Nerve to the zygomaticus major muscle for facial reanimation surgery: A cadaveric study for branching patterns and axonal count

Jirawatnotai, Supasid; Kaewpichai, Kitipong; Tirakotai, Wuttipong; Mothong, Wilaiwan; Kaewsema, Atitaya; Sriswadpong, Papat

doi:10.4103/ajns.ajns_90_20

Cited by 5 publications

(9 citation statements)

References 17 publications

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Section: Discussionmentioning

confidence: 99%

“…The identification of donor branches is one of the significant concerns in facial reanimation surgery. Previous studies examined the anatomy of donor branches(Dorafshar et al, 2013; Jirawatnotai et al, 2020; Kehrer et al, 2018; Kehrer et al, 2019). While some studies focused on the axonal counts of the branches(Hembd et al, 2017; Jirawatnotai et al, 2020), a more substantial nerve, such as the second branch in the present study, still contains non‐optimal signals that are carried to the orbicularis oculi muscle, which may cause unexpected movement coordinated with blinking in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

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Nerve to the zygomaticus major muscle: An anatomical study and surgical application to smile reconstruction

Yoshioka

Fernández-Miranda

2023

Clinical Anatomy

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Smile reconstruction using the branches that supply the zygomaticus major muscle as a motor source is an established procedure in facial reanimation surgery for facial paralysis. However, the anatomy of the nerve to the muscle remains unclear. Therefore, we herein examined the topographical anatomy of the nerve to the zygomaticus major muscle to obtain more detailed information on donor nerve anatomy. Preserved cadaver dissection was performed under a microscope on 13 hemifaces of 8 specimens. The branches that innervate the zygomaticus major muscle and their peripheral routes medial to the muscle were traced and examined. A median of four (ranges 2–4) branches innervated the zygomaticus major muscle. The proximal two branches (near the muscle origin) arose from the zygomatic branch, the second of which was the major branch. The distal branches (near the oral commissure) arose from the buccal branch or zygomaticobuccal plexus. The vertical distance from the caudal margin of the zygomatic arch to the major branch intersecting point was 19 ± 4.0 mm, while the horizontal distance parallel to the Frankfort plane was 29 ± 5.2 mm. The proximal two branches innervating the zygomaticus major muscle were detected in the majority of specimens. The anatomical findings obtained herein on the nerve to the zygomaticus major muscle will allow for more reliable donor selection in facial reanimation surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nerve to the zygomaticus major muscle: An anatomical study and surgical application to smile reconstruction

Yoshioka

Fernández-Miranda

2023

Clinical Anatomy

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“…Several studies have analyzed the number of myelinated fibers as a surrogate for axonal count in the motor nerves of muscles to be used as innervated flaps (Borschel et al, 2012; Coombs et al, 2009;Hembd et al, 2017; Jirawatnotai et al, 2020). Myelinated fibers include both motor and sensory fibers, which does not provide exact information for dynamic reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors measured the axonal load at the distal branches of the facial nerve (Hembd et al, 2017; Jirawatnotai et al, 2020), describing the total amount of myelinated fibers at transverse sections of the facial nerve. We cannot compare our findings to the distal facial nerve because our methodology is different, although more precise.…”

Section: Discussionmentioning

confidence: 99%

“…IVLF has been previously described as muscle flap for FP reanimation (Agrogiannis et al, 2015; Arpa et al, 2016; Becker et al, 2010; Borschel et al, 2012; Chong et al, 2017; Hembd et al, 2017; Jirawatnotai et al, 2020; Lasso et al, 2019; Lóderer et al, 2018; Mahmood et al, 2020; Mathes & Nahai, 1997; Revenaugh et al, 2012; Taylor et al, 1994; Yang et al, 2006), but to the best of our knowledge, IVLF has not been described in long‐standing FP as a one‐stage procedure.…”

Section: Discussionmentioning

confidence: 99%

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Anatomic and histomorphometric study of the nerve to the vastus lateralis in cadaver for its clinical application in facial reanimation

et al. 2023

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Background The innervated vastus lateralis flap (IVLF) is a barely used possibility for facial palsy reconstruction because of its thickness compared to the gracilis, latissimus dorsi, and pectoralis minor flaps. The aim of this study is to perform a precise description of the intramuscular distribution of the nerve motor branches and its relationship with the vascular pedicle in order to harvest a segmental muscle flap with the best contractile strength to restore facial reanimation. Methods The study was performed on 16 adult cadaver thighs identifying the vastus lateralis muscle and the distribution and relationships of its neurovascular pedicle and branches. We evaluated where the nerve pierced the muscle and the course of the nerve within it. Transverse segments of the nerve were obtained from the proximal and distal ends of the nerve and stained using anti‐ChAT (Choline acetyltransferase) antibodies which are specific of motor neurons. Results A nerve for the vastus lateralis from the posterior division of the femoral nerve divided into 2 branches in 56% of cases; the principal branch coursed along the vascular pedicle and pierced the muscle more proximally than the respective vessels, and a minor branch that pierced the muscle 25–60 mm proximally. There were 3 main intramuscular branches. The nerve length (mean 132.65 ± 22.89 mm) allowed to reach the contralateral side of the face in almost all cases (95%). The mean ChAT positive fibers was 351.0 ± 92.4/mm2 at the proximal end, and 270.3 ± 87.9/mm2 at the distal end (p = 0.49). The number of ChAT negative fibers was higher than ChAT positive in both proximal and distal ends of the nerve. Conclusion We propose the IVLF as a one‐step surgical flap for facial paralysis reanimation due to the constant neurovascular pattern and lengthy pedicle. The amount of motor fibers in several segments of the nerve is appropriate to produce a powerful contraction for dynamic reconstruction.

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Extracranial Facial Nerve Schwannoma—Histological Surprise or Therapeutic Planning?

et al. 2023

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Schwannomas (neurilemomas) are benign, slow-growing, encapsulated, white, yellow, or pink tumors originating in Schwann cells in the sheaths of cranial nerves or myelinated peripheral nerves. Facial nerve schwannomas (FNS) can form anywhere along the course of the nerve, from the pontocerebellar angle to the terminal branches of the facial nerve. In this article, we propose a review of the specialized literature regarding the diagnostic and therapeutic management of schwannomas of the extracranial segment of the facial nerve, also presenting our experience in this type of rare neurogenic tumor. The clinical exam reveals pretragial swelling or retromandibular swelling, the extrinsic compression of the lateral oropharyngeal wall like a parapharyngeal tumor. The function of the facial nerve is generally preserved due to the eccentric growth of the tumor pushing on the nerve fibers, and the incidence of peripheral facial paralysis in FNSs is described in 20–27% of cases. Magnetic Resonance Imaging (MRI) examination is the gold standard and describes a mass with iso signal to muscle on T1 and hyper signal to muscle on T2 and a characteristic “darts sign.” The most practical differential diagnoses are pleomorphic adenoma of the parotid gland and glossopharyngeal schwannoma. The surgical approach to FNSs requires an experienced surgeon, and radical ablation by extracapsular dissection with preservation of the facial nerve is the gold standard for the cure. The patient’s informed consent is important regarding the diagnosis of schwannoma and the possibility of facial nerve resection with reconstruction. Frozen section intraoperative examination is necessary to rule out malignancy or when sectioning of the facial nerve fibers is necessary. Alternative therapeutic strategies are imaging monitoring or stereotactic radiosurgery. The main factors which are considered during the management are the extension of the tumor, the presence or not of facial palsy, the experience of the surgeon, and the patient’s options.

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Nerve to the zygomaticus major muscle for facial reanimation surgery: A cadaveric study for branching patterns and axonal count

Cited by 5 publications

References 17 publications

Nerve to the zygomaticus major muscle: An anatomical study and surgical application to smile reconstruction

Nerve to the zygomaticus major muscle: An anatomical study and surgical application to smile reconstruction

Anatomic and histomorphometric study of the nerve to the vastus lateralis in cadaver for its clinical application in facial reanimation

Extracranial Facial Nerve Schwannoma—Histological Surprise or Therapeutic Planning?

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