Oncological safety of the Hayes-Martin manoeuvre in neck dissections for node-positive oropharyngeal squamous cell carcinoma

Abstract

In neck dissections for oropharyngeal squamous cell carcinoma, the marginal mandibular nerve and accompanying facial nodes can be safely preserved without oncological risk using the Hayes-Martin manoeuvre.

Lymph Nodes of the Perimandibular Area and the Hazard of the Hayes Martin Maneuver in Neck Dissection

“…17 Some authors, however, describe the maneuver by stating that the vein is ligated 2 fingerbreadths below the inferior mandibular margin, a limit that we consider unacceptable as it is likely to completely conceal level IB. 11 This maneuver was first described by Hayes Martin and is nowadays commonly performed. Nevertheless, the Hayes Martin maneuver cannot ensure complete clearance of the PFN.…”

Intraoperative monitoring of marginal mandibular nerve during neck dissection

“…The maneuver consists of ligating the anterior facial vein approximately 2 inches below the mandibular border and overturning the vein and the overlying tissues where the marginal mandibular nerve runs to create a fold to protect the nerve. However, when level I has to be cleared, this maneuver is not oncologically safe because some lymph nodes could remain undissected when the tissue is lifted up . In our study, we investigated injury to the marginal mandibular nerve, even though the literature also considers surgical damage to the cervical branch of the facial nerve as a potential factor influencing lower lip depressor weakness.…”

“…However, when level I has to be cleared, this maneuver is not oncologically safe because some lymph nodes could remain undissected when the tissue is lifted up. 36 In our study, we investigated injury to the marginal mandibular nerve, even though the literature also considers surgical damage to the cervical branch of the facial nerve as a potential factor influencing lower lip depressor weakness. The cervical branch is particularly important for its anastomoses and for innervation of the platysma muscle, which is active during downward and lateral lip movements.…”

Modified Risdon approach using periangular incision in surgical treatment of subcondylar mandibular fractures

“…Ziarah and Atkinson [16] pointed out that the MBFN could be traced 0.2-1.4 cm below the mandibular angle. Hayes Martin manoeuvre, described within submandibular approach, may not always be considered safe [17]. Because of that, other authors suggest identifying and dissecting the MBFN for more safety [12,15].…”