Because facial nerve paralysis can have a devastating functional and psychological impact, accurate surgery involving the facial nerve is essential. Consequently, I appreciate the attempt of Pereira et al1 to add to the literature on improving localization of the facial nerve. However, many limitations to their study relating to their assumptions, incision, measurements, and technique need to be mentioned.
The authors assume that the soft-tissue measurements obtained in fresh (n = 15) and formaldehyde-preserved (n = 25) cadaver dissections will be transferable to living patients. However, postmortem changes due to dehydration, gravity, and fixation will alter soft-tissue measurements2,3 (B. J. Schmitt, MS, personal communication, December 2003).