Comprising less than 3% of all head and neck neoplasms, eighty per cent of salivary gland tumors present as benign tumors, and the most common histopathological diagnosis is pleomorphic adenoma. The treatment of choice is surgery. As pleomorphic adenoma has a tendency to recur, as well as a potential for transformation into malignancy, thorough removal of the tumor via superficial and/or deep parotidectomy is warranted. It is a technical challenge to surgeons to excise the tumor and preserve the integrity of the facial nerve in parotid gland surgeries. Often, important anatomical landmarks will be chosen as reference points, including the landmark about 1 to 1.5 cm beneath the tragal point, and the anatomical relationship between the facial nerve and the retromandibular vein. In this report, we present a rare case of benign pleomorphic adenoma, in which both the upper and lower divisions of the facial nerve are located below the retromandibular vein, in contrast to the usual location of the facial nerve above the retromandibular vein.
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