Anatomical study of the variations in innervation of the orbicularis oculi by the facial nerve

Abstract Hemifacial spasm is characterized by painless and involuntary spasms of the muscles supplied by the facial nerve, most commonly involving the orbicularis oculi. The most common cause of hemifacial spasm is compression of the facial nerve's root by the anterior inferior, or posterior inferior, cerebellar arteries (AICA or PICA). However, in <1% of cases, the compression can be due to a dolichoectatic vertebral artery. Microvascular decompression using Teflon patties may be sufficient when the offending artery is small (eg, AICA or PICA). However, the size and tortuosity of the vertebral artery (especially one that is dolichoectatic) may require a more robust means of decompression (ie, “macrovascular decompression”). In this operative video we demonstrate our technique for managing a patient with hemifacial spasm due to a dolicoectatic vertebral artery. We use a Goretex® (W.L. Gore & Associates Inc, Newark, Delaware) sling secured to the dura of the posterior petrous ridge to suspend the vertebral and posterior inferior cerebellar arteries, thereby decompressing the root entry zone of the facial nerve. Teflon felt pieces are added as a second layer of security. Key steps to this technique include: (1) visualization of the root entry zone, (2) extensive arachnoid dissection to allow adequate mobilization of the vertebral artery, 12 and (3) securing the sling in a trajectory that prevents kinking of the vertebral artery and its branches.

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Clinico-anatomical study on damage to facial nerve and artery by arthroabspic puncture

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(91)90657-8 ◽

1991 ◽

Vol 49 (8) ◽

pp. 108

Author(s):

Natsuki Segami

Keyword(s):

Facial Nerve ◽

Anatomical Study

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End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face

Journal of Neurosurgery ◽

10.3171/jns.2006.104.3.457 ◽

2006 ◽

Vol 104 (3) ◽

pp. 457-460 ◽

Cited By ~ 19

Author(s):

Stefano Ferraresi ◽

Debora Garozzo ◽

Vittorino Migliorini ◽

Paolo Buffatti

Keyword(s):

Facial Nerve ◽

Cranial Nerve ◽

Orbicularis Oculi Muscle ◽

Orbicularis Oculi ◽

Fascial Sling ◽

The Face ◽

Gold Weight ◽

A New Technique ◽

12Th Cranial Nerve ◽

Graft Interposition

✓ The aim of this paper was to report on further experience with a new technique for reanimation of the facial nerve. This procedure allows a straight end-to-side hypoglossal–facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition. It is technically demanding and time consuming but offers an effective, reliable, and extraordinarily quick means of reinnervating the facial muscles, including the orbicularis oculi muscle, thus avoiding the need for a gold weight in the eyelid or a fascial sling.

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Study on Distribution of Terminal Branches of the Facial Nerve in Mimetic Muscles (Orbicularis Oculi Muscle and Orbicularis Oris Muscle)

Annals of Plastic Surgery ◽

10.1097/sap.0b013e318284eca0 ◽

2014 ◽

Vol 72 (1) ◽

pp. 71-74 ◽

Cited By ~ 6

Author(s):

Nobuyuki Mitsukawa ◽

Hiroshi Moriyama ◽

Kei Shiozawa ◽

Kaneshige Satoh

Keyword(s):

Facial Nerve ◽

Orbicularis Oculi Muscle ◽

Orbicularis Oculi ◽

Mimetic Muscles ◽

Orbicularis Oris Muscle

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Neuromuscular Monitoring at the Orbicularis Oculi May Overestimate the Blockade in Myasthenic Patients

Anesthesiology ◽

10.1097/00000542-200011000-00010 ◽

2000 ◽

Vol 93 (5) ◽

pp. 1194-1197 ◽

Cited By ~ 14

Author(s):

Hironori Itoh ◽

Keizo Shibata ◽

Masahiro Yoshida ◽

Ken Yamamoto

Keyword(s):

Nitrous Oxide ◽

Facial Nerve ◽

Myasthenia Gravis ◽

Neuromuscular Blockade ◽

Ulnar Nerve ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Neuromuscular Monitoring ◽

Adductor Pollicis ◽

Orbicularis Oculi

Background In most publications about myasthenia, monitoring neuromuscular blockade during anesthesia is recommended. In healthy patients, the relation of blockade between muscles has been established, but there is little information about the relation in myasthenic patients. Our objective was to investigate whether the relation between the orbicularis oculi and adductor pollicis muscles is the same in healthy patients and myasthenic patients. Methods After anesthesia was induced with 4-6 mg/kg thiopental and 2 microg/kg fentanyl, followed by 2% sevoflurane and 60% nitrous oxide in oxygen, 10 healthy patients and 10 myasthenic patients received 0. 025 and 0.01 mg/kg vecuronium, respectively. Neuromuscular monitoring was performed with use of accelerometry at the orbicularis oculi and the adductor pollicis muscles by stimulating the temporal branch of the facial nerve and the ulnar nerve. Results The relation of blockade between these two muscles was not the same in healthy patients and myasthenic patients: in healthy patients, the maximum neuromuscular blockade with 0.025 mg/kg vecuronium was less in the orbicularis oculi than in the adductor pollicis (median 72% vs. 91%; P < 0.05); in contrast, in myasthenic patients, the blockade with 0.01 mg/kg vecuronium was greater in the orbicularis oculi than in the adductor pollicis (median 96% vs. 62%; P < 0.05). Conclusion Neuromuscular monitoring at the orbicularis oculi may overestimate blockade in myasthenic patients. Extubation must be performed when the muscle most sensitive to neuromuscular blocking agents is recovered. Therefore, neuromuscular monitoring at the orbicularis oculi is recommended to avoid persistent neuromuscular blockade in patients with myasthenia gravis.

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ANATOMICAL STUDY ON INTRA-PAROTID COURSE OF FACIAL NERVE AND ITS TERMINAL BRANCHES

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/470 ◽

2013 ◽

Vol 2 (12) ◽

pp. 1828-1839 ◽

Cited By ~ 1

Author(s):

Kalai Anbusudar ◽

Balaji Arumugam

Keyword(s):

Facial Nerve ◽

Anatomical Study

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Marginal mandibular branch of the facial nerve: An anatomical study

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699405 ◽

2010 ◽

Vol 43 (01) ◽

pp. 060-064

Author(s):

Arvinder Pal Singh Batra ◽

Anupama Mahajan ◽

Karunesh Gupta

Keyword(s):

Facial Nerve ◽

Surgical Procedures ◽

Anatomical Study ◽

Facial Artery ◽

Submandibular Region ◽

Marginal Mandibular Nerve ◽

Marginal Mandibular Branch ◽

Important Landmark ◽

Mandibular Branch ◽

Main Factor

ABSTRACTSmile is one of the most natural and important expressions of human emotion. Man uses his lips mainly to register his emotions. Thus, the slightest asymmetry or weakness around the lips and mouth may transform this pleasant expression into embarrassment and distortion. The circumoral musculature, the major part of which is supplied by the marginal mandibular branch of the facial nerve, is the main factor in this expression. Therefore, an injury to this nerve during a surgical procedure can distort the expression of the smile as well as other facial expressions. This nerve often gets injured by surgeons in operative procedures in the submandibular region, like excision of the submandibular gland due to lack of accurate knowledge of variations in the course, branches and relations. In the present study, 50 facial halves were dissected to study the origin, entire course, termination, branches, muscles supplied by it, its anastomoses with other branches of facial nerve on the same as well as on the opposite side and its relations with the surrounding structures. The marginal mandibular branch of the facial nerve was found superficial to the facial artery and (anterior) facial vein in all the cases (100%). Thus the facial artery can be used as an important landmark in locating the marginal mandibular nerve during surgical procedures. Such a study can help in planning precise and accurate incisions and in preventing the unrecognized severance of this nerve during surgical procedures.

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