Mandlik, Veronika and Ruewe, Marc and Engelmann, Simon and Geis, Sebastian and Taeger, Christian and Kehrer, Michael and Tamm, Ernst R. and Bleys, Ronald and Prantl, Lukas and Kehrer, Andreas (2019) Significance of the Marginal Mandibular Branch in Relation to Facial Palsy Reconstruction Assessment of Microanatomy and Macroanatomy Including Axonal Load in 96 Facial Halves. ANNALS OF PLASTIC SURGERY, 83 (6). E43-E49. ISSN 0148-7043, 1536-3708
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Background The marginal mandibular branch (MMB) of the facial nerve provides lower lip symmetry apparent during human smile or crying and is mandatory for vocal phonation. In treating facial palsy patients, so far, little attention is directed at the MMB in facial reanimation surgery. However, isolated paralysis may occur congenital, in Bell's palsy or iatrogenic during surgery, prone to its anatomical course. A variety of therapies address symmetry with either weakening of the functional side or reconstruction of the paralyzed side. To further clarify the histoanatomic basis of facial reanimation procedures using nerve transfers, we conducted a human cadaver study examining macroanatomical and microanatomical features of the MMB including its axonal capacity. Methods Nerve biopsies of the MMB were available from 96 facial halves. Histological processing, digitalization, nerve morphometry investigation, and semiautomated axonal quantification were performed. Statistical analysis was conducted with P < 0.05 as level of significance. Results The main branch of 96 specimens contained an average of 3.72 fascicles 1 to 12, and the axonal capacity was 1603 +/- 849 (398-5110, n = 85). Differences were found for sex (P = 0.018), not for facial sides (P = 0.687). Diameters were measured with 1130 +/- 327 mu m (643-2139, n = 79). A significant difference was noted between sexes (P = 0.029), not for facial sides (P = 0.512.) One millimeter in diameter corresponded to 1480 +/- 630 axons (n = 71). A number of 900 axons was correlated with 0.97 mm (specificity, 90%; sensitivity, 72%). Conclusions Our morphometric results for the MMB provide basic information for further investigations, among dealing with functional reconstructive procedures such as nerve transfers, nerve grafting for direct neurotization or babysitter procedures, and neurectomies to provide ideal power and authenticity.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | BOTULINUM TOXIN; MUSCLE TRANSFER; SURGICAL ANATOMY; NERVE GRAFT; PART I; PARALYSIS; REANIMATION; LANDMARKS; FACE; RESTORATION; marginal mandibular nerve; facial nerve; facial muscles; facial paralysis; oral muscles; facial expression; axons |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie Medicine > Lehrstuhl für Mund-, Kiefer- und Gesichtschirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 24 Mar 2020 06:48 |
| Last Modified: | 24 Mar 2020 06:48 |
| URI: | https://pred.uni-regensburg.de/id/eprint/25775 |
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