Mandibular Branch Of Facial Nerve Research Articles

Hybrid Surgery for Revascularization of Chronic Occlusion of Internal Carotid Artery.

The aim of this study was to conclude the safety and effectiveness of hybrid surgery for revascularization of chronic occlusion of internal carotid artery (COICA). A total of 56 COCIA patients underwent hybrid surgery (carotid endarterectomy+carotid artery stenting) from September 2017 to September 2021 in our department. The clinical material and radiology data (preoperation and postoperation) were retrospectively analyzed to conclude the safety and effectiveness of hybrid surgery for revascularization of COICA. All 56 patients underwent hybrid surgery got revascularization successfully (with a successful rate of 100%) and improved intracranial blood flow. The computed tomography perfusion results indicate that the postoperative cerebral blood flow perfusion of the patient is significantly improved compared with before surgery. In 1 patient, postoperative brain magnetic resonance imaging within 24 hours showed spotted fresh infarction with head magnetic resonance imaging, without any clinical symptoms; 3 patients developing symptoms of ipsilateral neural-functional defect (hypoglossal nerve, superior laryngeal nerve, and mandibular branch of facial nerve, respectively), 2 weeks later the symptoms were disappeared. Imaging study at 3 and 6 months during the follow-up showed no abnormalities. Hybrid surgery is safe and effective for revascularization of COICA.

Delineation and histological examination of the intramuscular innervation of the platysma: Application to botulinum neurotoxin injection.

This study aimed to identify the whole innervation pattern of the platysma using the Sihler's staining, and the axonal composition profile of the sensory-motor anastomosis identified by immunofluorescence assays. The findings provide a comprehensive understanding of the neural anatomy of the platysma and facilitate efficient and safe manipulation for neurotoxin injection. Ten fixed and two fresh hemifaces were included in this study. Sihler's staining was used to the study 10 fixed hemifaces and two fresh hemifaces were used for immunofluorescence assays. In all cases, the cervical branch of facial nerve (Cbr) broadly innervated the platysma, and the marginal mandibular branch of facial nerve (MMbr) provided supplementary innervation to the uppermost part of the platysma. The transverse cervical nerve (TCN), great auricular nerve (GAN), and supraclavicular nerve (SCN) were observed in the lower half of the platysma. In 30% of all cases, there was a communicating loop between the Cbr and TCN. In 20% of all the cases, a communicating branch joined between the Cbr and GAN. For successful esthetic rejuvenation procedures, a clinician should consider the Cbr distribution to the overall platysma and additionally innervation by individual nerves (MMbr, GAN, TCN, and SCN) to the middle and lower portions of the platysma muscle.

Facial Nerve Axotomy Induces Changes on Hippocampal CA3-to-CA1 Long-term Synaptic Plasticity

Peripheral facial axotomy induces functional and structural central nervous system changes beyond facial motoneurons, causing, among others, changes in sensorimotor cortex and impairment in hippocampal-dependent memory tasks. Here, we explored facial nerve axotomy effects on basal transmission and long-term plasticity of commissural CA3-to-CA1 synapses. Adult, male rats were submitted to unilateral axotomy of the buccal and mandibular branches of facial nerve and allowed 1, 3, 7, or 21 days of recovery before performing electrophysiological recordings of contralateral CA3 (cCA3) stimulation-evoked CA1 field postsynaptic potential in basal conditions and after high frequency stimulation (HFS) (six, one-second length, 100 Hz stimuli trains). Facial nerve axotomy induced transient release probability enhancement during the first week after surgery, without significant changes in basal synaptic strength. In addition, peripheral axotomy caused persistent long-term potentiation (LTP) induction impairment, affecting mainly its presynaptic component. Such synaptic changes may underlie previously reported impairments in hippocampal-dependent memory tasks and suggest a direct hippocampal implication in sensorimotor integration in whisking behavior.

An Observational Study for Localization of Temporal and Marginal Mandibular Branch of Facial Nerve in Indian Cadavers

The aim of this study was to observe the variation in the course of frontotemporal and marginal mandibular branch of the facial nerve in Indian cadavers, by using fixed anatomical landmarks. A total of 30 hemi faces of 15 embalmed formalin-preserved cadavers were aged between 18 and 70 years, and dissection was carried to expose parotid and submandibular gland. Fronto-temporal and marginal mandibular branch of facial nerve were identified within the parotid gland. Retrograde dissection and identification of the fronto-temporal branch and marginal mandibular branch of the facial nerve were done to measure the distance, and anatomical landmarks were given. We found that mean distance between temporal branch of facial nerve and root of the zygomatic arch was 25.4 ± 4.6 mm. Mean distance from the lateral canthus to the temporal nerve was 21.1 ± 4.0 mm. Mean distance from the lateral canthus to the temporal nerve, superiorly was 17.7 ± 4.2 mm. Marginal mandibular branch of the facial nerve runs with the mean distance of 6.3 ± 1.7 mm inferiorly from anatomical angle. Mean distance from the antegonial notch to the marginal mandibular nerve was 6.1 ± 1.6 mm. Mean distance from the lower border of the mandible at the level of mental foramen was 1.1 ± 6.3 mm. Course and variations of the facial nerve in relation to fixed anatomical landmarks can guide the surgeon to avoid facial nerve injuries and further postoperative complications.

4362 The Utilization of Polyethylene Glycol Fusion to Improve Facial Reanimation

OBJECTIVES/GOALS: This study’s goal is to determine whether intraoperative treatment of facial nerves with polyethylene glycol (PEG) fusion technology improves facial paralysis outcomes. Improved facial nerve regeneration in facial paralysis patients would lead to improved recovery time and effectiveness. METHODS/STUDY POPULATION: 30 rats were utilized; 15 underwent facial nerve regeneration without PEG fusion, and 15 with PEG fusion. Facial paralysis was initiated on the left by transection of the buccal and marginal mandibular branches of facial nerve. The buccal branch was repaired though microsuture technique. Neurorrhaphy sites of rats in the PEG group were exposed to calcium free saline, methylene blue, and polyethylene glycol. Nerve continuity was assessed post-operative in 5 animals in each group through electron microscopy. Functionality was assessed in the other 10 per group by EMG and whisker analysis after surgery, and weekly for 8 weeks. At 8 weeks, nerves and distal muscles were histologically analyzed. RESULTS/ANTICIPATED RESULTS: PEG fusion technology immediately restored axonal continuity following surgery, demonstrated by electron microscopy. Electrophysiology was also similarly restored across the site immediately, determined through intraoperative nerve stimulation, in the PEG fusion group. The nonintervention group showed dramatically reduced functional recovery than the PEG fusion group following surgery, shown by lower whisking activity and poor electrophysiology outcomes. Furthermore, the PEG fusion group showed statistically significant higher fascicle counts, myelination diameter, axonal diameter, and distal muscle fibers histologically. DISCUSSION/SIGNIFICANCE OF IMPACT: This study demonstrates that polyethylene fusion technology may improve facial reanimation outcomes. PEG is already a FDA-approved drug, and thus the pathway to translational clinical application of this work may thus be streamlined, bringing new options to patients with facial paralysis.

Our Experience with Intraoral Submandibular Gland Excision.

The aim of this paper is to present our experience with intraoral approach for submandibular glandexcision in terms of effectiveness and safety in patients with chronic sialadenitis. This is a prospective study carried out from November, 2016 to April, 2018 analyzing 13 patients of chronic sialadenitis. The indication of intraoral approach was either failed attempt to remove the stone endoscopically, chronic sialadenitis or benign tumor. The surgical triangle was used as the landmark for hilar area and gland was dissected close to the capsule and removed via intraoral incision and preserving the sublingual gland. We were successfully able to remove the submandibular gland via intraoral approach in 10 cases. Two patients had to undergo transcervical gland excision and one patient refused for transcervical approach. Intraoral excision of submandibular gland is a safe and viable approach to be utilized in carefully selected patients. The major advantages being avoidance of transcervical scar and of injury to marginal mandibular branch of facial nerve.

Total temporomandibular joint replacement without a submandibular incision

Temporomandibular joint replacement is a well-accepted and successful treatment option for advanced pathology of the temporomandibular joint. There are however a number of complications associated with the procedure such as post-operative infection, facial nerve damage and scarring. Total joint replacement has traditionally involved the use of both a pre-auricular and submandibular incision. We present an approach that uses only a pre-auricular incision without the need for a submandibular incision. This approach is less invasive and has the potential to decrease risk of damage to the marginal mandibular branch of facial nerve and scarring of the neck.

Therapeutic observation on superficial needling with different frequencies for intractable facial paralysis

Objective: To obverse the therapeutic effect of superficial needling with different frequencies for intractable facial paralysis. Methods: A total of 120 patients with intractable peripheral facial paralysis were allocated into a superficial needling with high frequency group (150 times/min), a moderate frequency group (100 times/min) and a low frequency group (50 times/min) according to the random number table method. The Toronto facial grading system (TFGS) was used to evaluate facial nerve functions before treatment and after 2 weeks and 4 weeks of treatment respectively. The electromyography (EMG) test of the mandibular branch of facial nerve was used to compare the motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV) and monophasic action potential (MAP) among different groups, and was done before treatment and after 4 weeks of treatment. The clinical efficacy was also compared. Results: After 2 weeks and 4 weeks of treatment, the changes of TFGS scores in the three groups all showed statistical significance (all P 0.05). The total effective rate was 65.0%, 80.0% and 95.0% in the high frequency group, moderate frequency group and low frequency group respectively, and the between-group differences showed statistical significance (P<0.05). Conclusion: Compared with the superficial needling with high and moderate frequencies, superficial needling with low frequency can produce more significant clinical efficacy for intractable facial paralysis.

Trans-oral robotic submandibular gland removal

Submandibular gland excision was performed on two patients using trans-oral robotic surgery (TORS). Complications such as the injury of marginal mandibular branch of facial nerve, ranula in the floor of the mouth, and postoperative hemorrhage were not observed. Visible cervical scar can be avoided and esthetic outcome can be expected by using this surgical modality.

Modified Lateral Surgical Approach to the Pterygopalatine Fossa.

Oral cancer, especially that originates in the maxillary tuberosity, buccal mucosa, and maxillary alveolus, is apt to invade the pterygopalatine fossa, where an intraoral approach is nearly impossible. There are 2 main types of extraoral approach to the pterygopalatine fossa; the anterior approach and the lateral approach. Although the lateral approach has an advantage compared with the anterior approach in terms of cosmetics, after the operation numbness of the lower lip occurs due to the sacrifice of the mental nerve. In the conventional lateral approach, a vertical incision is made in the center of the lower lip; a lateral flap is then elevated with the sacrifice of the mental nerve. The authors introduce here a new lateral approach to the pterygopalatine fossa with preservation of the mental nerve. In the present technique, a vertical incision was made in the corner of the mouth, and a lateral flap was then elevated with preservation of the mental nerve. This technique could also preserve the marginal mandibular branch of facial nerve in patients without a large metastasis in the submandibular lymph nodes. Additionally, expedient mandibular osteotomy, which is applied in the conventional lateral approach, could be omitted in the present technique, thus helping to prevent postoperative infection. The present approach was applied to 5 patients with oral cancer invading the pterygopalatine fossa. The postoperative numbness of the lower lip was estimated using the current perception threshold. The lesions were successfully resected with little numbness of the lower lip, and no postoperative infection occurred in any of the patients. This technique is available as an approach to the pterygopalatine fossa that preserves the mental nerve and can prevent postoperative infection.

THREE DIMENSION RHOMBIC PLATES VERSUS TWO MINIPLATES FOR FIXATION OF UNILATERAL LOW SUBCONDYLAR MANDIBULAR FRACTURES

This study was designed to evaluate the use of three dimension miniplates (rhombic) versus two miniplates for fixation of displaced low subcondylar mandibular fractures both clinically and radiographically. Patients and methods: this study comprised 16 adult patients who required open reduction and internal fixation of the subcondylar fracture of the mandible via retromandibular approach. The patients were randomly divided into two equal groups. Group (1) comprised (8) patients treated with three dimension rhombic plates and group (II) comprised (8) patients treated with two non-compression miniplates. All patients were evaluated clinically for intraoperative complications of hemorrhage and damage of the marginal mandibular branch of facial nerve. Postoperative complications as occulusal discrepancy, function of TMJ, presence of infection and parotid fistula formation were evaluated at intervals: immediately, one week, two and six weeks and three months. Radiographically, via panoramic views, CT scans at three and six months. Results: none of the patients suffered from any major complication intra operatively and postoperatively. All patients showed great satisfactions about the results of their treatment by these means of internal fixation through the retromandibular approach. Conclusion: open reduction and internal fixation of subcondylar fractures using three dimensional rhombic plates giving better and excellent stability and neutralizes the changing strains in the condylar region and associated with minimal morbidity when fixed via retromandibular approach allowing early restoration of function and avoids prolonged maxillomandibular fixation.

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

The marginal mandibular branch (Mbr) of the facial nerve is vulnerable to damage during rhytidoplasty, surgical reduction of the mandibular angle, parotidectomy, and excision of the submandibular gland. The authors sought to map the Mbr and determine the relationship between the number of Mbr offshoots and the course of the Mbr. The Mbr was examined in 29 hemifaces from 12 embalmed and 4 fresh cadavers (10 males, 6 females; mean age, 73.7 years). The Mbr was located ≤5 mm from the gonion (Go) in 24 of 29 hemifaces (82.8%) and ≤10 mm from the intersection of the facial artery and mandible (ie, FM) in 26 hemifaces (89.7%). In 16 hemifaces (55.2%), offshoots arose from the Mbr inferior to the mandible. The Mbr ran below the Go in 14 hemifaces (48.3%) and ran below FM in 13 hemifaces (44.8%). Except for minute offshoots deep to the platysma, the Mbr was not found to pass >2 cm below the mandible. The mean (± standard deviation) quantity of Mbr offshoots was 1.5 (± 0.6). A greater number of offshoots was associated with a higher likelihood of an inferiorly located nerve. The Mbr proceeded under the lower border of the mandible in 13 hemifaces (44.8%) and reached the mandible at a mean distance of 33.1±5.2 mm anterior to the Go. To avoid damaging the Mbr, surgical maneuvers should be positioned 4.5 cm anterior to the Go and 2 cm below the mandible.

The Importance of Variant Anterior Digastric Musculature in Head and Neck Surgery

Anterior belly of the digastric muscle (ABDM) variations have been reported to occur in as few as 2.7% to as many as 69.6% of individuals. ABDM variants may cause confusion during surgeries including submental lipectomy, rhytidectomy, surgical alteration of the cervicomental angle via partial resection of the ABDM, muscle transfer for reanimation of the mouth, and submental artery flap procedures. Therefore, knowledge of ABMD variants may aid in surgical planning and prevent confusion and disorientation during operations in the submental region. This report presents examples of ABMD variants and promotes novel ideas for the utilization of variant ABDM transfer to reanimate the mouth after marginal mandibular branch of facial nerve (MMBFN) palsy. Also presented is a unique perspective with regard to exclusion of normal and variant ABDM from the submental artery flap as a surgical contingency plan in the event of MMBFN palsy occurring as a result of flap surgery. Research was supported by funding from the WV Research Challenge Fund [HEPC.dsr.14.13].

Bilobed lipoma of submandibular region: an unusual presentation.

A 55-year old male patient presented to the Department of Oral and Maxillofacial Surgery with a swelling of the right submandibular region since four years [Table/Fig-1]. Swelling was painless asymptomatic and gradually increasing in size. On palpation swelling was firm with well-defined margins approximately (7x4 cm), swelling was mobile not fixed to overlying skin and no sign of inflammation. Patient was systemically normal. A tentative diagnosis was formed based on clinical examination which includes non-specific enlargement of right submadibular gland, lipoma, and lymphoma. [Table/Fig-1]: Clinical picture of lipoma in right submandibular region Contrast CT of right submandibular region showed a well circumscribed bilobed mass with mild extension into the parapharynegal space [Table/Fig-2] which was suggestive of benign lipomatous condition. A decision was made to surgically explore the lesion. [Table/Fig-2]: Contrast CT scan of the right submandibular region revealing the bilobed Tumour mass with mild extension into the parapharyngeal space After obtaining pre anaesthetic clearance, patient was admitted for excision of mass under GA [Table/Fig-3]. A submandibular incision was given to create access to soft tissue mass blunt dissection was done preserving marginal mandibular branch of facial nerve and a yellowish bilobed soft encapsulated mass was excised [Table/Fig-4,​,5].5]. Postoperative recovery was uneventful. Histological examination under 5 x magnifications showed sheets of mature adipocytes and lobules of adipose tissue separated from the surface epithelium by fibrous connective tissue stroma. The adipocytes were loosely arranged in large areas which showed presence of empty cytoplasm and small nuclei. Tumour cells were arranged in lobules. These lobules were separated from each other by fibrovascular connective tissue septae [Table/Fig-6]. [Table/Fig-3]: Outline of submandibular incision along with marking of inferior border of the mandible in order to save the marginal mandibular nerve during dissection [Table/Fig-4]: Intraoperative view of bilobed lesion separated from surrounding structures [Table/Fig-5]: Completely excised lesion along with parapharyngeal extension [Table/Fig-6]: Depicting the mature adipocytes and fat lobules separated by fibrous septae The presence of lipoma in the submandibuar region is extremely rare and it accounts for only 1-2% of all lipomas of the body. Angiolipomas and infiltrating lipomas are rarely found in the oral cavity [1] . There have been reports of deep intra muscular lipoma in the submandibular region by Adachi et al., [2] . Pusiol e t al., reported an oncocyticsialo lipoma of submandibular gland [3] . Diagnostic imaging techniques such as ultrasonograpghy, MRI and CT help to differentiate lipomas from other soft tissue lesion. And helps to identify the nature and exact location of lesion. However, the soft tissue characterization with ultrasonography is less specific than CT or MRI. When the mass is difficult to identify on ultrasonogram, CT or MRI is necessary. On CT scan it shows a high density from 83 to 143 Hounsfield units with well or poorly defined margins depending on the capsule [4].

Diagnosis and treatment of faciocervical lymphatic malformations in infant

To discuss the treatment effect of infant lymphatic malformations (LMs) located in the head and neck. Fourty-six LMs located in the head and neck between 2009 and 2013 were retrospectively analyzed. There were 26 males and 20 females, aged from 9 months to 4 years, with a median age of 1.8 years. Phase Isurgical resection was performed in 28 cases. The low concentrations of pingyangmycin was injected in 18 cases, and Phase II surgical resection was performed in 6 cases after 6 months, because of the large tumors and a wide range of invasion. Two post-operative complications were found, one was minor paralyses of mandibular branch of facial nerve, manifestied as mouth askew. Another was injured accessory nerve, manifestied as right upper limb lifting weakness, which improved after rehabilitation treatment. Surgical treatment is effective to LMs. In order to avoid serious complications, the huge LMs and microcystic LMs may be given local injection of pingyangmycin after puncture fluid, and phase II surgical resection secondly if necessary.

Facial nerve morbidity following surgery for benign parotid tumours.

To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. A case series. ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. RESULTS were described as frequency percentages. Out of 235 patients, 159 (67.65%) were female and 76 (32.35%) were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour (n=194, 82.6%), followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 (72%) patients and nerve dysfunction was observed in 66 (28%) patients. Complete paresis involving all the branches of facial nerve was seen in 25 (10.6%) patients and 41 (17.4%) patients were having incomplete dysfunction. Of these, 62 (26.3%) recovered and 04 (1.7%) had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 (86.3%) cases. The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours.

Variant anterior digastric muscle transfer for marginal mandibular branch of facial nerve palsy.

Summary:Marginal mandibular branch of facial nerve (MMBFN) palsy is a common consequence of head and neck surgeries. MMBFN palsy results in paralysis of muscles which depress the inferior lip. Current management of MMBFN palsy involves ruination of normal neuromuscular anatomy and physiology to restore symmetry to the mouth. The article outlines the possibility to transfer variant anterior digastric musculature to accomplish reanimation of the mouth without adversely affecting normal nonvariant anatomy. The procedure may have the additional cosmetic benefit of correcting asymmetrical muscular bulk in the submental region.

Surgical management of elongated styloid process: intraoral or transcervical?

The purpose of this study is to compare the results of surgical approaches in management of elongated styloid process. Eight patients with Eagle's syndrome due to elongated styloid process were included in this study. All necessary preoperative diagnostic work-ups were done and four of them were operated transorally and four were operated extraorally. Preoperative and postoperative symptoms and postoperative patient satisfaction were investigated. No early or late postoperative complications were encountered in transoral group. One of the patients who was operated transcervically experienced a transient weakness in the marginal mandibular branch of facial nerve which resolved spontaneously within 2weeks. Complete remission of symptoms was achieved in seven patients at the final follow-up, only one of the patients, who was operated intraorally, had partial remission. Only one of the patients who had unilateral excision of elongated styloid process transcervically complained about the permanent scar. Transoral approach is a safe surgical alternative achieving adequate treatment. The advantages of intraoral approach include less surgical travma, less surgical time and lack of servical scar, with similar outcomes when compared with transcervical approach.

Assessment of the marginal mandibular nerve function after Risdon approach

Detailed knowledge of the anatomy of the facial nerve and its branches, especially the marginal mandibular, is of fundamental importance in surgical treatment of mandibular fractures by making use of the Risdon surgical approach, avoiding possible injury which may lead to partial or total incapacity of the motor function. The aim of this study is to evaluate the function of the marginal mandibular branch of facial nerve after surgical treatment of mandibular fractures by access type Risdon. 44 patients with fractures of the mandibular body and angle, and the marginal mandibular nerve function being analyzed through visual inspection based on the rating scale in House-Brackmann facial nerve, in the preoperative and postoperatively (24 h). Patients who had some degree of dysfunction within 24 h were reassessed during 01 week, 01 month and 03 months postoperatively. Of all patients studied, thirteen (29.55%) had some degree of dysfunction in a postoperative day and thirty one (70.45%) patients had normal function at that time, being females the most affected ones (71.43%). At the end of the third month, 91% of patients had grade I (normal) on the rating scale, and 9% had grade II (mild dysfunction). Thus we can conclude that the majority of patients tested showed normal function of the marginal mandibular nerve at all times postoperatively, with mild dysfunction found most frequently and at the end of the study, patients who still had dysfunction, this one was showed in a milder degree, demonstrating safety in the Risdon approaches performed.

Management of Mandibular Sub Condylar and Condylar Fractures Using Retromandibular Approach and Assessment of Associated Surgical Complications

To evaluate surgical complications associated with open reduction and internal fixation of condylar fractures using retromandibular approach in terms of intraoperative and postoperative complications. Ten patients with displaced unilateral/bilateral condylar fractures were selected for the study. Intraoperative complications were evaluated in the form of haemorrhage due to damage to retromandibular vein and damage to marginal mandibular branch of facial nerve. Postoperative complications like presence of infection, signs of Frey's syndrome, parotid fistula formation, facial nerve palsy, and discrepancy in occlusion and functions of temporomandibular joint were evaluated at intervals of 24h, one week, six weeks and three months postoperative. Radiographically, the approximation of fracture fragments, plate fracture and screw loosening on orthopantomograph and Reverse Towne's view were evaluated at intervals of 24h, six weeks and three months postoperatively. None of the patients suffered from any major complication intra and post operatively. Open reduction and internal fixation should be given due consideration in the management of displaced mandibular condylar fractures and is associated with minimal morbidity using retromandibular approach.