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Medhurst R, Tremblay C, Marrelli K, Best C, Jadeski L, Brace M. Defining the Safe Entry Point in Deep Plane Facelifting with Novel Landmark for the Buccal Branch of the Facial Nerve. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5749. [PMID: 38633508 PMCID: PMC11023607 DOI: 10.1097/gox.0000000000005749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
Background In deep facial surgery, accurate preoperative landmarking of branches of the facial nerve is helpful in avoiding inadvertent facial nerve injury. The objective of our study was to determine the accuracy at which the intersection point of two bisecting lines that join facial surface landmarks can be used to accurately locate the buccal branch(es) of the facial nerve, specifically at the deep plane entry point (ie, intercept landmark). Methods Thirty-three cadavers were dissected to determine the position of the buccal rami relative to the intercept. Results Buccal rami crossed the intercept in 12.12% of specimens (0 mm from intercept, n = 4). Buccal rami passed superiorly in 66.67% of specimens (3.71 ± 3.28 mm from intercept, n = 7) and inferiorly in 21.21% of specimens (2.44 ± 0.92 mm from intercept, n = 7). Noteworthy, buccal rami were located within 1 cm of the intercept landmark with 96.97% accuracy (32/33 cadavers). Conclusions These data suggest that this novel intercept (1) reliably locates the buccal branch of the facial nerve as it courses distal to the parotid gland, and (2) helps define a "safe zone" for entry into the deep plane where the likelihood of encountering the facial nerve is extremely low.
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Affiliation(s)
- Ryan Medhurst
- From the Department of Human Health and Nutritional Sciences, Human Anatomy Laboratory, University of Guelph, Ontario, Canada
| | - Cory Tremblay
- Department of Medicine, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Kristina Marrelli
- From the Department of Human Health and Nutritional Sciences, Human Anatomy Laboratory, University of Guelph, Ontario, Canada
| | - Corliss Best
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Lorraine Jadeski
- From the Department of Human Health and Nutritional Sciences, Human Anatomy Laboratory, University of Guelph, Ontario, Canada
| | - Matthew Brace
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
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Zhao J, Zeng W, Qiu C, Liu J, Li K, Huang J, Tong MCF, Zhang X. Protection of the marginal mandibular branches of the facial nerves by different surgical procedures in comprehensive cervical lymphadenectomy for locally advanced oral and oropharyngeal cancer: a multicenter experience. World J Surg Oncol 2023; 21:30. [PMID: 36721264 PMCID: PMC9887872 DOI: 10.1186/s12957-023-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE According to the different characteristics of patients and cervical lymph node metastasis of oral and oropharyngeal cancer, the marginal mandibular branches of facial nerves were treated by different surgical procedures, and the safety and protective effects of different surgical procedures were investigated. METHODS One hundred ninety-seven patients with oral and oropharyngeal cancer satisfying the inclusion criteria were selected. According to the different characteristics of patients and cervical metastatic lymph nodes, three different surgical procedures were used to treat the marginal mandibular branches of the facial nerve: finding and exposing the marginal mandibular branches of the facial nerves at the mandibular angles of the platysma flaps, finding and exposing the marginal mandibular branches of facial nerves at the intersections of the distal ends of facial arteries and veins with the mandible, and not exposing the marginal mandibular branches of the facial nerves. The anatomical position, injury, and complications of the marginal mandibular branches of the facial nerves were observed. RESULTS The marginal mandibular branches of the facial nerves were found and exposed at the mandibular angles of the platysma flaps in 102 patients; the marginal mandibular branches of facial nerves were found and exposed at the intersections of the distal ends of the facial arteries and veins with the mandibles in 64 patients; the marginal mandibular branches of facial nerves were not exposed in 31 patients; among them, four patients had permanent injury of the marginal mandibular branches of the facial nerves, and temporary injury occurred in seven patients. There were statistically significant differences in the protection of the mandibular marginal branch of the facial nerve among the three different surgical methods (P = 0.0184). The best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap, and the injury rate was only 2.94%. CONCLUSION The three different surgical procedures were all safe and effective in treating the marginal mandibular branches of the facial nerves, the best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap.
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Affiliation(s)
- Jiuzhou Zhao
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Wen Zeng
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Chengyu Qiu
- Department of Oral and Maxillofacial Surgery, First Hospital of Qiqihaer City, Heilongjiang Province, Qiqihaer, People’s Republic of China
| | - Jiafeng Liu
- grid.452437.3Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province People’s Republic of China
| | - Ke Li
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Jing Huang
- Department of Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Michael C. F. Tong
- grid.10784.3a0000 0004 1937 0482Department of Otorhinolaryngology, Head & Neck Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China
| | - Xiangmin Zhang
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
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Marolt C, Freed B, Coker C, Steele R, Johnson K, Arellanes R, Gordon V, Wright B, Stephens R, Surek CC. Key Anatomical Clarifications for the Marginal Mandibular Branch of the Facial Nerve: Clinical Significance for the Plastic Surgeon. Aesthet Surg J 2021; 41:1223-1228. [PMID: 33326569 DOI: 10.1093/asj/sjaa368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The marginal mandibular branch (MMBr) of the facial nerve is the least likely to recover from injury due to infrequent anastomosis with other branches. The MMBr has been described as coursing superior to the inferior border of the mandible. However, studies have reported variations in its location in embalmed and fresh specimens. It has been postulated that the embalming process may effect its anatomic position. OBJECTIVES The aim of this study was to re-evalulate the location of the MMBr relative to the inferior border of the mandible in both fresh and embalmed cadavers, and investigate variation in its position with sex, side of the face, and age. METHODS Superficial fascial planes were dissected to reveal the MMBr and its anatomic relations. Distance between the most inferior branch of the MMBr and the antegonial notch were measured bilaterally. The most inferior position of the MMBr between the antegonial notch and gonion was measured. Fresh heads were used as a comparison, with an additional measurement taken of the distance between the MMBr and the gonial angle. RESULTS The MMBr was located inferior to the border of the mandible (90.3%) more often than above (9.6%). No significant differences were found between fresh and embalmed cadavers, sex, side of body, or age (P > 0.05). No significant difference was found between intact cadavers and fresh heads (P > 0.05). CONCLUSIONS This study confirms and describes reliable landmarks for safety zones for the MMBr during plastic and reconstructive surgery of the lower face and upper neck. These data add reliability to studies that have investigated nerve locations in embalmed cadavers.
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Affiliation(s)
- Clayton Marolt
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Blair Freed
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Charles Coker
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Robert Steele
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Kenneth Johnson
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Russell Arellanes
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Victoria Gordon
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Barth Wright
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Robert Stephens
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
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Assessment of Anterior Loop of Inferior Alveolar Nerve and Its Anatomic Variations with Age, Gender, and Dentition Status in Indian Population: A CBCT Study. Int J Dent 2021; 2021:1813603. [PMID: 34512756 PMCID: PMC8424254 DOI: 10.1155/2021/1813603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background The posterior region of the mandible is more often related to iatrogenic errors, but the interforaminal region is also not spared for neurovascular complications. This study aimed to use CBCT images to evaluate the prevalence of anterior nerve looping and its variations with age, gender, and dentition status. Methods This retrospective study was carried out by studying 600 CBCT scans retrieved from archival records of a CBCT center in Lucknow. The scans were inspected by two trained investigators. The length of the anterior loop was measured using the measuring tool of Carestream 3D imaging software. Descriptive and analytical tests were performed. Results The prevalence of the anterior loop of the inferior alveolar nerve was found to be 56%. The prevalence was found to be more on the right side (29.0%) compared to the left side (27.0%). The most common anterior looping of the inferior alveolar nerve was type 3 followed by type 1. Males were found to have significantly higher loops compared to females. The number of loops was found to decrease significantly with age. The mean length of the loop was found to vary from 1.14 to 1.61 mm. Conclusion The anterior looping of IAN is very much prevalent in the Lucknow population. The use of the CBCT technique and appropriate preplanning prior to surgery or implant placement should be performed to prevent nerve injury.
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Zourntou SE, Makridis KG, Tsougos CI, Skoulakis C, Vlychou M, Vassiou A. Facial nerve: A review of the anatomical, surgical landmarks and its iatrogenic injuries. Injury 2021; 52:2038-2048. [PMID: 34074487 DOI: 10.1016/j.injury.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
Facial nerve iatrogenic injuries are serious and can negatively affect the quality of life of the patients. Due to the properties of the nerve, the complications are devastating involving the aesthetic appearance and the function of the face. Moreover, the multiple branches of the nerve increase the risk of an iatrogenic injury making the detailed knowledge of the anatomical correlations around them critical. In this review, a meticulous analysis was performed including the surgical procedures posing the greater risk of an iatrogenic injury as well as the full description of all the reported anatomical landmarks involving the extracranial course of the facial nerve.
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Affiliation(s)
| | | | | | - Charalampos Skoulakis
- Otolaryngology Department Neurology & Sensory Organs, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Marianna Vlychou
- Radiology Department Clinical and Laboratory Research, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Aikaterini Vassiou
- Anatomy Department Morphology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
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Sindel A, Özalp Ö, Yıldırımyan N, Oğuz N, Sindel M, Llankovan V. Evaluation of the course of the marginal mandibular branch of the facial nerve: a fresh cadaveric study. Br J Oral Maxillofac Surg 2020; 59:179-183. [PMID: 33483156 DOI: 10.1016/j.bjoms.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022]
Abstract
The aim of this study was to determine the course of marginal mandibular nerve (MMN) in relation to the inferior border of the mandible from the gonion until its terminal insertion to the depressor anguli oris, relating the position to a palpable anatomical landmark with emphasis on the depth of the nerve in relation to platysma and the deep cervical fascia. Twelve fresh adult cadavers were dissected and the mandibular base was contoured using needles with 5mm gaps, starting from the mandibular angle to the muscular termination point of the nerve bilaterally. The distance between the MMN and the mandibular base and total length of the nerve was measured bilaterally. The highest levels of MMN were measured 6.9mm and 6.5mm above, and the lowest levels were measured 4mm and 3mm below the mandibular base on right and left sides, respectively. The mean (SD) total length of the nerve until the muscular termination point was calculated 33.57 (3.41) mm on the right and 33.51 (4.88) mm on the left side. Previous publications that we had read all fell short of defining the schematic pathway of the nerve, as the described landmarks were of a combination of bone and soft tissue, which are not always clinically reliable. We have overcome this difficulty by standardising the inferior border of the mandible as a point in order to trace the marginal mandibular branch pathway. It originates along the gonion and ends at the second premolar tooth area.
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Affiliation(s)
- A Sindel
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Akdeniz University, Antalya, Turkey.
| | - Ö Özalp
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Akdeniz University, Antalya, Turkey.
| | - N Yıldırımyan
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Akdeniz University, Antalya, Turkey.
| | - N Oğuz
- Department of Anatomy, School of Medicine, Akdeniz University, Antalya, Turkey.
| | - M Sindel
- Department of Anatomy, School of Medicine, Akdeniz University, Antalya, Turkey.
| | - V Llankovan
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Poole, United Kingdom.
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Versatility of the Berger-Tenenhaus Approach for Mandibular Fractures. J Craniofac Surg 2020; 31:1129-1132. [PMID: 32168128 DOI: 10.1097/scs.0000000000006298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Mandibular fractures between the angle and condyle can be difficult to access and treat. The authors sought to evaluate a small transcutaneous incision between the marginal mandibular and buccal nerve branches (Berger-Tenenhaus incision) to treat these fractures. METHODS Ten cadaveric hemi-faces were dissected. Surrounding facial nerve branches were identified and measured in relation to the discussed incision. Our clinical experience with the approach for mandibular angle, ramus, subcondylar, and condylar fractures was reviewed. Operative technique and postoperative outcomes were examined. RESULTS The incision is located in a safe interval between neighboring facial nerve branches. Marginal mandibular nerve branches maintained a consistent distance beneath the incision along its length (median distances of 0.95-cm (SD ± 0.5), 1.05-cm (SD ± 0.5), and 1.00-cm (SD ± 0.8) posterior to anterior, respectively). Buccal nerve branches increased in distance and ascended away from the incision line (median distances of 0.75-cm (SD ± 0.9), 1.4-cm (SD ± 0.8), and 1.45-cm (SD ± 0.9) respectively posterior to anterior). No nerves were injured. In our clinical experience, all postoperative patients (n = 9) have had successful fracture reduction with restoration of occlusion, intact facial nerve function and an acceptable cosmetic result. CONCLUSIONS The Berger-Tenenhaus incision can safely and efficiently be used to treat difficult to access mandible fractures between the angle and condyle. LEVEL OF EVIDENCE VI.
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Tirelli G, Bergamini PR, Scardoni A, Gatto A, Boscolo Nata F, Marcuzzo AV. Intraoperative monitoring of marginal mandibular nerve during neck dissection. Head Neck 2018; 40:1016-1023. [PMID: 29389042 DOI: 10.1002/hed.25078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 10/04/2017] [Accepted: 12/06/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection. METHODS This prospective study compared 36 patients undergoing NIM-assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor. RESULTS The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM-assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy. CONCLUSION In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissection.
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Affiliation(s)
- Giancarlo Tirelli
- Hospital of Cattinara, University of Trieste, Ear, Nose, and Throat Clinic, Head and Neck Department, Trieste, Italy
| | - Pier Riccardo Bergamini
- Struttura semplice di Deontologia e responsabilità professionale - Azienda Sanitaria Universitaria Integrata di Trieste - ASUITS, Trieste, Italy
| | | | - Annalisa Gatto
- Hospital of Cattinara, University of Trieste, Ear, Nose, and Throat Clinic, Head and Neck Department, Trieste, Italy
| | - Francesca Boscolo Nata
- Hospital of Cattinara, University of Trieste, Ear, Nose, and Throat Clinic, Head and Neck Department, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Hospital of Cattinara, University of Trieste, Ear, Nose, and Throat Clinic, Head and Neck Department, Trieste, Italy
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