Revisiting the Topographic Anatomy of the Marginal Mandibular Branch of Facial Nerve Relating to the Surgical Approach

Yang, Hun Mu; Kim, Hee Jin; Park, Hyoung Woo; Sohn, Hyun Joon; Ok, Hyun Tae; Moon, Jung Hwan; Woo, Seung Hoon

doi:10.1093/asj/sjw045

Cited by 35 publications

(26 citation statements)

References 23 publications

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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 …”

mentioning

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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“…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 …”

mentioning

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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“…Possible reasons that make the marginal branch more liable to be injured and stretched during surgery include the relatively fewer connecting anastomoses and its thinner diameter and longer tracts embedded in the parotid gland. Furthermore, some parotid tumors, such as Warthin tumor, have a tendency to be located in the lower pole of the parotid gland and, therefore, in the path of this facial nerve branch 9 .…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of facial palsy after parotidectomy: analysis of 166 operations

et al. 2019

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A B S T R A C TObjectives: Facial nerve injury is one of the most important complications in parotid gland surgery. This study aims to identify possible predictive factors for iatrogenic facial paralysis in parotidectomy. Material and method:We performed a retrospective analysis of cases of parotidectomy in the treatment of parotid tumors carried out at a Portuguese Oncology Institute, during a period of 25 years. Socio-demographic data, patient's comorbidities, surgical procedure and tumor histopathology were reviewed. Results:The study sample consisted of a total of 166 patients (86 males and 80 females), with a mean age of 56.9 ± 16.8 years. In 62 cases (37.4 %), some degree of postoperative facial palsy was observed. The extent of surgery (rho = 0.177; p = 0.023) and tumor size (rho = 0.159; p = 0.045) showed correlation with facial nerve injury. The factors malignancy of the lesion (rho = 0.568; p < 0.001), extension of the surgery (rho = 0.485; p < 0.001) and enlargement of the excision to the skin (rho = 0.7211; p < 0.001) correlated with the facial nerve sacrifice. The percentage of persistent facial palsy was only 7.6%. Conclusions: Tumors of larger size and with extension to the deep lobe of the parotid are significantly correlated with iatrogenic facial palsy. Malignancy of the lesion and greater extension of surgery correlate with facial nerve sacrifice. 1130-0558/

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“…• The more significant risk of stretch or thermal injury to the marginal mandibular nerve occurs over and inferior to the gonial angle, 21 where fibers of the massetericocutaneous and lateral retaining pseudo-ligaments condense the tissues.…”

Section: The Platysmamentioning

confidence: 99%

The “Segmental SMAS Model”: A Didactic Concept of Face and Neck Lift Anatomy

Gassner

Magdum²,

Hanga

2020

Facial Plast Surg

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Profound understanding of the surgical anatomy of the face and neck is the key to successful face lift surgery. The “Segmental SMAS Model” presented herein is the result of a decade-long effort in teaching fellows a logical and coherent anatomic model of face lift anatomy. The superficial musculo-aponeurotic system (SMAS) consists of segments with distinct surgical characteristics. These are determined by the presence of a deep gliding plane and/or adhesion through fibrous insertions. In this article, we define SMAS segments that are profoundly heterogeneous in their behavior and have surgical implications on the maneuvers required for a deep plane face lift. The present model introduces several novel interpretations of the surgical anatomy of the face and neck lift procedure and hopes to convey a better understanding of face lift anatomy to training surgeons.

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Revisiting the Topographic Anatomy of the Marginal Mandibular Branch of Facial Nerve Relating to the Surgical Approach

Abstract: To avoid damaging the Mbr, surgical maneuvers should be positioned 4.5 cm anterior to the Go and 2 cm below the mandible.

Cited by 35 publications

References 23 publications

Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function

Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function

Predictive factors of facial palsy after parotidectomy: analysis of 166 operations

The “Segmental SMAS Model”: A Didactic Concept of Face and Neck Lift Anatomy

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