{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:03:11Z","timestamp":1784538191225,"version":"3.55.0"},"reference-count":70,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: The facial nerve (FN) possesses one of the most intricate anatomical courses in the head and neck, traversing the brainstem, temporal bone, and parotid gland before terminating within the muscles of facial expression. Owing to its complex anatomy, marked anatomical variability, and frequent distortion by adjacent pathology, preservation of FN integrity remains a fundamental challenge in skull base, otologic, and head and neck surgery. This review aims to provide a comprehensive synthesis of the contemporary literature regarding the clinical anatomy of the FN and to examine how anatomical variation, pathology-induced distortion, surgical strategy, and emerging technologies influence nerve preservation and functional outcomes. Methods: A comprehensive narrative review of the literature was conducted using PubMed, Scopus, and Google Scholar. Publications from 1983 through 2026 were searched using combinations of keywords, including \u201cfacial nerve,\u201d \u201cfacial nerve anatomy,\u201d \u201canatomical variation,\u201d \u201cvestibular schwannoma,\u201d \u201chemifacial spasm,\u201d \u201cparotid surgery,\u201d \u201cfacial nerve injury,\u201d \u201cfacial nerve reconstruction,\u201d \u201cfacial reanimation,\u201d \u201cdiffusion tensor imaging,\u201d \u201cintraoperative neurophysiological monitoring,\u201d and \u201cartificial intelligence.\u201d Peer-reviewed anatomical, radiological, clinical, and review articles published in English were included, while conference abstracts and studies lacking direct anatomical or surgical relevance were excluded. Particular emphasis was placed on surgically relevant anatomical variations, pathology-related anatomical distortion, advanced imaging modalities, intraoperative neurophysiological monitoring, reconstructive techniques, and predictors of postoperative facial nerve function. Results: Facial nerve preservation was found to depend on the interplay between individual anatomical variability, disease-related anatomical distortion, and operative strategy. In vestibular schwannoma surgery, nerve displacement, capsular adhesion, and cystic tumor degeneration were consistently associated with increased surgical complexity and less favorable postoperative facial function. In hemifacial spasm, successful microvascular decompression relied on precise identification of neurovascular conflict at the root exit zone. Within the parotid gland, substantial variability in branching architecture and surgical landmarks contributed to an increased risk of iatrogenic injury. Advanced imaging techniques, particularly diffusion tensor imaging tractography, improved preoperative prediction of FN location, while intraoperative neurophysiological monitoring enabled real-time assessment of neural integrity and functional preservation. Emerging artificial intelligence-based predictive models demonstrated potential to enhance patient-specific surgical planning and prognostication. Conclusions: Contemporary facial nerve surgery has evolved toward an individualized, anatomy-driven, and function-preserving paradigm supported by advanced imaging, intraoperative monitoring, and reconstructive strategies. Detailed understanding of both normal FN anatomy and pathology-induced anatomical distortion remains essential for optimizing surgical decision-making, maximizing nerve preservation, and improving long-term functional outcomes. Future developments integrating multimodal imaging, predictive analytics, and artificial intelligence may further refine patient-specific management and enhance postoperative facial function.<\/jats:p>","DOI":"10.3390\/jcm15145622","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:54:13Z","timestamp":1784534053000},"page":"5622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Facial Nerve in Contemporary Surgery: Anatomical Variability, Pathology-Induced Distortion, and Functional Preservation"],"prefix":"10.3390","volume":"15","author":[{"given":"Piotr","family":"\u0141ab\u0119towicz","sequence":"first","affiliation":[{"name":"Department of Forensic Medicine, Pathology and Histology, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"},{"name":"VARIANTIS Research Laboratory, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Szczerba","sequence":"additional","affiliation":[{"name":"Department of Clinical Anatomy, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"},{"name":"VARIA Research Laboratory, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0141ukasz","family":"Olewnik","sequence":"additional","affiliation":[{"name":"VARIANTIS Research Laboratory, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"},{"name":"Department of Clinical Anatomy, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5544-0425","authenticated-orcid":false,"given":"Nazar","family":"W\u0142odarczyk","sequence":"additional","affiliation":[{"name":"VARIA Research Laboratory, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"},{"name":"Department of Interventional Radiology, Medical University of Lodz, 90-419 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3035-8962","authenticated-orcid":false,"given":"Kuba","family":"Borowski","sequence":"additional","affiliation":[{"name":"VARIA Research Laboratory, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"},{"name":"Clinic of Orthopaedic and Paediatric Orthopaedics, Medical University of Lodz, 90-419 \u0141\u00f3d\u017a, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2374-5392","authenticated-orcid":false,"given":"Ingrid C.","family":"Landfald","sequence":"additional","affiliation":[{"name":"VARIANTIS Research Laboratory, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"},{"name":"Department of Clinical Anatomy, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"},{"name":"VARIA Research Laboratory, Mazovian University in P\u0142ock, 09-402 P\u0142ock, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1017\/S0022215114000541","article-title":"Factors affecting final facial nerve outcome following vestibular schwannoma surgery","volume":"128","author":"Moffat","year":"2014","journal-title":"J. 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