting. Mean tympanomastoid suture–trunk distances differed from 2.5 mm in one cadaveric series to 10.0 mm in another. In 32 operations for benign superficial-lobe masses, the tragal pointer, posterior belly of digastric and suture were exposed in 32, 26 and 25 cases, respectively. Comparative evidence on dissection direction predominantly concerns benign disease, limiting extrapolation to revision, malignant and irradiated fields. Conclusions: Complementary landmarks support anatomical orientation, but proximity and concordance do not establish a safe dissection plane or improved postoperative function. The proposed operative framework integrates landmark reassessment, alternative identification routes and adjunctive stimulation; it remains unvalidated and requires prospective evaluation against operative and functional outcomes.