In essentially all cases the nerve is located above the inferior border of mandible beyond the facial artery. 21). Management of nerve palsy can be broadly categorized as restorative techniques and reconstructive techniques. AK constructed the framework of this article, including the data compilation, analysis, and exhibition. It is essential to understand the probable anatomical course and branches of the nerve, landmarks used to isolate the nerve, and strategize surgical approaches aimed deliberately to protect the nerve and avert the repercussions of nerve damage. This Second Edition includes full-color intraoperative photographs that complement the surgical drawings. Predicting the course of the marginal mandibular. The marginal mandibular nerve in relation to the inferior border of the mandible. A new, more cohesive full-color illustration program richly captures visual nuances of clinical presentation and operative technique. A bonus CD-ROM allows you to use all of the images from the book in electronic presentations. Marginal mandibular nerve — a wandering enigma and ways to tackle it. In this report, we describe the first case in literature of a patient with multiple schwannomas of the marginal mandibular branch of the facial nerve. 2014 Jul;25(4):1476-81. doi: 10.1097/SCS.0000000000000577. Background: Marginal mandibular nerve injuries are more likely to be symptomatic than other facial nerve injuries following facelift procedures. Anat., 33:739-750, 2020. The marginal mandibular nerve (MMN) leaves from anterior caudal margin of the parotid gland underneath the parotid-masseteric and deep cervical neck fascia just below the angle of the mandible and is anatomically protected by a thick superficial musculo-aponeurotic system (SMAS) after it exits the parotid gland [9] (Fig. The marginal mandibular nerve may be injured during surgery in the neck region, especially during excision of the submandibular salivary gland or during trlgeminus dissections due to lack of accurate knowledge of variations in the course, branches and relations. Clin Anat 32(2):169–175. The (a) branch communicates with the (AB) branch of (GAN) superficial to masster (M) muscle. Images are entirely unidentifiable and there are no details on individuals reported within the manuscript. Twelve fresh adult cadavers were dissected and the mandibular base was contoured using needles with 5mm gaps, starting from the mandibular angle to the muscular termination point of the nerve bilaterally. Baur DA, Kaiser AC, Leech BN, Landers MA, Altay MA, Quereshy F. J Oral Maxillofac Surg. Rev Stomatol Chir Maxillofac. Epub 2012 Jan 10. 23). The PubMed and Scopus databases were investigated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Incising the submandibular fascia, ligating the facial vein, and retracting the nerve superiorly may also protect the nerve. This muscle pro pulls down the mouth in frowning. It leaves the anterior-inferior border of the parotid gland, makes a curve down to the submandibular gland, and runs along the angle and inferior border of the mandible. Found inside – Page iThis book is a practical and detailed guide on how to perform a range of surgical techniques for facial bone contouring. Aesthetic Surg J 36(9):977–982. [16] in their study and they concluded that the mean distance from the lower mandibular margin to where MMN intersects the facial artery, considering all branches of the nerve, was found to be 1.73 mm. Woltman M, Fauri Rd, Sqrott EA. Epub 2014 Jul 5. Keywords: nerve as anastomotic arcades between marginal mandibular and other branches of facial nerve is relatively rare.Identification of marginal mandibular branch ,and knowledge of its course,anatomical variations and relations of the marginal mandibular nerve is therefore essential to avoid surgical complications. It has a sensory role in the head, and is associated with parasympathetic fibres of other cranial nerves. The pterygo-masseteric sling is incised to retract the masseter as the nerve travels over the masseter muscle (Figs. Bookshelf Anatomy and Filler Complications emphasizes on the importance in training and educating physicians. Prevention is the only recourse, as it will be discussed extensively in this book Privacy, Help The liposuction process can injure the nerve but typically does not sever it completely. Tirelli G, de Groodt J, Sia E, Belgrano MG, Degrassi F, Boscolo-Rizzo P, Cova MA, Marcuzzo AV. Nelson and Gingrass [35] reported MMN to course below the lower mandibular border in almost 100% cases. Based on the relation of the nerve to the facial artery, we recommend the node of the Stahr approach, which can be used to identify MMN by localizing facial artery during mandibular body traumatic surgeries (Figs. Surg Radiol Anat 19:311-314. It is commonly known to be aware of this nerve when performing neck liposuction and facelift type procedures. Such deficits can affect the patient’s quality of life and have several legal implications [6]. Marginal mandibular nerve and its relation with lower border of mandible and facial artery. In this article, various surgical techniques have been discussed in view of the abovementioned considerations to preserve the MMN from iatrogenic injuries during orofacial surgical procedures, which have proven to be highly beneficial in our clinical practice. J Craniofac Surg 26:245, Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India, Adarsh Kudva, Kiruthika Babu, Mehul Saha, Smriti Puri, Lakshmi Pandey & Shruti Gunashekhar, Manipal Academy of Higher Education, Manipal, India, You can also search for this author in We recommend placing the incision in the submandibular crease with caution, considering that the position of nerve inevitably changes with rotation of the neck and pull of the deep cervical fascia. N2 - Background: 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. [47] proposed the use of upper buccal or cervical branches to correct marginal mandibular nerve defects and argued that this technique showed better functional results in comparison to greater auricular nerve graft or hypoglossal nerve anastomosis in the reconstruction of facial nerve defects. PubMed  Egypt J Otolaryngol 37, 74 (2021). https://doi.org/10.1590/S0103-64402006000100016, Toure G (2019) Tran De Fremicourt MK, Randriamanantena T, Vlavonou S, Priano V, Vacher C: Vascular and nerve relations of the marginal mandibular nerve of the face: anatomy and clinical relevance. The distance of the nerve from the inferior border of the mandible varied from 13.06-40.08 mm, with an average distance of 21.91 mm. Anatomic variations of the marginal mandibular nerve. Objectives: The authors describe the location of the marginal mandibular nerve based on superficial anatomic landmarks as it crosses the . 2012 Mar;3(1):8-11. doi: 10.1007/s13193-011-0121-3. [Positional relationship between branches of the facial nerve and the plane of angulus oris: an anatomical study]. Epub 2014 Jul 5. The muscle fibers are then located and a strip of the muscle is removed to disrupt its function. 2007. 24). The importance of the facial artery as a landmark to localize the nerve was highlighted by Balagopal et al. Part of 16 and 17). Head Neck 40(5):1016–1023. This book will be of value to beginners, and experienced practitioners in not only cosmetic surgery but also plastic surgery, general surgery, oral maxillofacial surgery, neurosurgery, dermatology, otolaryngology, and ophthalmology. The aim of this study was to determine the course of marginal mandibular nerve (MMN) in relation to the inferior border of the mandible from the gonion until its terminal insertion to the depressor anguli oris, relating the position to a palpable anatomical landmark with emphasis on the depth of the nerve in relation to platysma and the deep cervical fascia. 2014 Nov;72(11):2221-6. doi: 10.1016/j.joms.2014.06.453. The systematic approaches described in this study have helped the authors precisely determine which particular MMN preserving approach to be adopted for each aspect of head and neck surgery. Woltman M, Fauri Rd, Sqrott EA. The position of this branch is variable when posterior to the facial artery; it is above the inferior border of the mandible in 81% and below the inferior border of the mandible in 19% of the cases. Month in review. Found insideVolume 3 is basically the sequel to Volumes 1 and 2; 93 specialists from nine countries contributed to 32 chapters providing comprehensive coverage of advanced topics in OMF surgery. Google Scholar, Marcuzzo AV, Uran-brunelli ANŠ, Cin EDAL, Rigo S, Piccinato A, Nata FB, Tofanelli M, Boscolo-rizzo P, Grill V, Lenarda RDI, Tirelli G (2020) Surgical anatomy of the marginal mandibular nerve: a systematic review and meta-analysis, vol 750, p 739, Ghumman NU, FDS R, Yasser F, Phil M (2014) Marginal mandibular nerve and its relation with lower border of mandible and facial artery, vol 34, p 11, Khanfour AA, Metwally ESAM (2014) Marginal mandibular branch of the facial nerve: an anatomical study. 8, 9, 10, and 11). The authors read and approved the final manuscript. This video shows a patient recovering from a marginal mandibular nerve injury. The cervicofacial branch divided into its own branches, including the marginal mandibular nerve (MMN), which ran within the investing (superficial) layer of the deep cervical fascia. Innervated by the Marginal Mandibular branch. Bethesda, MD 20894, Copyright Intracranial. Diesel will remain anonymous. nerve in 14, hypoglossal in 13, marginal mandibular branch of facial nerve in six and superior laryngeal in five. Although the facial artery is a significant landmark in localizing the MMN, the facial vein is considered a definitive landmark as it exhibits a more dependable relationship with MMN, and the nerve is found lateral to the facial vein in 95% of cases [13]. Seckel B: Facial danger zones: avoiding nerve injury in facial plastic surgery. A Caucasian patient presented with a sudden onset of left lower facial nerve palsy House-Brackmann score III for 1 month. Curr Opin Otolaryngol Head Neck Surg 27(2):104–109. Indian J Surg Oncol. Dermatol Surg 44(5):733–735. 2006;17(1):71-4. doi: 10.1590/s0103-64402006000100016. https://doi.org/10.1159/000147176, Lin B, Lu X, Shan X, Zhang L, Cai Z (2015) Preoperative percutaneous nerve mapping of the mandibular marginal branch of the facial nerve. Found insideRegional Nerve Blocks in Anesthesia and Pain Medicine provides essential guidelines for the application of regional anesthesia in clinical practice and is intended for anesthesiologists and all specialties engaged in the field of pain ... Manage cookies/Do not sell my data we use in the preference centre. Correspondence to Additionally, this book uniquely provides a detailed description of the bones of the head and face in order for the reader to understand the routes taken by the cranial nerves through the skull. The marginal and cervical branches of the facial nerve are interconnected in both an anatomic and functional relationship, working together in lower lip animation. The facial nerve (CN VII) is the seventh paired cranial nerve. Found insideThe second edition of Facial Danger Zones Subperiosteal, extended sub-SMAS, deep plane, and composite rhytidectomy are all names that have been used to describe the current, more extensive operations for facial rejuvenation. This is a patient of Dr. Tanveer Janjua, a board certified plastic surgeon. Injury to the marginal mandibular nerve is a very morbid complication resulting . Classical description by Dingman and Grabb [20] implies nerve injury can be avoided by placing incisions 2 cm below inferior mandibular margin but on the contrast abovementioned clinical dissection, studies [4, 37] concluded that nerve is at greater risk when the incision is placed 2 cm below the inferior mandibular margin. The authors declare that they have no competing interests. Motor - muscles of facial expression, posterior belly of the digastric, stylohyoid and stapedius muscles. The MMN is more often jointly found with perifacial lymph nodes in the submandibular triangle (Fig. Clipboard, Search History, and several other advanced features are temporarily unavailable. Clin Anat 29(2):151–156. What does the mandibular nerve divide into? The MMN had one (PP = 35% 95% CI:18-54%), two (PP =35% 95% CI:18-54%), three (PP = 18% 95% CI:0-35%), or four branches (PP = 2% 95% CI:0-8%). © 2019 Wiley Periodicals, Inc. Keywords: Int J Oral Maxillofac Surg 36(8):712–715. https://doi.org/10.1097/PRS.0000000000005360, De Bonnecaze G, Vergez S, Chaput B, Vairel B, Serrano E, Chantalat E, Chaynes P (2019) Variability in facial-muscle innervation: a comparative study based on electrostimulation and anatomical dissection. Anatomical dissections by Toure et al. Werner C, D'Antoni AV, Iwanaga J, Watanabe K, Dumont AS, Tubbs RS. The right marginal mandibular nerve (n) emerging from the parotid gland (p). Clin Plast Surg 35(4):469–477. At least one branch of the MMN was found below the inferior border of the mandible (IBM), with a PP of 39% (95% CI:30-50%). https://doi.org/10.1159/000276616, CAS  Testing another bug. Marginal Mandibular Nerve (MMN) is a branch of the facial nerve. Neurosurg Rev. [12] which concludes that the nerve originates from the parotid apex in 70% cases and is consistent with studies by Batra et al. Next, by using the extraoral submandibular approach on both sides, after the skin incision was made 1.5 cm below the mandibular border, the platysma muscle and the superficial layer of the deep cervical fascia were sectioned, and with taking care of the marginal mandibular branch of the facial nerve, facial vein, and facial artery, the pterygomasseteric connection was reached. https://doi.org/10.1016/j.ijom.2012.02.013, Horne SK, Gal TJ, Brennan JA (2007) Prevalence and patterns of intraoperative nerve monitoring for thyroidectomy. PubMed Central  Neck dissection: An early step of neck dissection is the identification of the marginal mandibular nerve deep to the superior sub-plastysmal flap. Int J Oral Maxillofac Surg 41(8):930–933. This site needs JavaScript to work properly. You are very early in the recovery phase, as return of motor nerve function can take much longer than than four weeks. The high number of marginal mandibular nerve (MMN) anatomical variants have a well-known clinical significance due to the risk of nerve injury in several surgical procedures. The MMN has high anatomical variability and it is more often represented by one or two branches; its origin is frequently described at the parotid apex and above the IBM, although in its course at least one branch often runs below the IBM. Published by Elsevier Ltd. All rights reserved. FOIA Cite this article. [41] outlined the “Marginal branch triangle” limited by the anterior border platysma muscle, base of the mastoid apophysis, and superiorly by the lateral labial commissure. This technique avoids a large area of subplatysmal dissection. The parotid-masseteric fascia technique for approaching condyle using a periangular approach is proposed considering the origin and course of MMN in the parotid region (Figs. Nason et al. Springer Nature. To observe the course of the marginal mandibular branch of the facial nerve (MMBFN) and its relation to the inferior border of the mandible and facial vessels. Surg Radiol Anat 19(2):69–72. The collection has been updated annually since 1992 for use in the annual Iowa Head and Neck Cancer and Reconstructive Surgery Course. Epub 2006 May 2. The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments. Through the same incision, the terminal branches of the marginal mandibular nerve (branch of the facial nerve) is also removed. Pulls down the corner of the mouth (Frowning) Innervated by the Marginal Mandibular branch. Folia Morphol 66:307-313. Arch Plast Surg 42(6):735–740. The facial vein is identified and ligated over the surface of the submandibular gland at two fingerbreadths below the mandible and the ligated vein is flipped superiorly by retracting the superficial cervical fascia, as in the majority of cases, the nerve courses over the facial vein (Figs. The marginal mandibular branch is one of the terminal branches of the mandibular division of the facial nerve. The instance of lower lip paralysis is limited due to the variability in branching and anastomosis pattern of MMN with other nerves or its own branches [12, 36] (Table 1). https://doi.org/10.1002/(SICI)1097-0347(199701)19:1<48::AID-HED9>3.0.CO;2-V, https://doi.org/10.1016/j.ijom.2007.02.011, https://doi.org/10.1017/S0022215100083869, https://doi.org/10.1016/j.ajme.2013.12.004, https://doi.org/10.1097/DSS.0000000000001291, https://doi.org/10.1016/j.cps.2008.05.011, https://doi.org/10.1007/s13193-011-0121-3, https://doi.org/10.1097/PRS.0000000000001244, https://doi.org/10.1097/00006534-196203000-00005, https://doi.org/10.1097/SCS.0000000000001408, https://doi.org/10.1097/MOO.0000000000000523, https://doi.org/10.1002/(SICI)1096-9098(199709)66:1<54::AID-JSO11>3.0.CO;2-O, https://doi.org/10.1097/00006534-197910000-00006, https://doi.org/10.1097/00006534-197912000-00005, https://doi.org/10.1590/S0103-64402006000100016, https://doi.org/10.1097/PRS.0000000000005360, https://doi.org/10.1016/j.bjps.2015.10.028, https://doi.org/10.1016/j.ijom.2012.02.013, https://doi.org/10.1016/j.otohns.2007.02.011, https://doi.org/10.5999/aps.2015.42.6.735, https://doi.org/10.1097/SCS.0000000000004739, http://creativecommons.org/licenses/by/4.0/, https://doi.org/10.1186/s43163-021-00134-5. This zone is described as an area of 2 cm radius with the center located at a point 2 cm posterior to labial commissure. With cases reflecting the classic presentation format of each disease process, this book prepares students for patient encounters during their oral and maxillofacial surgery rotations. They concluded that the MMN showed fewer communicating branches in comparison to other facial nerve branches and commented that the lower lip muscles displayed the least supplemental innervation by MMN. Although the precise location of the nerve and its branches is variable, the knowledge about its relationship in soft tissue relative to fascial planes helps the surgeon to determine appropriate depth and plane of dissection to protect the nerve from iatrogenic injuries [19]. They also reported that the visualization of nerve did not have a significant effect on the postoperative functionality of the nerve and commented that the incidence of nerve damage was higher in cases of neck dissections followed by radiotherapy. In this report, we describe the first case in literature of a patient with multiple schwannomas of the marginal mandibular branch of the facial nerve.

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