Impact of Hayes Martin Maneuver and Anterograde Dissection on Identification and Preservation of Marginal Mandibular Nerve during Neck Dissection in Patients with Oral Squamous Cell Carcinoma

Abstract

Background: Hayes Martin maneuver (HMM) and Anterograde dissection technique (ADT) were originally described in 1951 as a means of preserving the marginal mandibular nerve (MMN) during level 1B clearance in a neck dissection procedure address the cervical metastasis in patients with oral squamous cell carcinomas.
 Objectives: To compare and evaluate the efficacy of HMM and ADT in preservation of MMN using Electromyography of muscles supplied by the nerve ie Mentalis, Depressor labii inferioris and depressor anguli oris, to evaluate muscle function.
 Methodology: 20 patients undergoing neck dissection over a period of 6 months grouped were into two groups (10 patients for Hayes Martin manoeuvre and 10 patients for anterograde dissection technique) calculated by purposive sampling method. Postoperative Electromyography and assessment of nerve function using House and Brackmann grading was done on day 5,15 and 30.
 Expected Results: HMM proves to be a less time consuming technique than Anterograde dissection by a significant margin considering perifacial node clearance and level 1B clearance. Anterograde dissection technique proved to be more effective than Hayes Martin Maneuver for preservation of MMN as average neuromuscular electrical activity in anterograde dissection cases was higher than the average of HMM cases. Although, no significant statistical difference was found when the neural function was compared on a house and brackmann grading scale
 Conclusion: Anterograde dissection technique is technique sensitive, relatively time consuming and requires a higher surgical operator skill. However, provides statistically proven better results in terms of neural electric activity and post-operative functional neural deficit in the operated subjects.