To Evaluate the Feasibility of Neurotisation of Facial Nerve Branches with Ipsilateral Masseteric Nerve: An Anatomic Study

Abstract BACKGROUND Hypoglossal-facial anastomosis (HFA) is a popular facial reanimation technique. Mobilizing the intratemporal segment of the facial nerve and using the post-descendens hypoglossal nerve (ie, the segment distal to the take-off of descendens hypoglossi) have been proposed to improve results. However, no anatomic study has verified the feasibility of this technique. OBJECTIVE To assess the anatomic feasibility of HFA and the structural compatibility between the 2 nerves when the intratemporal facial and post-descendens hypoglossal nerves are used. METHODS The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads. The feasibility of a side-to-end (ie, partial end-to-end) HFA with partial sectioning of the post-descendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. The axonal count and cross-sectional area of the facial and hypoglossal nerves at the point of anastomosis were assessed. RESULTS The HFA was feasible in all specimens with a mean (standard deviation) 9.3 (5.5) mm of extra length on the facial nerve. The axonal counts and cross-sectional areas of the hypoglossal and facial nerves matched well. Considering the reduction in the facial nerve cross-sectional area after paralysis, the post-descendens hypoglossal nerve can provide adequate axonal count and area to accommodate the facial nerve stump. CONCLUSION Using the post-descendens hypoglossal nerve for side-to-end anastomosis with the mobilized intratemporal facial nerve is anatomically feasible and provides adequate axonal count for facial reanimation. When compared with use of the pre-descendens hypoglossal nerve, this technique preserves C1 fibers and has a potential to reduce glottic complications.

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An Anatomical study for localisation of Zygomatic branch of Facial nerve and Masseteric nerve – An aid to nerve coaptation for facial reanimation surgery: A cadaver based study in Eastern India

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_128_16 ◽

2017 ◽

Vol 50 (01) ◽

pp. 074-078

Author(s):

Ratnadeep Poddar ◽

Alipta Bhattacharya ◽

Iman Sinha ◽

Asis Kumar Ghosal

Keyword(s):

Facial Nerve ◽

Reference Point ◽

Copper Wire ◽

Anatomical Study ◽

Cross Sectional Study ◽

Reference Points ◽

Circular Area ◽

Cross Sectional ◽

Facial Reanimation ◽

Masseteric Nerve

ABSTRACT Context: In cases of chronic facial palsy, where direct neurotisation is possible, ipsilateral masseteric nerve is a very suitable motor donor. We have tried to specifically locate the masseteric nerve for this purpose. Aims: Describing an approach of localisation and exposure of both the zygomatic branch of Facial nerve and the nerve to masseter, with respect to a soft tissue reference point over face. Settings and Design: Observational cross sectional study, conducted on 12 fresh cadavers. Subjects and Methods: A curved incision was given, passing about 0.5cms in front of the tragal cartilage. A reference point “R” was pointed out. The zygomatic branch of facial nerve and masseteric nerve were dissected out and their specific locations were recorded from fixed reference points with help of copper wire and slide callipers. Statistical Analysis Used: Central Tendency measurements and Unpaired “t” test. Results: Zygomatic branch of the Facial nerve was located within a small circular area of radius 1 cm, the centre of which lies at a distance of 1.1 cms (±0.4cm) in males and 0.2cm (±0.1cm) in females from the point, ‘R’, in a vertical (coronal) plane. The nerve to masseter was noted to lie within a circular area of 1 cm radius, the centre of which was at a distance of 2.5cms (±0.4cm) and 1.7cms (±0.2cm) from R, in male and female cadavers, respectively. Finally, Masseteric nerve's depth, from the masseteric surface was found to be 1cm (±0.1cm; male) and 0.8cm (±0.1cm; female). Conclusions: This novel approach can reduce the post operative cosmetic morbidity and per-operative complications of facial reanimation surgery.

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Direct coaptation of extensive facial nerve defects after removal of the superficial part of the parotid gland: An anatomic study

Head & Neck ◽

10.1002/hed.10164 ◽

2002 ◽

Vol 24 (12) ◽

pp. 1047-1053 ◽

Cited By ~ 8

Author(s):

Alexander Gardetto ◽

Peter Kovacs ◽

Johannes Piegger ◽

Christian Rainer ◽

Romed Meirer ◽

...

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Anatomic Study

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The Masseteric-Facial Anastomosis With Intratemporal Translocation of the Facial Nerve: Step-by-Step Technique and Results

Operative Neurosurgery ◽

10.1093/ons/opab286 ◽

2021 ◽

Author(s):

Stefano Ferraresi ◽

Elisabetta Basso ◽

Lorenzo Maistrello ◽

Piero Di Pasquale

Keyword(s):

Facial Nerve ◽

Emotional Response ◽

Hypoglossal Nerve ◽

Direct Transfer ◽

Nerve Stump ◽

Surgical Timing ◽

Quality Of Results ◽

Facial Reanimation ◽

Masseteric Nerve

Abstract BACKGROUND In the absence of a viable proximal nerve stump, damaged after surgical procedures around the skull base, numerous techniques for facial reanimation have been developed over time, aiming to restore baseline symmetry and active mimicry. OBJECTIVE To report experience using the masseteric nerve as a direct transfer to the facial nerve rerouted after intratemporal translocation. This paper illustrates the main steps of the technique and the quality of results. METHODS Eleven patients were treated with a masseteric direct transfer to the facial nerve. Its extratemporal rerouting toward the zygoma allowed tension-free coaptation between donor and recipient nerves. RESULTS Of the 11 patients, 8 had a good to excellent recovery, showing different patterns of time and scores, according to age, surgical timing, and masseteric nerve function quality. The return of activity in the frontalis muscle, never obtained after reinnervation via the hypoglossal nerve, is of particular interest. The quality of the smile can be improved with re-education and practice but remains under volitional control. A true emotional response is still lacking. CONCLUSION The masseteric nerve is an excellent alternative to the hypoglossal nerve and can reinnervate the whole territory of the facial nerve rerouted after intratemporal translocation. The overall results are remarkable, but the low quality of the trigeminal nerve, eventually affected by the first surgery, may be an important limitation. Even if the patients appear more at ease in re-education than with other techniques, a fully natural facial expression remains impossible to obtain.

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