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Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
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2016 (English)In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 4, no 12, p. e1164-Article in journal (Refereed) Published
Abstract [en]

Background: Injuries of the marginal mandibular nerve (MMN) of the facial nerve result in paralysis of the lower lip muscle depressors and an asymmetrical smile. Nerve reconstruction, when possible, is the method of choice; however, in cases of long nerve gaps or delayed nerve reconstruction, conventional nerve repairs may be difficult to perform or may provide suboptimal outcomes. Herein, we investigate the anatomical technical feasibility of transfer of the platysma motor nerve (PMN) to the MMN for restoration of lower lip function, and we present a clinical case where this nerve transfer was successfully performed.

Methods: Ten adult fresh cadavers were dissected. Measurements included the number of MMN and PMN branches, the maximal length of dissection of the PMN from the parotid, and the distance from the anterior border of the parotid to the facial artery. The PMN reach for direct coaptation to the MMN at the level of the crossing with the facial artery was assessed. We performed histomorphometric analysis of the MMN and PMN branches.

Results: The anatomy of the MMN and PMN was consistent in all dissections, with an average number of subbranches of 1.5 for the MMN and 1.2 for the PMN. The average maximal length of dissection of the PMN was 46.5 mm, and in every case, tension-free coaptation with the MMN was possible. Histomorphometric analysis demonstrated that the MMN contained an average of 3,866 myelinated fiber counts per millimeter, and the PMN contained 5,025. After a 3-year follow-up of the clinical case, complete recovery of MMN function was observed, without the need of central relearning and without functional or aesthetic impairment resulting from denervation of the platysma muscle.

Conclusions: PMN to MMN transfer is an anatomically feasible procedure for reconstruction of isolated MMN injuries. In our patient, by direct nerve coaptation, a faster and full recovery of lower lip muscle depressors was achieved without the need of central relearning because of the synergistic functions of the PMN and MMN functions and minimal donor-site morbidity.

Place, publisher, year, edition, pages
2016. Vol. 4, no 12, p. e1164-
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-315905DOI: 10.1097/GOX.0000000000001164OAI: oai:DiVA.org:uu-315905DiVA, id: diva2:1076318
Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2019-10-03Bibliographically approved
In thesis
1. Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
Open this publication in new window or tab >>Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sequelae after peripheral facial palsy, which among others include synkinesis, non-functional smile and/or lower lip asymmetry, may be devastating for the patient. Bell’s palsy is the most common form of peripheral facial palsy. 

Aim: The aim was to study a) frequency and potential predictive factors of synkinesis in Bell’s palsy b) new surgical treatment options after facial nerve injury c) coactivation between muscles innervated by the facial nerve and the most common donor nerves in smile reanimation d) anatomical features of the lower lip depressors. 

Methods: I: Frequency, severity and early predictors of synkinesis development were studied in 829 Bell’s palsy patients. II and IV: Anatomical technical feasibility of intra-facial nerve transfers was analyzed. V: Anatomical features of lower lip depressor muscles were studied and a literature review for lower lip depressor myectomies was performed. III: Coactivation of muscles innervated by cranial nerves during voluntary facial movements was measured with electromyography. 

Results: I: In Bell’s palsy, synkinesis frequency was 21.3% at 12-months and Sunnybrook composite score at one month was found to be a good predictor for synkinesis. II and IV: A tension-free oculo-zygomatic and platysma-marginal mandibular nerve transfer was anatomically feasible. Full recovery of the lower lip after platsysma-marginal mandibular nerve transfer was found in a clinical case. III: The masseter muscle had a narrower coactivation pattern compared to the tongue. Bite induced a strong coactivation in the zygomaticus major muscle. V: The width of the depressor labii inferioris was 20 ± 4 mm and the distance from the midline to the lateral muscle border was 32 ± 4 mm. For the depressor anguli oris muscle, the corresponding measurements were 14 ± 3 mm and 54 ± 4 mm. The mean recurrence rate after lower lip myectomy reported in the literature is 21%.  

Conclusion: I: Synkinesis in Bell’s palsy was 21%. Sunnybrook composite score at one month is a good predictor for synkinesis. II: Oculo-zygomatic nerve transfer may be a suitable technique to reduce eye synkinesis and achieve a stronger smile. III: The narrow coactivation pattern in the masseter muscle may be advantageous for spontaneous smile development. IV: The platysma motor nerve transfer is a feasible procedure and can lead to full recovery in lower lip paralysis. V: Knowledge of the width of the depressor muscles is of importance to ensure complete resection in lower lip myectomy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 44
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1601
Keywords
Facial palsy, Marginal mandibular paralysis, Smile reconstruction, Synkinesis
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-394136 (URN)978-91-513-0766-4 (ISBN)
Public defence
2019-11-30, Skoog salen, Ingång 78-79, Akademiska sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2019-11-11 Created: 2019-10-03 Last updated: 2019-11-27

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Rodríguez-Lorenzo, AndresJensson, David

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