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Cadaveric Study of Topographic Anatomy of Temporal and Marginal Mandibular Branches of the Facial Nerve in Relation to Temporomandibular Joint Surgery. J Oral Maxillofac Surg 2020; 79:343.e1-343.e11. [PMID: 33075306 DOI: 10.1016/j.joms.2020.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Detailed anatomy of the facial nerve, including the variations among different ethnic groups, is essential to prevent an iatrogenic injury. The purpose of the study was to document topographic anatomy of temporal and marginal mandibular (MM) branches of the facial nerve in relation to temporomandibular joint (TMJ) surgery. The specific aim was to demonstrate detailed course of temporal and MM nerves, their surgical implications, and to compare the results obtained with the previous studies. METHODS The investigators implemented a prospective cadaveric study. A dissection was carried out on 52 facial halves. The facial nerve was dissected according to the instructions described in the Cunningham's dissection manual. Anatomic landmarks were selected as determined by Al-Kayat and Bramley, and results obtained were compared with previous published articles. RESULTS The study sample was composed of 52 facial halves (males, n = 35; females, n = 17). The number of branches of temporal nerve varied in dissected facial halves from 3 (n = 37 [70%]), 2 (n = 14 [26%]), to 1 (n = 1 [2%]). The distance between the lowest concavity of the bony external auditory meatus to the point at which the facial nerve bifurcates (distance B) was considerably less in the study population (1.79 cm) when compared with the reported literature (2.3 cm). There was no significant influence of gender and cephalic index on distances measured. There was 1 branch in 15% of the dissected facial halves (1 in 52) and 2 branches in 85% (44 of 52). The MM nerve was seen coursing below the inferior border of the mandible, and in 44 (85%), the nerve was present above the inferior border of mandible all along the course. CONCLUSIONS The topographic anatomy of the temporal and MM nerves is the same as reported in the literature. The only considerable difference was found in distance B; hence, surgical procedures involving the distance B require special consideration.
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Strantzias P, Botou A, Manoli A, Skandalakis PN, Filippou D. Variation of Marginal Mandibular Nerve in a Caucasian Male Cadaver: A Study Using the Anatomage Table. Cureus 2019; 11:e6168. [PMID: 31890376 PMCID: PMC6913982 DOI: 10.7759/cureus.6168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Anatomage (Anatomage, Inc., San Jose, CA) is a modern method for studying anatomy. It is a state-of-the-art method used for the representation of the structure of the human body. In our study, we examined the seventh cranial nerve of a male Caucasian cadaver using an Anatomage Table in the Anatomy Department of the School of Medicine, National and Kapodistrian University, Athens, Greece. After exiting the skull from the stylomastoid foramen, the facial nerve divided into the temporofacial and cervicofacial main branches. The cervicofacial branch divided into its own branches, including the marginal mandibular nerve (MMN), which ran within the investing (superficial) layer of the deep cervical fascia. We found a variation of the course of the marginal mandibular branch of the facial nerve. In the area of the lower border of the mandible, where the MMN actually crossed the facial artery and vein, it appeared to run deeper than both of those vessels, rather than running superficially. This seemed to be a rare variation of the location of the MMN relative to the facial vessels, which suggested that extra care is essential in surgical approaches within this area.
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Affiliation(s)
- Paschalis Strantzias
- Oral Medicine, Medical School of National and Kapodistrian University of Athens, Athens, GRC
| | - Anna Botou
- Ophthalmology, Medical School of National and Kapodistrian University of Athens, Athens, GRC
| | - Arezina Manoli
- Otolaryngology, Medical School of National and Kapodistrian University of Athens, Athens, GRC
| | | | - Dimitrios Filippou
- Surgery, Medical School of National and Kapodistrian University of Athens, Athens, GRC
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Mandibular subcondylar fracture accessibility with transparotid approach by rhytidectomy and modified Risdon approach: An anatomical comparative study. J Craniomaxillofac Surg 2018; 46:2256-2260. [PMID: 30420152 DOI: 10.1016/j.jcms.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/25/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of our anatomical study was to compare the accessibility of the area at the level of the neck of the condyle and the condylar head by two different approaches: the modified Risdon approach and a transparotid approach by rhytidectomy (TPAR). METHODS An anatomical study was performed on 12 heads of cadavers preserved with a solution rich in glycerin and ethanol, but very low in formalin. A modified Risdon approach and a TPAR were each performed on a hemiface of the same head. The bone surface was rendered digitally accessible on an anatomical diagram using Image J software. The software was used to determine a concordance score between the area of accessibility and the area of interest necessary for osteosynthesis of a high subcondylar fracture. This score was presented as a numerical scale from 0 to 100. We measured the total number of pixels in our area of interest and assigned it a score of 100. We then compared the area of accessibility with the area of interest necessary for osteosynthesis of a high subcondylar fracture. RESULTS Using the modified Risdon approach, an average score of 55.88 (SD = 18.96) was found, or 55.88% of the accessible area of interest. Using TPAR, we found a score of 91.05 (SD = 7.95) or 91.05% of the accessible area of interest. This difference in score between the two techniques was significantly different (p < 0.001), taking into account intra-hemiface and intra-individual correlation. CONCLUSION TPAR seems to be more effective in treating high condylar process fractures of the mandible.
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Anthony DJ, Oshan Deshanjana Basnayake BM, Mathangasinghe Y, Malalasekera AP. Preserving the marginal mandibular branch of the facial nerve during submandibular region surgery: a cadaveric safety study. Patient Saf Surg 2018; 12:23. [PMID: 30159033 PMCID: PMC6106836 DOI: 10.1186/s13037-018-0170-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/15/2018] [Indexed: 11/17/2022] Open
Abstract
Background The marginal mandibular branch of the facial nerve is vulnerable to iatrogenic injuries during surgeries involving the submandibular region. This leads to significant post-operative morbidity. Studies assessing accurate anatomical landmarks of the marginal mandibular branch are sparse in South Asian countries. Present study was conducted to assess the relationship between the marginal mandibular branch and the inferior border of the body of mandible. Methods Twenty-two preserved cadavers of Sri Lankan nationality were selected. Cadavers were positioned dorsal decubitus with necks in extension. The maximum perpendicular distance between the inferior/caudal most ramus of the marginal mandibular branch and the inferior border of the body of the mandible was recorded on both hemi faces. Results Recorded maximum distance was 17.65 mm on left side and 10.80 mm on right side. Mean maximum distance, was 7.12 ± 2.97 mm. There was no statistically significant difference in the maximum deviation on left (7.84 ± 3.41 mm) and right sides (6.44 ± 2.37 mm). Conclusion Course of the marginal mandibular nerve is complex. If the distance of the incision in the posterior submandibular approach is less than 2 cm from the inferior border of the mandible, there is a high probability of damaging the inferior ramus of the marginal mandibular branch of the facial nerve.
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Affiliation(s)
- Dimonge Joseph Anthony
- Department of Anatomy, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 08, Sri Lanka
| | | | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 08, Sri Lanka
| | - Ajith Peiris Malalasekera
- Department of Anatomy, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 08, Sri Lanka
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A More Favorable Lower-Lip Incision for the Removal of Deep Intraoral Malignancies. J Craniofac Surg 2017; 27:e228-9. [PMID: 27159868 DOI: 10.1097/scs.0000000000002360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The straight midline lower lip-splitting incision has traditionally been performed with different types of deep intraoral malignancies for obtaining wide surgical access, and it can also be extended to the submandibular region or the neck to concurrently perform a neck dissection. But meanwhile, it is associated with unfavorable aesthetic and functional complications such as conspicuous facial scar, lip vermilion notching, stenosis of the labial sulcus, decreased lip sensation and movement, and oral incontinence. We designed a more favorable lower-lip incision, namely, para-lower lip incision, using the exposure and en blot resection of deep intraoral tumors. Compared with the traditional incision line, our designed line is shorter, and 20 outpatients (primary tumor site including buccal mucosa, tongue, mandibular gingiva, maxillary sinus, palate, and mouth floor) follow-ups indicated the postoperative scar is inconspicuous, no lip contour deformity and dysfunction or complications of facial paralysis such as distortion of commissure happened. This article reports one case of our patients who underwent para-lower-lip incision approach for the removal of squamous cell carcinoma (T3N2M0) in the left plate and the results of the patient were favorable.
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Tzou CH, Meng S, Ines T, Reissig L, Pichler U, Steinbacher J, Pona I, Roka-Palkovits J, Rath T, Weninger WJ, Cheng MH. Surgical anatomy of the vascularized submental lymph node flap: Anatomic study of correlation of submental artery perforators and quantity of submental lymph node. J Surg Oncol 2016; 115:54-59. [DOI: 10.1002/jso.24336] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Chieh Han Tzou
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Stefan Meng
- Department of Systematic Anatomy; Institute of Anatomy; Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Tinhofer Ines
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Lukas Reissig
- Department of Systematic Anatomy; Institute of Anatomy; Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Ursula Pichler
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Johannes Steinbacher
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Igor Pona
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Julia Roka-Palkovits
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Thomas Rath
- Division of Plastic and Reconstructive Surgery; Department of Surgery; Medical University of Vienna; Vienna Austria
| | - Wolfgang J. Weninger
- Department of Systematic Anatomy; Institute of Anatomy; Center for Anatomy and Cell Biology; Medical University of Vienna; Austria
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery; Department of Plastic and Reconstructive Surgery; Center for Tissue Engineering; Chang Gung Memorial Hospital; College of Medicine; Chang Gung University; Taoyuan Taiwan
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The marginal branch triangle: Anatomic reference for its location and preservation during cosmetic surgery. J Plast Reconstr Aesthet Surg 2016; 69:387-94. [DOI: 10.1016/j.bjps.2015.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/19/2015] [Indexed: 11/23/2022]
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Ricour C, Ferri J, Thiery G, Fontaine C, Raoul G. [Anatomic study of the submental artery relationships for submental flap raising]. ACTA ACUST UNITED AC 2016; 117:72-6. [PMID: 26917502 DOI: 10.1016/j.revsto.2016.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/05/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Submental flap is useful for intra-oral reconstructions and reconstructions of the lower two thirds of the face. Dissection is delicate because of a difficult exposure under the lower rim of the mandible, numerous collateral arterial branches and the proximity of the marginal branch of the facial nerve. The aim of our work was to propose anatomical landmarks in order to facilitate the submental flap raising. MATERIAL AND METHOD Ten bodies preserved in Biomet liquid were dissected bilaterally. The anatomic relationships between the marginal branch of the facial nerve and the mandible, the relationships of the submental artery, the amount and the location of its collateral branches were measured by means of a caliper. RESULTS The highest marginal branch observed was located 0.5 cm above the mandibular lower rim, while the lower one was located 0.6cm below this rim. The mean length measured between the facial artery at its crossing over the mandibular rim at the level of the pre-angular notch and the origin of the submental artery was 1.5cm. The average number of collateral branches was 3.6. DISCUSSION A skin incision made directly under the mandibular lower rim, as mentioned by some authors, may endanger the mandibular marginal branch of the facial nerve. Three positions of the submental artery in relation to the sub-maxillary gland are reported. The collateral branches are intended for gland, muscle, skin and bone. It is necessary to pay particular attention to the sub-lingual artery, an artery of big diameter that arises at 2.8cm on average from its origin and plunges towards the mouth's floor. It must not be followed at risk of clamping the thin pedicle destined to the digastric muscle. It is important to preserve the fat tissue around the submental pedicle in order to avoid venous congestion of the flap.
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Affiliation(s)
- C Ricour
- Service de chirurgie maxillo-faciale, CHRU de Lille, rue Émile-Laine, 59000 Lille, France.
| | - J Ferri
- Service de chirurgie maxillo-faciale, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - G Thiery
- Service de chirurgie maxillo-faciale, centre hospitalier, hôpital d'instruction des armées Lavéran, 34, boulevard Laveran, 13013 Marseille, France
| | - C Fontaine
- Service de chirurgie orthopédique et traumatologique, laboratoire d'anatomie, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
| | - G Raoul
- Service de chirurgie maxillo-faciale, CHRU de Lille, rue Émile-Laine, 59000 Lille, France
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Relationship between facial nerve damage and transbuccal trocar placement: an anatomical cohort study. Int J Oral Maxillofac Surg 2015; 45:582-7. [PMID: 26688292 DOI: 10.1016/j.ijom.2015.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/10/2015] [Accepted: 11/03/2015] [Indexed: 11/23/2022]
Abstract
The surgical treatment of ramus and mandibular angle fractures is typically performed by intraoral and transbuccal approaches. As these approaches may result in nerve damage, this anatomical study was performed to establish the relationship between the transbuccal trocar position and the likelihood of inducing facial nerve damage. Twenty dissections of the parotid regions were performed after a simulation of surgical approaches aimed at addressing mandibular condylar and angle fractures. Two trocar tubes, ramic and angular, were inserted and left in position throughout the dissection. This procedure allowed the qualitative relationship between the various tube positions and facial nerve damage to be analyzed. The potential risk of contact between the ramic trocar and the facial nerve branches was 90%, while the angular trocar was in contact in 45% of cases. There was no contact with the trunk, cervicofacial division, or temporofacial division of the facial nerve. The contacts occurred at the level of secondary division branches, particularly pronounced for superior and inferior buccal branches, despite the absence of macroscopically visible trauma. Based on these findings, it is proposed that trocars should be used in procedures aimed at addressing subcondylar or angle fractures of the mandible.
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Al-Qahtani K, Mlynarek A, Adamis J, Harris J, Seikaly H, Islam T. Intraoperative localization of the marginal mandibular nerve: a landmark study. BMC Res Notes 2015; 8:382. [PMID: 26310931 PMCID: PMC4549948 DOI: 10.1186/s13104-015-1322-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 08/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background Identification and preservation of the marginal mandibular nerve (MMN) remains an important step in otolaryngology procedures. Current publications place the MMN at least 1 cm below the mandible. This study will evaluate the accuracy of the method of determining the surgical location of this branch of the facial nerve in vivo. Methods MMN were examined in 52 consecutive otolaryngology patients. Using a validated landmarking scheme, distances were measured from the inferior edge of the mandible and the lowest point of the nerve. A comparison of 33 nerves pairs was undertaken. Effect of patient’s age was analysed. Results Eighty five nerves were landmarked. The mean position of the nerve was 0.2–3.4 mm higher than the margin of the mandible. There were no significant difference in position with respect to age and left versus right comparisons. Conclusion The marginal mandibular nerve (MMN) is significantly higher than previously published. The location of the nerve on the right does not correlate with the left. Location of the nerve does not correlate with patient’s age.
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Affiliation(s)
- Khalid Al-Qahtani
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada. .,Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. .,King Abdul Aziz University Hospital, King Saud University, PO Box no-245, Riyadh, 11411, Kingdom of Saudi Arabia.
| | - Alex Mlynarek
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Jon Adamis
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Jeffery Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada.
| | - Tahera Islam
- College of Medicine and Research Center, King Saud University, Riyadh, Saudi Arabia.
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Davies JC, Ravichandiran M, Agur AM, Fattah A. Evaluation of clinically relevant landmarks of the marginal mandibular branch of the facial nerve: A three-dimensional study with application to avoiding facial nerve palsy. Clin Anat 2015; 29:151-6. [PMID: 26096443 DOI: 10.1002/ca.22570] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 11/05/2022]
Abstract
Injury to the marginal mandibular branch of the facial nerve (MMN) during surgery often results in poor functional and cosmetic outcomes. A line two finger breadths or 2 cm inferior to the border of the mandible is commonly used in planning neck incisions to avoid injury to the MMN. The purpose was to compare the two finger breadth/2 cm landmarks in predicting MMN course, and their accuracy/reliability. Thirty-one cadaveric specimens were scanned to obtain 3D surface topography (FARO® scanner). Four independent raters pinned the inferior border of the mandible and a two finger breadth line and 2cm line below. The location of each pin was digitized (Microscribe™). A preauricular flap was raised, and MMN branches were digitized and modelled (Geomagic®/Maya®) enabling quantification of the accuracy of these landmarks. The location of the two-finger breadth line was variable, spanning 25-51 mm below the inferior border of the mandible (ICC = 0.10). The most inferior MMN branch did not pass below the two-finger breadth line in any specimen, but a narrow clearance zone (≤5 mm) was found in two. In contrast, in 7/31 specimens, the most inferior MMN branch coursed below the 2 cm line and would be at risk of injury. It was concluded that an incision two finger breadths below the inferior border of the mandible could provide safer access than the 2 cm line. After an incision has been placed using the two finger-breadth landmark, caution must be exercised during dissection as branches of the MMN may lie only a few millimeters superior to the incision.
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Affiliation(s)
- Joel C Davies
- Division of Anatomy, Department of Surgery, University of Toronto, Ontario, M5S 1A8, Canada
| | | | - Anne M Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Ontario, M5S 1A8, Canada
| | - Adel Fattah
- Facial Nerve Programme, Regional Paediatric Burns and Plastic Surgery service, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK
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Bruneau S, Foletti JM, Holweck G, Laversanne S, Brignol L, Thiéry G. Traitement des plis d’amertume par section du depressor anguli oris : note technique. ACTA ACUST UNITED AC 2012; 113:402-6. [DOI: 10.1016/j.stomax.2012.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 11/23/2011] [Accepted: 04/30/2012] [Indexed: 11/16/2022]
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Batra APS, Mahajan A, Gupta K. Marginal mandibular branch of the facial nerve: An anatomical study. Indian J Plast Surg 2011; 43:60-4. [PMID: 20924452 PMCID: PMC2938626 DOI: 10.4103/0970-0358.63968] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Smile is one of the most natural and important expressions of human emotion. Man uses his lips mainly to register his emotions. Thus, the slightest asymmetry or weakness around the lips and mouth may transform this pleasant expression into embarrassment and distortion. The circumoral musculature, the major part of which is supplied by the marginal mandibular branch of the facial nerve, is the main factor in this expression. Therefore, an injury to this nerve during a surgical procedure can distort the expression of the smile as well as other facial expressions. This nerve often gets injured by surgeons in operative procedures in the submandibular region, like excision of the submandibular gland due to lack of accurate knowledge of variations in the course, branches and relations. In the present study, 50 facial halves were dissected to study the origin, entire course, termination, branches, muscles supplied by it, its anastomoses with other branches of facial nerve on the same as well as on the opposite side and its relations with the surrounding structures. The marginal mandibular branch of the facial nerve was found superficial to the facial artery and (anterior) facial vein in all the cases (100%). Thus the facial artery can be used as an important landmark in locating the marginal mandibular nerve during surgical procedures. Such a study can help in planning precise and accurate incisions and in preventing the unrecognized severance of this nerve during surgical procedures.
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Lutz JC, Clavert P, Wolfram-Gabel R, Wilk A, Kahn JL. Is the high submandibular transmasseteric approach to the mandibular condyle safe for the inferior buccal branch? Surg Radiol Anat 2010; 32:963-9. [PMID: 20461515 DOI: 10.1007/s00276-010-0663-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE There are basically 3 main approaches for extra-articular mandibular condyle fractures: low cervical, retromandibular and preauricular. These include a risk of facial palsy affecting the marginal mandibular branch. We use a high submandibular transmasseteric approach featuring masseter section 10-20 mm above the mandibular basilar edge. Our null hypothesis was that both the marginal mandibular and the inferior buccal branches are not more at risk than in other surgical approaches. METHODS This study was based on 20 parotidomasseteric dissections from 10 embalmed cadaveric heads. We used as reference the vertical line, passing through the mandibular angle, parallel to the preauricular line. We performed measurements of the marginal mandibular and inferior buccal branches' heights. RESULTS The inferior buccal branch had an average height of 16.8 mm and the highest standard deviation (7.2). Extremes were, respectively, 32 and 7 mm. The marginal mandibular branch had an average height of 3.2 mm with standard deviation equal to 3.0. Extremes were, respectively, 9 and -3 mm. CONCLUSION The high submandibular transmasseteric approach provides great exposure of facial nerve branches lying on the masseter muscle, if even encountered. Through masseteric incision performed between 10 and 20 mm above the basilar edge of the mandible, the marginal mandibular branch is safe from wound with an added safety margin of 4 mm. The surgeon using this approach is most likely to encounter the inferior buccal branch. It can then be avoided under visual control. This makes it a swift and safe approach to the mandibular condyle.
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Affiliation(s)
- Jean-Christophe Lutz
- Anatomy Department, Strasbourg University of Medicine, 4, rue Kirschleger, 67085, Strasbourg Cedex, France.
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Woltmann M, Faveri RD, Sgrott EA. Anatomosurgical study of the marginal mandibular branch of the facial nerve for submandibular surgical approach. Braz Dent J 2006; 17:71-4. [PMID: 16721470 DOI: 10.1590/s0103-64402006000100016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to estimate the distance from the mandibular marginal branch of the facial nerve to the inferior margin of the mandible in order to determine the best and safest location to approach the posterior mandibular region. Forty-five hemi-faces of 27 Brazilian adult cadavers were dissected and the distance between the mandibular marginal branch and the inferior margin of the mandible was measured. The number of marginal branches and anastomoses with other branches of the facial nerve was also recorded. The evaluation of the anatomic pieces showed 1 to 3 branches of the marginal mandibular branch, anastomoses with the buccal and cervical branches of the facial nerve and distances between 1.3 cm to +1.2 cm from the inferior margin of the mandible. In 57.7% of the cases, the nerve passed superiorly and along the length of the inferior margin of the mandible. Based on the findings of the present anatomosurgical study, it may be recommended an incision 3 cm below the inferior margin of the mandible associated to a careful dissection in planes and flap retraction. This is expected to reduce the risk of neuropraxia of the marginal mandibular nerve making the submandibular incision a safe approach.
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Affiliation(s)
- Marcus Woltmann
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Regional University of Blumenau, Blumenau, SC, Brazil.
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Potgieter W, Meiring JH, Boon JM, Pretorius E, Pretorius JP, Becker PJ. Mandibular landmarks as an aid in minimizing injury to the marginal mandibular branch: A metric and geometric anatomical study. Clin Anat 2005; 18:171-8. [PMID: 15768421 DOI: 10.1002/ca.20099] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Iatrogenic injury to the marginal mandibular branch is an important reason for medicolegal actions. The aim of this study was to determine the distance of the marginal mandibular branch to the inferior border of the mandible as well as variation of nerve position in relation to this border. The marginal mandibular branch was dissected carefully in a number of 36 facial halves. Three points were identified on the inferior border of the mandibular ramus: Point A at the angle of the mandible, Point B just anterior to the facial artery, and Point C, 2 cm anterior to Point B. A metric and geometric morphometric analysis, including thin-plate spline and relative warp analysis was done to determine the variation of nerve position in relation to these three bony landmarks. The metric study indicated a median distance from Point A to the nerve 2.3 mm inferior to Point A, 2.4 mm superior to Point B, and 10.7 mm superior to Point C. The shape analysis indicated that variation in the position of the nerve occurs most commonly at Points A and B. We conclude that these mandibular landmarks may assist surgeons in minimizing marginal mandibular branch injury and patient discomfort.
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Affiliation(s)
- W Potgieter
- Department of Anatomy, Section of Clinical Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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