Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study.

Abstract

Despite its significant roles in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, a consideration critical for ensuring the safety of neck surgeries. We aimed to clarify the anatomical discrepancies associated with the cervical branch of the facial nerve to enhance surgical safety. The study utilized twenty fresh-frozen hemiheads. A two-stage surgical procedure was employed, beginning with an initial deep-plane facelift including extensive neck dissection, followed by a superficial parotidectomy on fresh frozen cadavers. This approach allowed for a thorough exploration and mapping of the cervical nerve in relation to its surrounding anatomical structures. Upon exiting the parotid gland, the cervical nerve consistently traveled beneath the investing layer of the deep cervical fascia for a brief distance, traversing the deep fascia to travel within the areolar connective tissue before terminating anteriorly in the platysma muscle. Single branch was observed in two cases, while two branches were noted in eighteen cases. The cervical nerve's relatively deeper position below the mandible's angle facilitates a safer subplatysmal dissection via a lateral approach for the release of the cervical retaining ligaments. Due to the absence of a protective barrier, the nerve is more susceptible to injuries from direct trauma or thermal damage caused by electrocautery, especially during median approaches.