Temporal Branch Of Facial Nerve Research Articles

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.

Safe Zone for Dissection in Frontotemporal Region to Avoid Injury to the Temporal Branch of Facial Nerve.

The objective of this study is to provide a reliable roadmap for temporal branch of the facial nerve, in order to minimize, the risk of injury to the nerve during surgical dissections. A literature search was conducted on temporal branch of facial nerve. The date search range was 1950 to 2017. Databases searched included Medline, Web of science, Biosis, SciELO, Data Citation, and Zoologic Records. Data were collected on, author specialty, date of publication, and the relationship of the temporal branch of facial nerve to various landmarks in the frontotemporal region reported in human anatomic studies. Among the 48 studies reviewed, a total of 3477 anatomic dissections were performed in the craniofacial region. Temporal branch of facial nerve was located between 2.5 and 3 cm from lateral orbital rim. In relation to the zygomatic arch, it was found anywhere from the midpoint of the arch to 1 finger breath posterior to the arch. For the plane, it was most commonly described as being under the superficial temporal fascia (STF) or within the loose areolar tissue. Most anatomic dissections found 2 to 4 twigs of the temporal branch of facial nerve. In relation to the lateral canthus, it was found to be 2.85 +/- 0.69 cm superior and 2.54 +/- 0.43 cm lateral to the lateral canthus. Our study suggests consolidated data on surgical landmarks in order to ensure safe dissection in temporal region and prevent injury to the temporal branch of facial nerve.

Modified Temporal Incision for the Management of Zygomatic Arch fractures-A Retrospective Study for 7 Years.

Retrospective cross-sectional study. The objective of this retrospective study was to evaluate the clinical outcomes of Modified temporal incision in the management of zygomatic arch fractures (ZAF). Records of 34 patients who underwent open reduction for zygomatic arch fractures were retrieved and included in the study between 2011 and 2018. These patients were followed up at 4 weeks, 8 weeks and 12 weeks respectively. Clinical parameters such as post-operative infection, hematoma, scarring, degree of mouth opening, palpability of plates, alopecia and weakness of temporal branch of Facial nerve recorded were analyzed for complications of modified temporal incision in the management of ZAF. A thorough analysis of the clinical parameters revealed that at the end of 4 weeks scarring was present in 4 patients and temporal branch of Facial nerve weakness was present in 21 patients. None of the patients had hematoma, infection or palpability of miniplates. At the end of 8 weeks the only complication recorded was weakness of temporal branch of Facial nerve in 21 patients. By 12 weeks, all patients had complete recovery and none of the patient had weakness of temporal branch of Facial nerve. The results obtained proved that the Modified temporal incision can be considered as a reliable method in the management of zygomatic arch fractures. The incision can be adopted with confidence in suitable cases of zygomatic arch fractures without any permanent morbidity.

Primary Observation of the Causes of Temporal Hypertrophy Secondary to Fat Grafting and the Effect of Liposuction on the Hypertrophy.

In Asia, the temporal hollowing is considered to be a sign of bad fortune and aging. Many people demand to correct the temporal hollowing with fat grafting. Subsequently, the temporal hypertrophy secondary to fat grafting become more and more. This study attempted to preliminarily explore the causes of temporal hypertrophy and observe the safety and effectiveness of liposuction in correcting temporal hypertrophy. A diagnostic criteria for temporal hypertrophy was established, and 55 of 78 patients who complained of temporal swelling were defined as temporal hypertrophy, and filled out a questionnaire which included patients' basic information, preoperative, intraoperative, and postoperative problems related to fat grafting, as well as their acceptance of liposuction. Analyze the results of the questionnaire to explore which factors are associated with hypertrophy. Practice liposuction on patients who are willing to try liposuction. Postoperative complications were observed to determine the safety of liposuction. The patients, doctors, and bystanders were followed up 3 months postoperative to investigate the satisfaction of the operation for analyzing the effectiveness of liposuction for temporal hypertrophy. Before fat grafting, 13 (23.6%) patients without significant temporal hollowing and 42 (76.4%) patients with obvious temporal hollowing; 28 (50.9%) patients with 1 fat grafting, 20 (36.4%) with 2 fat gratings, 7 (12.7%) with 3 fat grafting. The mean time between 2 fat gratings was 4.8 months. The fat donor sites: 50 (90.9%) patients in thigh, 4 (7.3%) in abdomen, and in 1 (1.8%) in waist. The average onset time of hypertrophy in 55 patients was 13.1 months after the last fat grafting. The average onset time of temporal hypertrophy of the weight-gain group (25.7 months) was significant later than that of the weight-invariant group (7 months) (P < 0.01).No irregularities, skin necrosis, hematoma, or infection was found in all patients. One patient showed the damage to temporal branch of facial nerve on right side, which fully recovered at 1 week postoperative. 7 (22.6%) patients, 10 (32.3%) doctors, and 8 (25.8%) laypersons reported satisfactory results; 14 (45.2%) patients, 15 (48.4%) doctors, and 14 (45.2%) laypersons reported mostly satisfactory results; 10 (32.3%) patients, 6 (19.4%) doctors, and 9 (29.0%) laypersons reported dissatisfactory results. To prevent temporal hypertrophy, the following points are important: to rationally choose of indication of temporal fat grafting, to wait 1 to 2 years before next fat grafting, to maintain weight stability after fat grafting, to practice conservative fat grafting, to prudently choose fat donor site. Liposuction is safe for temporal hypertrophy, but it is not easy to operate and difficult to correct all cases. Therefore, a superior treatment plan should be explored.

61. Stimulated single-fiber electromyography of the frontal muscle: Normative data using concentric needle

To obtain normative values we performed in healthy volunteers (HV) stimulated single-fiber electromyography (SFEMG) of the Frontal muscle using concentric needle electrode (CNE). Frontal muscles SFEMG, after stimulation with needle electrodes of the temporal branch of facial nerve, was conducted in 16 HV (6 males, mean age 43.1, range 20–60 years). Filter settings were 1000 Hz to 10 kHz.The mean consecutive difference (MCD) of the individual fiber and the mean MCD per study were determined. Using the 95% percentile the upper normal limit for the individual fibers of jitter and the mean MCD per study in the HV was 37 μs and 27 μs respectively. Having defined these limits, we evaluated 7 patients affected by seronegative Ocular Myasthenia gravis. All these patients showed mean MCD >27 μs and >2 individual fiber Jitter >37 μs. The 95% prediction limit might be optimal cut-off value, depending on the clinical question. The obtained reference values were narrow than those reported previously using concentric needles. Stimulation jitter recordings with CNE could be used in practice but borderline findings should be carefully assessed in a prospective study in which consecutive patients with clinical suspicion of Myasthenia Gravis will be enrolled.

The Relationship of the Temporal Branch of the Facial Nerve to the Fascial Planes of Temporal Region in Human Fetuses.

The aim of this study was to obtain information by assessing the relationship between temporal region fascial structures, fat pads, and temporal branches of facial nerve in human fetuses to use the knowledge on treatment of early childhood period surgeries. This anatomic dissection study was conducted on 40 hemifaces with no visible external abnormalities on their faces. Fascial layers and related fat pads of temporal region were dissected layer by layer beginning from superficial to deep. The relations of temporal branches of facial nerve and temporoparietal fascia and the structures of these fascial layers were evaluated. Temporoparietal fascia showed continuity below zygomatic arc with superficial musculoaponeurotic system. Temporal branches of facial nerve showed a multiple branching. Parotid-masseteric fascia became very thin on the superficial of zygomatic arch and ran with superficial layer of temporal fascia above without attaching to periosteum. Temporal branches of facial nerve entered between multilayered layers of temporoparietal fascia. Temporoparietal fascia became thicker on anterior and middle parts because of the localization of superficial temporal fat pad. Temporal fascia was a 2-layered thick and fibrous tissue enveloping intermediate fat pad. Deep layer connected to periosteum of zygomatic arch and superficial layer continued passing superficial of zygomatic arch and connected to the parotid-masseteric fascia. Deep temporal fat pad was found on the deep to deep layer of temporal fascia and surface of temporal muscle. The findings of this study may contribute to the knowledge of the topographical localization of temporal branches of facial nerve with temporal region fascial structures and fat pads in fetuses.

Management of Zygomatico-Maxillary Complex Fracture in Military Dental Centre, Dhaka: A Study of 40 Cases

Introduction: Zygomatic bone is closely associated with the maxilla, frontal, temporal bones which are usually involved when a zygomatic bone fracture occurs. The most common causes of these fractures are from the assaults, road traffic accidents and falls. Aesthetic beauties and functions are greatly hampered with the displacement of the fractured fragments.&#x0D; Objective: To analyze the aetiology, clinical presentations, surgical intervention and complications associated with zygomatic complex (ZC) fractures in a tertiary level healthcare facility.&#x0D; Materials and Methods: This descriptive observational study was carried out in the Oral and Maxillofacial Department, Military Dental Centre, Dhaka during the period of January 2016 to December 2016. Data were obtained from clinical notes and surgical records of the patients using standardized data collection form specifically designed to examine the variables and features of zygomatic complex fractures.&#x0D; Results: Road traffic accidents were the leading cause (75%) of zygomatic fractures. The mean operation time was found 99.5±31.2 minutes with a range from 60 to 125 minutes. Open reduction and two-point internal fixation were employed in more than two-third (67.5%) of the cases. Four (10.0%) patients developed postoperative complications; among them 2(5.0%) cases suffered paresis of temporal branch of facial nerve and trismus. Other complications included paraesthesia, ectropion, scar and palpability of plate. Twenty-five (62.5%) patients were found having limited mouth opening preoperatively and postoperative improvement occurred in 21(52.5%). Thirty three (82.5%) patients had facial asymmetry preoperatively and postoperative improvement occurred in 29(72.5%).&#x0D; Conclusion: More than two-third of the patients received two point fixations. Only four patients out of forty in this study were found having post operative complications. The functional and Aesthetic outcome was found to be fair in terms of improvement in limitation of mouth opening and correction of facial asymmetry.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 71-74

[An anatomy study of temporal layers : the safe space for hyaluronic acid injection].

To determine the safe space for hyaluronic acid(HA) injection through anatomy study of temporal layers. 6 fresh and 8 formaldehyde-fixed cadaver heads were dissected. The skin soft-tissue layers of temporal region were incised through the cranial coronal plane and elevated layer by layer. The morphological features of layers were observed and documented, as well as the relationship of the superficial temporal artery (STA),the temporal branch of facial nerve (TFN) and the middle temporal vein(MTV) with corresponding layers. Relevant neasurements of the superficial temporal fat pad (sTFD) were recorded. With reference of cardever dissection, temporal region injection with HA was carried out clinically to confirm the safety and effect. In the temporal region, from surface to the temporal fossa, the layers are skin, subcutaneous tissue, superfiacial temporal fascia (STF),loose areolar tissue, superficial layer of deep temporal fascia(sDTF), sTFD, deep layer of deep temporal fascia (dDTF),deep temporal fat pad (dTFD) and temporalis. The temporal skin is tightly attached with the subcutaneous tissue. The STA runs within the subcutaneous tissue on the STF, whereas the TFN within the areolar tissue was just beneath the STF. The loose areolar tissue is a potential layer space. The DTF splits into two sheets of fascia at the line 1 cm above the upper orbital rim to envelope the sTFD, within which the MTV runs backward. The dTFD is the temporal extension of buccal fat pad. With reference of cadever dissection, the target space of temporal HA injection was beneath the temporalis for the area superior to the MTV, whereas within the sTFD for the area inferior to the MTV.67 cases were completed with good result and no complication. In the upper area of temporal region adjacent to the frontal border, the sub-temporalis space is the safety space for HA injection, while inferior to the middle temporal vein and near the zygoma, the superficial temporal fat pad is the target space for safe HA injection.

Aberrant temporal branch of facial nerve

There is a high risk of injury to the temporal branch of the facial nerve during operations on the head and neck because of the complexity of its course. We report an aberrant branch that arose from the main trunk before bifurcation into the temporofacial and cervicofacial divisions. It had no anastomosis with other branches, and damage could have caused uncompensated injury.

Treatment of Temporomandibular Joint Ankylosis with Temporalis Superficial Fascia Flap, a case series

Background: Different interpositional materials have been used to prevent recurrence after gap arthroplasty in temporomandibular joint ankylosis. In this study, the temporalis superficial fascia flap was evaluated as an interpositional material after condylectomy.&#x0D;  Materials and Methods: 9 Cases of unilateral or bilateral temporomandibular joint ankylosis were evaluated in this study with a follow-up of 12 months. The Al-khayat approach was used as the surgical technique with the inferiorly based temporalis superficial fascia flap.&#x0D;  Results: 9 Patients (6 female and 3 male) had a preoperative maximal inter-incisal opening of 3 to 10 mm. During the last follow-up observation after surgery, patients had a maximum inter-incisal opening of 40 to 45 mm. Paresthesia or anesthesia of the temporal branch of facial nerve was absent in all cases. There were no signs of re-ankylosing in any of the patients.&#x0D;  Conclusion: The findings of this study showed that the temporalis superficial fascia flap is a good alternative as an interpositional material in treatment of temporomandibular joint ankylosis.

Clinical anatomy of three major salivary glands to treat xerophthalmia

Background Salivary transplantation or duct transposition can provide continuous physiological secretion of tear substitutes.This may be an ideal method in treatment of dry eye.But the relative anatomical literatures is few,and some of the conclusions in the literatures are still controversial,which limit its clinical application.Objective This study was to discuss the possibility and the advantage and disadvantage of applying three major salivary glands to treat xerophthalmia.Methods The relationship between the branches of the facial nerve out of the parotid gland and the salivary glands,the salivary glands size,origin of blood supply,out diameter of vessels and adjacent relation were observed in 34 sides pate specimens perfused with red latex under the operating microscope.To find the vessels in recipient site to anastomose,the vessels around fossa orbitalis and forehead were anatomized and observed.The parotid gland duct transfer operation,the submandibular gland free transplantation surgery and sublingual gland free transplantation surgery in the human anatomy specimens were simulated.Results The position of parotid duct was constant.The duct length was(4.20± 1.10) cm,duct diameter was (O.60±0.30) cm.The stensen's duct was likely to be prolonged by the cheek mucous membrane or venous andthe damage of buccal branch,zygomatic branch and temporal branches of facial nerve should be avoided during the operation of transplanting stensen' s duct.When submandibular gland was transplanted,facial vessel was taken as its pedicle,whose outside diameter was (2.70 ± 0.28) mm,and the length of the transplant vascular pedicle was (1.90 ± O.30) cm.Thc anastomosed vessel was superficial temporal vessel in recipient site.When sublingual gland was transplanted,sublingual(88.2％,30 sides) or submental vessel(11.8％,4 sides) was taken as its pedicle,whose outside diameter was(1.92±0.36) mm and (1.96±0.54) mm,and the length of the transplant vascular pedicle was(2.60± 1.10) cm and(3.50±0.40) cm,and the anastomosed vessel was the frontal branch of superficial temporal vessel in recipient site.Three sides of specimens lacked sublingual glands.Conclusions It is feasible that treating severe xerophthalmia by the operation of grafting the major salivary glands or transplanting stensen' s duct on the point of anatomical view.Parotid duct inversion and the submandibular gland transplantation have been applied to clinic.However,sublingual transplantation remains to be further confirmed by the animal experiments. Key words: Salivary glands ;  Xerophthalmia ;  Applied anatomy

Modified Gap Arthroplasty and Myrhaug's Incision as a Treatment Option in Management of Temporomandibular Joint Ankylosis: A Study of 10 Cases

The purpose of this study was to evaluate effectiveness of modified gap arthroplasty procedure and modified Myrhaug's preauricular incision for treating bony temporomandibular joint (TMJ) ankylosis. A total of 10 cases were included in the study with Sawhney's type III and IV TMJ ankylosis. Study consisted of 6 males and 4 females. Three cases were treated for bilateral ankylosis and 7 were treated for unilateral ankylosis. All the patients were treated with modified gap arthroplasty and modified Myrhaug's incision was used. In this modification, osteotomy cuts were modified in such a way that coronoid process was also removed simultaneously along with the osteotomized ankylosed mass in one piece. All the patients were followed up for 5 years and none of them presented with recurrence. Two patients had transient paresis to zygomatic and temporal branch of facial nerve and none had permanent damage to the nerve. Seven patients had mouth opening more than 25 mm (p) when followed for 5 years. Anterior open bite was seen in 4 patients and deviation of the jaw on ipsilateral side was noted in 2 patients. Modified gap arthroplasty gave successful results in the follow-up period and eliminated the need of separate coronoidectomy. Use of modified Myrhaug's preauricular approach, provided excellent visibility particularly of the elongated coronoid process, minimized bleeding, prevented damage to the vital anatomical structures surrounding the joint and gave acceptable cosmetic results. The modified incision has been found to be reducing intra- and postoperative morbidity as well as provides excellent accessibility. The modified osteotomy technique eliminated the need for separate coronoidectomy thus significantly reducing the operating time.

Temporal flap approach for preauricular epidermal cyst excision

A 40-year-old male presented with a fluctuant swelling in front of the right ear. His past history is significant for having undergone surgery for the swelling four times in the past 6 years with recurrence each time. We excised the swelling by using a preauricular incision with reverse question mark type extension into the temporal area. The advantages are complete unhindered exposure, excellent cosmesis, and prevention of damage to the temporal branch of facial nerve.

Anatomic Bases of Superficial Temporal Artery and Temporal Branch of Facial Nerve

The superficial temporal artery (STA)-based flaps have been used for different reconstructive purposes. These operations may cause facial nerve injury. The variations of the STA and its relation to temporal branch of the facial nerve (TBFN) were evaluated in this study. Thirteen cadavers with 26 STA and TBFN have been dissected. The bifurcation of STA was found to be 60% above the superior border of the zygomatic arc and 40% below this level. The mean lengths of frontal and temporal branches (FB and TB) of STA were 11.5 and 11.4 cm, respectively. The mean numbers of perforators of FB and TB to deep plane were 1.30 and 1.34, respectively. The mean diameter of STA at the superior border of zygomatic arc was 2.5 mm. The mean diameters of TB and FB at the level of bifurcation were 1.8 mm and 2.0 mm, respectively. The mean number of TBFN at the level of zygomatic arc was 3.70. The mean distance of the first and last branching of TBFN to tragus was found to be 24 mm. The mean number of TBFN at the level of the middle orbita was found to be 2.7. The mean distance of first and last branches of TBFN to the lateral orbital rim was 12 and 24 mm, respectively. The results found in this study may increase the accuracy of flaps based on STA and decrease the risk of facial nerve paralysis during these operations.

Reposition of zygomatic complex fracture via subciliary incision combined with preauricular temporal approach

Objective To investigate the application of subciliary incision combined with preauricular temporal approach in the treatment of zygomatic complex fracture. Methods Fifty-three patients with zygomatic complex fracture including 41 males and 12 females were selected. Subciliary incision combined with preauricular temporal incision was employed to exp the site of fracture. After reduction of the fractures, rigid internal fixation was applied to fix the fractured bones. The facial profile, mouth opening, occlusion, view sight, movement of eye ball and local scar were evaluated postoperatively. Results The wounds of all the cases healed by first intension. All the cases had been recovered with normal face profile, mouth opening, occlusion, view-sight and eye ball movement. Facial nerve function of one case among the three cases with facial nerve trauma preoperatively was recovered totally after surgical treatment. And one case with suborbital nerve dysfunction preoperatively was not recovered. There was no case with the complications of entropion and ectropion, visible scar and temporal amyotrophia. Permanent trauma of temporal branch of facial nerve and supraorbital nerve was not observed after surgical therapy, but temporary facial nerve dysfunction occurred in 18 cases postoperative 1-3 months. Conclusion It is suggested that the approach of subciliary incision combined with preatrricular temporal incision could be employed to treat zygomatic complex fracture. Key words: Zygomatic complex;  Fracture;  Subciliary incision;  Preauricular temporal approach

Use of Temporalis Fascia as an Interpositional Arthroplasty in Temporomandibular Joint Ankylosis: Analysis of 8 Cases

Different interpositional materials have been used to prevent recurrence after gap arthroplasty in temporomandibular joint ankylosis. In this study, the versatility of the temporalis fascia as an interpositional arthroplasty was evaluated. Eight cases of unilateral temporomandibular joint ankylosis were evaluated, with a follow-up of 11 months to 6 years. Patients had a preoperative maximal interincisal opening of 1 to 9 mm (mean, 2.75 mm). During the last follow-up observation after surgery, patients had a maximum interincisal opening of 32 to 40 mm (mean, 36.5 mm). Deviation to the affected side was observed in all cases. Paresthesia or anesthesia of the temporal branch of facial nerve was absent in all cases. Periodic panoramic radiographs showed that the intra-articular space was well maintained because of interposed tissue, without signs of relapse. There were no signs of reankylosis in any patient. The findings of this study show that the temporalis fascia is a good alternative for interpositional arthroplasty.

Temporal branch of facial nerve: a normative study of nerve conduction

The temporal branch of the facial nerve is particularly vulnerable to traumatic injuries during surgical procedures. It may also be affected in clinical conditions. Electrodiagnostic studies may add additional information about the type and severity of injuries, thus allowing prognostic inferences. The objective of the present study was to develop and standardize an electrophysiological technique to specifically evaluate the temporal branch of the facial nerve. Healthy volunteers (n=115) underwent stimulation of two points along the nerve trajectory, on both sides of the face. The stimulated points were distal (on the temple, over the temporal branch) and proximal (in retro-auricular region). Activities were recorded on the ipsilateral frontalis muscle. The following variables were studied: amplitude (A), distal motor latency (DML) and conduction velocity (NCV). Differences between the sides were not significant. The proposed reference values were: A > or = 0.4 mV, DML <3.9 ms and NCV > or = 40 m/s. Variation between hemifaces should account for less than 60% for amplitudes and latency, and should be inferior to 20% for conduction velocity. These measurements are an adequate way for proposing normative values for the electrophysiological evaluation of the temporal branch.

Anastomosis between the temporal branch of facial nerve and auriculotemporal nerve

Anastomosis between the temporal branch of facial nerve and auriculotemporal nerve