Background & Importance: Primary hemifacial spasm is usually caused by microvascular compression of the facial nerve at its root exit zone at brainstem without any space-occupying pathology. Secondary or so-called symptomatic hemifacial spasm has an additional underlying pathology e.g. tumors leading to the microvascular compression. We review and discuss the pathophysiology and the literature of secondary hemifacial spasm.

Case Presentation: We report on a 23 year-old man with a secondary right-sided hemifacial spasm in association with an ipsilateral epidermoid tumor of the cerbello-pontine angle.

Conclusion: Intraoperatively, no offending vessel was observed near the root exit zone of the facial nerve. Microsurgical tumor removal relieved the patient also from his hemifacial spasm.

Background & Aim: Various landmarks are discussed to find the facial nerve during parotid surgery. The surgeon should use existing landmarks for a safe surgical use. To evaluate two new landmarks in parotid surgery, this study was done.

Methods & Materials/Patients: This cross-sectional study was conducted on 43 patients with parotid masses, whom were referred to Alzahra and Kashani tertiary hospitals in 2013. In a parotid surgery, the greater auricular nerve was detected; then the greater auricular nerve and facial nerve diameter were measured by the compass with precision of 0.1 millimeter and recorded. After facial nerve exploration, if the other landmarks of vascular and tail signs are detected, they are recorded in the files.

Results: This study contained 43 patients, 22 men and 21 women. There were 21 (48.8%) masses in deep lobes and others on superficial lobes. In 36 cases (83.7%), vascular signs were observed. In 23 cases (53.5%), tail signs were found. The diameter of facial nerve was 2.647(±4641) mm (minimum: 2 mm and maximum: 4 mm). The diameter of greater auricular nerve was 2.691(±4545) mm (minimum: 2 mm and maximum: 4 mm). By paired T-test, there was no significant difference between the diameter of facial and greater auricular nerves. Of all cases, 76.7% had differences less than 0.5 mm. Conclusion: This study showed that greater auricular nerve can be used as a proper graft for facial nerve, and we can use “vascular sign” as a good indicator of facial nerve.