The nerve supply of zygomaticus major: Variability and distinguishing zygomatic from buccal facial nerve branches

Kehrer, Andreas; Engelmann, Simon; Bauer, Robert A.; Taeger, Christian D.; Grechenig, Stephan; Kehrer, Michael; Prantl, Lukas; Tamm, Ernst R.; Bleys, Ronald L. A. W.; Mandlik, Veronika

doi:10.1002/ca.23044

Cited by 26 publications

(21 citation statements)

References 42 publications

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“…(File reference number 14-101-0251, Ethics Committee of the University Regensburg, Germany). A detailed anatomical dissection of the facial halves was carried out as described previously 23 .…”

Section: Methodsmentioning

confidence: 99%

Rapid and Precise Semi-Automatic Axon Quantification in Human Peripheral Nerves

Engelmann

Ruewe

Geis

et al. 2020

Sci Rep

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We developed a time-efficient semi-automated axon quantification method using freeware in human cranial nerve sections stained with paraphenylenediamine (PPD). It was used to analyze a total of 1238 facial and masseteric nerve biopsies. The technique was validated by comparing manual and semiautomated quantification of 129 (10.4%) randomly selected biopsies. The software-based method demonstrated a sensitivity of 94% and a specificity of 87%. Semi-automatic axon counting was significantly faster (p < 0.001) than manual counting. It took 1 hour and 47 minutes for all 129 biopsies (averaging 50 sec per biopsy, 0.04 seconds per axon). The counting process is automatic and does not need to be supervised. Manual counting took 21 hours and 6 minutes in total (average 9 minutes and 49 seconds per biopsy, 0.52 seconds per axon). Our method showed a linear correlation to the manual counts (R = 0.944 Spearman rho). Attempts have been made by several research groups to automate axonal load quantification. These methods often require specific hard-and software and are therefore only accessible to a few specialized laboratories. Our semi-automated axon quantification is precise, reliable and time-sparing using publicly available software and should be useful for an effective axon quantification in various human peripheral nerves. Microscopic analysis of peripheral nerves is key for many clinical and research based projects. Peripheral nerves have been analyzed through multiple methods, which can generally be categorized into 'manual' , 'automated' and 'semi-automated' methods. Here, the terms for 'manual' and 'fully automated' morphometry will be used as previously described 1-4. 'Semi-automated' will be used synonymously with Urso-Baiardas 'interactive automated' approach; an automated method with the opportunity for manual preparation or alteration 3. In the past, no prime and uniform method could be found, that is simple, cost efficient and time sparing. Therefore, tendentially, small research collectives use manual methods for analysis 1,2,5. Attempts have been made by several research groups throughout medical and scientific research, to automate this process 3,6-8. Unfortunately, it is often found, that these methods are either highly specialized, thus accessible to only few expert laboratories, or, in the case of highly developed software and hardware, very costly 3,9. By example, Marina et al. have coined a method which, similar to this project, focuses on simpler semi-automated anaylsis 10. Other research groups such as Hunter et al. focus on highly specialized methods, which are able to produce a wide range of data and process numerous variables 11. The semi-automated quantification method proposed in this study was developed as part of a greater study on Human facial nerves, for which a time sparing, cost efficient and user-friendly method of axonal quantification was required. Patients with facial palsy, caused by dysfunction of the seventh cranial nerve, suffer emotional distress and are often socially isolated 1...

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Section: Methodsmentioning

confidence: 99%

Rapid and Precise Semi-Automatic Axon Quantification in Human Peripheral Nerves

Engelmann

Ruewe

Geis

et al. 2020

Sci Rep

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“…A previously described cut‐off threshold of zygomatic and buccal facial nerve branches in the transition zone was used for differentiation of zygomatic and buccal nerve branch systems (Kehrer et al, ). Any branch lying clearly superficial to the zygoma was defined as a zygomatic branch, whereas any inferior branch was defined as of buccal origin.…”

Section: Methodsmentioning

confidence: 99%

“…In one of our previous articles focusing on ZM, a precise method for differentiation of zygomatic and buccal branch systems in the area of the zygoma was established. It was suggested for clinicians to use the same terminology of facial nerve branches in this transition zone (Kehrer et al, ).…”

Section: Introductionmentioning

confidence: 99%

Anatomical study of the zygomatic and buccal branches of the facial nerve: Application to facial reanimation procedures

et al. 2019

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The facial nerve is responsible for any facial expression channeling human emotions. Facial paralysis causes asymmetry, lagophthalmus, oral incontinence, and social limitations. Facial dynamics may be re-established with cross-face-nervegrafts (CFNG). Our aim was to reappraise the zygomaticobuccal branch system relevant for facial reanimation surgery with respect to anastomoses and crossings. Dissection was performed on 106 facial halves of 53 fresh frozen cadavers. Study endpoints were quantity and relative thickness of branches, correlation to "Zuker's point", interconnection patterns and crossings. Level I and level II branches were classified as relevant for CFNG. Anastomoses and fusion patterns were assessed in both levels. The zygomatic branch showed 2.98 AE 0.86 (range 2-5) twigs at level II and the buccal branch 3.45 AE 0.96 (range 2-5), respectively. In the zygomatic system a single dominant branch was present in 50%, two co-dominant branches in 9% and three in 1%. In 66% of cases a single dominant buccal twig, two co-dominant in 12.6%, and three in 1% of cases were detected. The most inferior zygomatic branch was the most dominant branch (P = 0.003). Using Zuker's point, a facial nerve branch was found within 5 mm in all facial halves. Fusions were detected in 80% of specimens. Two different types of fusion patterns could be identified. Undercrossing of branches was found in 24% at levels I and II. Our study describes facial nerve branch systems relevant for facial reanimation surgery in a three-dimensional relationship of branches to each other. Clin. Anat. 32:480-488, 2019.

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“…Any facial nerve branch lying superficial to or in contact with the zygomatic arch was accepted as the ZB. Whereas, any branch lying inferior to the zygomatic arch was accepted as the BB, as stated by Kehrer et al [18] Dissections were carried under a surgical microscope (Zeiss OPMI Pico, Jena, Germany) and a digital caliper (0.01 mm precision) was used for measurements. Dissections and meas-urements were conducted by the same researcher (ÖE).…”

Section: Methodsmentioning

confidence: 99%

Relationship between buccal branches of the facial nerve, parotid duct, buccal fat pad and Zuker’s point

Elvan

Bobuş

2020

Anatomy

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Objectives: The aim of this study was to determine the relationship of the buccal branches of the facial nerve with the parotid duct, the buccal fat pad and the Zuker’s point, and reveal the incidence of the neural communications of buccal branch with the zygomatic and marginal mandibular branches of the facial nerve. Methods: Fifteen formalin-fixed cadaveric heads (8 females and 7 males) with a mean age of 73.93±14.42 years were dissected bilaterally to reveal the buccal, zygomatic and marginal mandibular branches of the facial nerve, the parotid duct and the buccal fat pad. Positional relationships of these structures and the anatomical features of buccal and zygomatic branches were evaluated. Results: The mean number of buccal and zygomatic branches was 2.40±0.62 and 1.90±0.60 respectively. Buccal branches crossed the parotid duct in 67%, formed a plexus along the parotid duct in 27% and coursed superior or inferior to the parotid duct without crossing in 6% of the dissected specimens. The mean number of intersection points of buccal branches on parotid duct was 4.03±1.03. Parotid duct crossed along the superior border of buccal fat pad in 66%, deep to buccal fat pad in 27% and between the superior and inferior lobes of buccal fat pad in 7%. Buccal branches crossed superficial to buccal fat pad in 80% and some branches passed superficial and through the buccal fat pad in 20%. Conclusion: It is essential to know the positional interrelations of the buccal branches of the facial nerve with the parotid duct and buccal fat pad for clinical implications. The relation of Zuker’s point with zygomatic and buccal branches and with parotid duct should not be overlooked.

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The nerve supply of zygomaticus major: Variability and distinguishing zygomatic from buccal facial nerve branches

Cited by 26 publications

References 42 publications

Rapid and Precise Semi-Automatic Axon Quantification in Human Peripheral Nerves

Rapid and Precise Semi-Automatic Axon Quantification in Human Peripheral Nerves

Anatomical study of the zygomatic and buccal branches of the facial nerve: Application to facial reanimation procedures

Relationship between buccal branches of the facial nerve, parotid duct, buccal fat pad and Zuker’s point

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