Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearance

Batstone, Martin; Scott, B.; Lowe, Derek; Rogers, Simon N.

doi:10.1002/hed.21013

Cited by 48 publications

(43 citation statements)

References 14 publications

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“…Multiple studies have now demonstrated that the facial nerve can be weak post-operatively despite anatomical and neurophysiological confirmation of its integrity due to factors including traction, devascularisation or the conduction block due to diathermy current during flap elevation [15,16]. The gross anatomical preservation of the nerve can still result in weakness as seen by a report which demonstrates that up to 23% of patients have a lower number of functional motor units in the orbicularis oris despite clear preservation [17].…”

Section: Discussionmentioning

confidence: 99%

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Riffat

Mahrous

Buchanan

et al. 2012

J. Maxillofac. Oral Surg.

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Introduction The current practice for removal of clinically benign superficial parotid lesions is an appropriate superficial parotidectomy with a cuff of normal parotid tissue for complete pathological clearance. This technique requires the identification of the facial nerve at the main trunk and dissection of the segment of the facial nerve deep to the lesion. The reported major complications of this procedure include temporary or permanent facial nerve weakness, Frey's syndrome and salivary leaks. In order to avoid these complications, a local extracapsular dissection technique can be utilised in the management of small inferiorly located benign lesions of the parotid gland. Methods A retrospective case note review was performed for all parotidectomies between 2004 and 2009 in Addenbrooke's Hospital, Cambridge by the senior authors. Results A total of 172 cases were identified out which 46 underwent an extracapsular dissection. The average size of these lesions was 1.9 cm (0.9-2.4 cm) with all universally located inferior or posterior to the angle of the mandible. The pathologies were 14 pleomorphic adenomas, 24 Warthin's tumours, 6 lymphangiomas and 2 simple cysts. There were no post-operative facial nerve weaknesses, Frey's syndrome or salivary leaks within the extracapsular dissection group. The median follow-up of these patients were 4.6 years (2-6 years) with 6 patients lost to followup. No recurrences have been noted in the cohort at followup.

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Section: Discussionmentioning

confidence: 99%

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Riffat

Mahrous

Buchanan

et al. 2012

J. Maxillofac. Oral Surg.

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“…1 The most common causes of paralysis of the MMN are iatrogenic injuries of the nerve during operations in the submandibular or parotid regions. 2 …”

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confidence: 99%

Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function

Rodríguez-Lorenzo

Jensson

Weninger

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:Injuries of the marginal mandibular nerve (MMN) of the facial nerve result in paralysis of the lower lip muscle depressors and an asymmetrical smile. Nerve reconstruction, when possible, is the method of choice; however, in cases of long nerve gaps or delayed nerve reconstruction, conventional nerve repairs may be difficult to perform or may provide suboptimal outcomes. Herein, we investigate the anatomical technical feasibility of transfer of the platysma motor nerve (PMN) to the MMN for restoration of lower lip function, and we present a clinical case where this nerve transfer was successfully performed.Methods:Ten adult fresh cadavers were dissected. Measurements included the number of MMN and PMN branches, the maximal length of dissection of the PMN from the parotid, and the distance from the anterior border of the parotid to the facial artery. The PMN reach for direct coaptation to the MMN at the level of the crossing with the facial artery was assessed. We performed histomorphometric analysis of the MMN and PMN branches.Results:The anatomy of the MMN and PMN was consistent in all dissections, with an average number of subbranches of 1.5 for the MMN and 1.2 for the PMN. The average maximal length of dissection of the PMN was 46.5 mm, and in every case, tension-free coaptation with the MMN was possible. Histomorphometric analysis demonstrated that the MMN contained an average of 3,866 myelinated fiber counts per millimeter, and the PMN contained 5,025. After a 3-year follow-up of the clinical case, complete recovery of MMN function was observed, without the need of central relearning and without functional or aesthetic impairment resulting from denervation of the platysma muscle.Conclusions:PMN to MMN transfer is an anatomically feasible procedure for reconstruction of isolated MMN injuries. In our patient, by direct nerve coaptation, a faster and full recovery of lower lip muscle depressors was achieved without the need of central relearning because of the synergistic functions of the PMN and MMN functions and minimal donor-site morbidity.

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“…Much attention has been drawn to the frequency of injury of the spinal accessory nerve after neck dissection [15,19,22], whereas few studies have reported on the actual frequency of permanent injury of the MMN in conjunction with neck dissection [3,15,16,22]. Paralysis of the MMN was noted in 18-21% of the patients in whom it was intended to preserve the nerve during the operation [3,15,16,22]. In our study, the overall risk of MMN paresis was 16.8% (19/113; table 1) at the clinical control 2 weeks postoperatively as regards dissection in level I to V. We found a statistically signiWcantly higher frequency of MMN injury after the combination of parotic cancer surgery and neck dissection (33.3%) as compared with the corresponding frequency after oral cancer surgery and neck dissection (13.7%).…”

Section: Discussionmentioning

confidence: 99%

“…1). However, the risk of injury to the MMN during neck dissections for malignancies has only scarcely been addressed in the medical literature [15,16]. Dissection for removal of possibly metastatic lymph nodes in level I B resulted in injury of the MMN in 18-21% of the cases even though preservation of the nerve function was intended during the operations [3,16].…”

Section: Introductionmentioning

confidence: 98%

Risk of marginal mandibular nerve injury in neck dissection

Möller

Sørensen

2011

Eur Arch Otorhinolaryngol

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The immediate and permanent frequency of injury to the marginal mandibular branch of the facial nerve (MMN) after neck dissection has only scarcely been addressed in the medical literature. We investigated the risk of injury in 159 consecutive patients after neck dissection for various reasons in level I B and level II A, respectively. In 95 patients with oral cancer 13 (14%) of the cases had malfunction of the lower lip domain 2 weeks after neck dissection in level I B indicating paresis to the MMN. Follow-up analyses 1-2 years after the operation showed permanent paralysis in 4 to 7% of the cases in whom two of them had the nerve sacrificed for oncologic reasons during the operation. In 18 patients with parotic cancer the corresponding permanent frequency of MMN paralysis was 11.1%. In 46 patients with neck dissection in level II A but not in level I B, no paresis of the MMN was registered. Recognition of the MMN during the operation, pre- or postoperative radiation therapy, re-operation for deep hemorrhage, age, gender or postoperative infection did not have any statistically significant influence on the frequency of MMN injury. In conclusion we found a moderate risk of injury to the MMN after neck dissection in level I B whereas the corresponding risk after level II A dissection was negligible.

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Marginal mandibular nerve injury during neck dissection and its impact on patient perception of appearance

Cited by 48 publications

References 14 publications

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Safety of Extracapsular Dissection in Benign Superficial Parotid Lesions

Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function

Risk of marginal mandibular nerve injury in neck dissection

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