Interrelated buccal fat pad with facial buccal branches and parotid duct

The facial nerve branches are vulnerable during manipulation of the buccal fat pad. The aim of this study is to describe the precise anatomical interrelation among the buccal fat pad, buccal branches of the facial nerve, and parotid duct. Nineteen hemifaces of Korean cadavers (11 male and 8 female) fixed in 10% formaldehyde solution were dissected. An average 3.6 buccal branches of the facial nerve were found. The facial buccal branches and parotid duct crossed each other within a semicircle with a 30-mm radius. The base (diameter) is parallel to a horizontal line passing the corner of the mouth and 12 mm above. Its center is located 53 mm lateral to it. The buccal branches of the facial nerve have two locations at the buccal fat pad: Type I, branches crossing superficial to the buccal fat pad in 14 of 19 (73.7%) specimens; and Type II, two twigs passing through buccal extension of the buccal fat pad in 5 of 19 (26.3%). An interrelation of parotid duct and buccal fat pad is as follows: parotid duct crossing superficial to the buccal extension of buccal fat pad in 8 of 19 (42.1%) specimens, crossing deep to the buccal extension of buccal fat pad in 5 of 19 (26.3%) specimens and crossing along the superior border of the buccal extension of buccal fat pad in 6 of 19 (31.6%) specimens. There is a 26.3% chance of injury to the buccal branch during total removal of buccal fat pad. The parotid duct runs deep to the buccal extension of buccal fat pad in 26.3% of cases.     

The course of the temporal branch of the facial nerve in the periorbital region.

PURPOSE: This study identified the terminal temporal and zygomatic branches of the facial nerve as they enter the orbicularis oculi muscle and related these branches to identifiable surface markings. MATERIALS AND METHODS: The temporal and zygomatic branches of the facial nerve were dissected from 5 preserved cadavers (10 sides). The most superior temporal branch entering the orbicularis oculi muscle was identified and related to the lateral canthus of the eye. A vertical line was passed through this point so that the line was equidistant from the nasal tip and chin point. A line perpendicular to the vertical line through the lateral canthus served as the horizontal scale. Vertical and horizontal lines through the lateral canthus were used to establish the anatomic relationship between the lateral canthus and the branch of the temporal nerve entering the orbicularis oculi muscle. RESULTS: The temporal branch was an average of 2.85 +/- 0.69 cm superior to the lateral canthus and an average of 2.54 +/- 0.43 cm lateral to the lateral canthus as it courses into the orbicularis oculi muscle. At the lateral border of the orbicularis oculi muscle, where the temporal and zygomatic nerves insert into the muscle, the mean vertical distance between the temporal and zygomatic nerves was 1.72 +/- 0.62 cm. CONCLUSION: Incisions superior or inferior and parallel to the course of the facial nerve, can provide access to the fronto zygomatic suture and the superior and lateral orbit without damaging its branches.     

腮腺手术与面神经主要分支损伤

目的 分析腮腺切除手术后面神经下颌缘支,颊支和颧支和损伤与病理诊断及手术方式的关系。方法 对101例经病理诊断为腮腺的病例术后面神经功能情况进行临床追踪观察,并对其结果进行分析。结果 腮腺恶性肿瘤术后面神经下颌缘支,颊支和颧支损伤发生机率分别是良性肿瘤的2．5,2．4,5．4倍;腮腺全切术后面神经重要分支损伤发生率明显高于浅叶摘除术和节段切除术;下颌缘支损伤的机率较其他分支高。结论 面神经主要分支损伤与手术方式、肿瘤性质密切相关,选择适当的手术方式可减少其发生机率。     

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目的 探讨采用肿瘤及其就位腺体区域性切除的方法治疗腮腺浅叶良性肿瘤的可行性。方法 对2004—2006年甘肃嘉峪关市第一人民医院口腔科收治的28例腮腺浅叶良性肿瘤患者,采用肿瘤及其就位腺体区域性切除+局部面神经解剖并且保留腮腺主导管的术式治疗,术后随访观察疗效。结果 28例腮腺浅叶良性肿瘤患者治疗后,经过3～5年的随访无一例复发,均达到治愈目的。术后并发症：出现面神经颧支暂时性瘫痪1例,颊支暂时性瘫痪2例,经应用营养神经药物治疗,1 ~ 3个月后均恢复正常;发生腮腺局部积液4例,经穿刺抽液换药,加压包扎后均得到痊愈,无一例涎瘘发生;出现味觉出汗综合征1例,但范围较小;愈后检查患者,手术侧凹陷不明显,面部左右基本对称,腮腺检查分泌功能基本正常。结论 肿瘤及其就位腺体区域性切除的方法是治疗腮腺浅叶多形性腺瘤或其他良性肿瘤合适的手术方式。与标准的保留面神经的肿瘤及腮腺浅叶或全腮腺切除术相比,能减少面神经损伤、涎瘘、味觉出汗综合征的发生,更重要的是能够保持面部形态的对称性,避免畸形等并发症的发生。     

腮腺切除术对面神经损伤和恢复的影响

目的：分析腮腺切除术后面神经功能损伤的发生率及其与腮腺切除的范围,临床特点的关系。方法：对62例腮腺混合瘤的病案资料进行回顾性分析。结果：62例治疗手术中,面神经损伤22例,占35．48％。其中腮腺区域性切除32例,术后即刻出现面神经颧支及颊支暂时性麻痹2例(6．3％),下颌缘支暂时性麻痹3例(9．4％),1个月后自行恢复。腮腺浅叶摘除20例中,术后即刻出现面神经颧支及颊支暂时性麻痹2例(10％),下颌缘支暂时性麻痹5例(25％)。腮腺全切解剖面神经的10例,术后全部即刻出现面神经暂时性面瘫(100％),所有麻痹均在1～2个月恢复。结论：面瘫的发生率与手术术式、瘤体与面神经的位置关系、以及面神经的解剖形态密切相关。     

Clinical significance of buccal branches of the facial nerve and their relationship with the emergence of Stensen's duct: An anatomical study on adult Taiwanese cadavers

ObjectiveThis observational study on adult Taiwanese cadavers focused mainly on the intersection of buccal branches of the facial nerve with Stensen's duct, using the emergence of Stensen's duct as the reference landmark.Materials and methodsThirty-five cadaveric hemifaces were included in our research. Samples with facial defects due to tumor, trauma, or surgery were all excluded. Buccal branches of the facial nerve were identified according to the Gray's Anatomy 40th edition definition. The distance was measured from the intersection to the emergence of Stensen's duct, running from the anterior border of the parotid gland.ResultsIn the 35 hemifaces, the number of buccal branch/Stensen's duct intersections ranged from 1 to 5 (average 2.49 ± 1.15). Two-point intersections accounted for 37% (13 hemifaces) of the sample, forming the largest group. Samples of facial nerve buccal branches were divided into four types: Type 1, with two buccal branches, accounted for 37.15% (13/35); Type 2, with three buccal branches, made up 48.59% (17/35) of our samples — the biggest group (Type 2-a was the most frequent pattern among our samples, with two superior buccal branches and one inferior buccal branch, accounting for 34.31% of our samples); Type 3, with four buccal branches, accounted for only 5.7%. Three cases of double Stensen's duct were classified as Type 4, though this is supposed to be a very rare anatomical variation. With Type 2a, the most frequent pattern among our specimens, the distance from the emergence of the Stensen's duct to the emergence point of the first superior buccal branch along the anterior border of the parotid gland was 9.58 ± 5.68 mm. The distance from the emergence point to the emergence of the inferior buccal branch along the anterior border of the parotid gland was 11.03 ± 5.38 mm. The distance (D1) from Stensen's duct to the emergence of the first superiorly located buccal branch of the group Type 2-a was statistically different from the distance (D1) of the other groups (p = 0.02). No direct anastomoses or communicating fibers between upper and lower buccal branches were noted in 11 hemifaces (31%).ConclusionThe distribution of buccal branches was described using the emergence of Stensen's duct as a reference landmark. According to our observations, the relationship between the buccal branches and Stensen's duct was much more complicated than described in previous studies. This was the first study to investigate the complete distribution of buccal branches of the facial nerve emerging from the anterior of the parotid gland, and their relative locations and branching numbers.     

Anatomic bases of superficial temporal artery and temporal branch of facial nerve

The superficial temporal artery (STA)-based flaps have been used for different reconstructive purposes. These operations may cause facial nerve injury. The variations of the STA and its relation to temporal branch of the facial nerve (TBFN) were evaluated in this study. Thirteen cadavers with 26 STA and TBFN have been dissected. The bifurcation of STA was found to be 60% above the superior border of the zygomatic arc and 40% below this level. The mean lengths of frontal and temporal branches (FB and TB) of STA were 11.5 and 11.4 cm, respectively. The mean numbers of perforators of FB and TB to deep plane were 1.30 and 1.34, respectively. The mean diameter of STA at the superior border of zygomatic arc was 2.5 mm. The mean diameters of TB and FB at the level of bifurcation were 1.8 mm and 2.0 mm, respectively. The mean number of TBFN at the level of zygomatic arc was 3.70. The mean distance of the first and last branching of TBFN to tragus was found to be 24 mm. The mean number of TBFN at the level of the middle orbita was found to be 2.7. The mean distance of first and last branches of TBFN to the lateral orbital rim was 12 and 24 mm, respectively. The results found in this study may increase the accuracy of flaps based on STA and decrease the risk of facial nerve paralysis during these operations.     

Localization of the marginal mandibular branch of the facial nerve

The aim of this study was to observe the course of the marginal mandibular branch of the facial nerve (MMBFN) in relation to the inferior border of the mandible and parotid gland and its relevance to surgical procedures such as rhytidectomy and parotid gland surgery. In this study, 50 specimens were dissected. The relationships between the MMBFN and the inferior border of the mandible were recorded and analyzed. We found that posterior to the facial artery, the MMBFN ran above the inferior border of the mandible in 37 (74%) of the specimens. In 11 (22%) specimens, below the inferior border of the mandible it was divided into two branches at the crossing point with the facial artery. In 2 (4%) specimens the MMBFN divided into two branches at the point of emergence from the parotid gland. There were no statistical differences between the left and right sides, and both sexes. The MMBFN is one of the most vulnerable branches to surgical injury because of its location. For this reason, the surgeons who are willing to operate on this area, especially for the rhytidectomies, should have a true knowledge about the anatomy of this branch.     

大鼠与家兔面神经颅外段解剖的比较研究

目的:观测正常大鼠及家兔面神经的颅外段主干及分支的解剖及组织学指标,研究并评价两种实验动物模型在面神经缺损修复中的应用特点。方法:在手术显微镜下解剖大鼠与家兔双侧面神经,游标卡尺测量各分支的长度、中点外径。改良特殊三色法染色,在光学显微镜观察细胞、轴突、髓鞘形态。结果:大鼠和家兔面神经出茎乳孔后分为颞支、颧支、颊支、下颌缘支和颈支至面部表情肌。大鼠5个主要分支共干发出,而家兔颞支和颧支由颞面干发出;颊支分叉较多,分为上下颊支,行至口角。大鼠各分支神经束较少,多为2～3束,而家兔神经束平均为9束。结论:家兔表情肌活动较明显,应选择家兔作为面神经缺损修复动物模型;大鼠面神经各分支分叉少,可用于病理学及组织学的研究。在分支的选取上首先考虑面神经颊支和下颌缘支。     

Horizontal branch of the supraorbital nerve and temporal branch of the facial nerve

The aim of this article is to describe anatomical detail of the course and territory of the horizontal branch of the supraorbital nerve, which connects with temporal branch of the facial nerve. Eighteen hemifaces of Korean cadavers (11 male, 7 female) fixed in 10% formaldehyde solution were dissected. All 18 specimens had horizontal branch of the supraorbital nerve. The horizontal branch emerges out of the supraorbital foramen, runs upward about 12 mm, and then turns laterally at an angle of 104.7 degrees toward the end of the eyebrow. The average number of horizontal branches was 1.7 +/- 0.8. The skin boundary supplied by the horizontal branch was a circle with a diameter of 30 mm. The center was located at 30 mm lateral to the supraorbital foramen and 12 mm above. Grossly, the horizontal branch of the supraorbital nerve connected with the temporal branch of the facial nerve in 8 of 18 (44%) specimens. Microscopically, both nerve branches had common epineurium, but the perineuria were separated. The horizontal branch of the supraorbital nerve is in touch with the temporal branch of the facial nerve, and there are actual connections between them in 44% of cases.     

Anatomosurgical study of the marginal mandibular branch of the facial nerve for submandibular surgical approach

The purpose of this study was to estimate the distance from the mandibular marginal branch of the facial nerve to the inferior margin of the mandible in order to determine the best and safest location to approach the posterior mandibular region. Forty-five hemi-faces of 27 Brazilian adult cadavers were dissected and the distance between the mandibular marginal branch and the inferior margin of the mandible was measured. The number of marginal branches and anastomoses with other branches of the facial nerve was also recorded. The evaluation of the anatomic pieces showed 1 to 3 branches of the marginal mandibular branch, anastomoses with the buccal and cervical branches of the facial nerve and distances between 1.3 cm to +1.2 cm from the inferior margin of the mandible. In 57.7% of the cases, the nerve passed superiorly and along the length of the inferior margin of the mandible. Based on the findings of the present anatomosurgical study, it may be recommended an incision 3 cm below the inferior margin of the mandible associated to a careful dissection in planes and flap retraction. This is expected to reduce the risk of neuropraxia of the marginal mandibular nerve making the submandibular incision a safe approach.     

下颌后越腮腺前缘穿咬肌入路治疗髁突低位骨折的临床研究

目的:探讨下颌后越腮腺前缘穿咬肌入路在髁突低位骨折手术中的应用。方法:利用5具国人成人男性标本,对颞下颌关节及腮腺区解剖进行观察。结合局部解剖,对18例髁突低位骨折患者采用下颌后越腮腺前缘穿咬肌入路,切开皮肤及皮下组织达腮腺筋膜表面,沿腮腺筋膜表面向前解剖分离到腮腺前缘,将腮腺组织向后牵开显露咬肌表面,钝分离咬肌,暴露骨折断端,用一块L型钛板复位固定骨折。结果:18例患者术后咬合关系恢复良好,张口度正常,无1例患者出现面瘫。术后3个月复诊骨折愈合良好。结论:对于髁突低位骨折,应用下颌后越腮腺穿咬肌入路,操作简单,创伤小,利于保护面神经,术野清晰,便于复位固定。且切口隐蔽,术后瘢痕不明显。熟知颞下颌关节及腮腺区的解剖可明显减少手术创伤及预防手术并发症的发生。     

Proximal and distal Facial nerve exploration during superficial parotidectomy

One of the most technique sensitive surgeries in the maxillofacial region is the parotid gland surgery owing to the close relation between the gland and the extra-cranial course of facial nerve. Facial nerve is generally located by means of a proximal surgical identification technique aimed at identifying the facial nerve at its point of exit from the stylomastoid foramen to its entry into the posteromedial surface of parotid gland. There are reports in the literature on distal nerve identification techniques, either as a choice or in cases where proximal nerve identification is difficult. The present report deals with personal clinical experience, describing both the techniques for detection of the facial nerve in 17 cases reported. The technique mainly chosen was conventional proximal nerve identification technique in 16 cases. Distal exploration of the buccal branch was undertaken only in one case, on account of difficulty in locating the main trunk intraoperatively, due to the presence of a post inflammatory fibrosis. The decision to resort to the identification of the buccal nerve is supported by the regular course and adequate size of this branch of facial nerve in its peripheral area co-located with stenson’s duct, which enable it to be easily identified during surgery.     

Resection of accessory parotid gland tumors through a peroral approach with facial nerve monitoring

Accessory parotid glands are an anatomic variation. Pathologic alterations, which occur in these tissues, are related to those found in the parotid gland. At this time, first-line therapy consists of total resection. In consideration of the delicate anatomy in this region, a careful approach through a lateral parotidectomy or a facelift incision is recommended. In this report, we give an account of a minimally invasive surgical alternative through a peroral approach with facial nerve monitoring. The histologically secured pleomorphic adenoma was completely removed. During surgery, a branch of the facial nerve was detected and secured with active nerve monitoring. We are confident that the peroral resection, supported by active and passive facial nerve monitoring, is a discussable alternative for well-selected tumors of accessory parotid glands.     

Relation of mental nerve with mandibular branch of the facial nerve

The aim of this study is to elucidate the detailed anatomical relation of mental nerve with marginal mandibular branch of the facial nerve. Twenty-three hemi-faces of adult Korean cadavers (11 Male and 7 female) were dissected. All locations of crossing (C) of marginal mandibular branch of the facial nerve and mental nerve were measured below the inferior verge of the lower vermillion (V): a vertical distance (V-Gn) between V and gnathion (Gn) and horizontal distance (V-OC) between V and oral commissure (OC). The mental foramen located at 19.8 +/- 4.4 mm below the inferior verge of the lower vermillion (V) and 34.3 +/- 5.2 mm laterally from the midline. In all specimens there were found interconnections between marginal mandibular branch of the facial nerve and mental nerve. The number of connecting site was 8.26 +/- 2.49. Microscopically, both of the nerve branches had a common epineurium, but the perineurium separated. V-Gn and the vertical distance between V and the connecting point (C) was in the ratio of approximately 2:1, and V-OC and the horizontal distance from V:C was an equal ratio. The proximity of the mental nerve and marginal mandibular branch of the facial nerve to each other draws an attention as operating the mental area.     

面神经三种解剖方法的比较研究

目的:通过比较腮腺肿物手术中3种不同的面神经逆行解剖方法,探讨通过颈支逆行解剖面神经的可行性。方法:腮腺区肿物患者83例,依据肿瘤部位及性质分别采取面神经颈支、下颌缘支和颊支的逆行解剖方法。随访时间6个月至2年,观察治疗效果。结果:面神经颈支逆行解剖组术后面瘫发生率(10.7%)明显低于下颌缘支组(37.1%)和颊支组(45.0%)。三组术式肿瘤复发率无明显差别。结论:面神经颈支逆行解剖法可有效降低面瘫的发生,并能保留颈阔肌功能,有一定的临床应用价值。     

Great auricular communication with the marginal mandibular nerve - a previously unreported anatomical variant

The great auricular nerve that originates from the cervical plexus and supplies sensation to the lower part of the auricle and the skin overlying the angle of the mandible has no motor component. During an elective neck dissection for a squamous cell carcinoma of the tongue, we found that the anterior division of the great auricular nerve divided, with a long branch that passed into the submandibular triangle anterior and superficial to the facial vein, and was joined on its deep surface by the marginal mandibular division of the facial nerve. Although anatomical variants of other branches of the cervical plexus have been described, this is, to our knowledge, the first time a communication between the great auricular nerve and a branch of the facial nerve has been reported outside the parotid gland.     

解剖面神经颧支在腮腺切除术中的临床应用

目的：总结解剖面神经颧支在腮腺良性肿瘤切除术中的临床应用。方法：采用经典的面部除皱手术切口,在腮腺嚼肌筋膜下翻瓣,先在耳屏前颧弓下解剖显露面神经的颧支,然后沿该支显露面神经的颞面干及面神经总干,再根据肿瘤的位置沿总干选择性地解剖面神经颈面干及各分支,行肿瘤及腮腺部分切除术。最后采用蒂在上方的胸锁乳突肌肌瓣转移填塞腮腺切除后的凹陷区,避免了常规术式术后耳前区的凹陷畸形。结果：采用该术式对19例患者行腮腺良性肿瘤切除术,所有手术均顺利完成,术后随访3～4年,患者面部疤痕不明显,外形恢复良好,面神经损伤均完全恢复。结论：本术式更易于显露和保护面神经,改善术后面部畸形。     

Anatomic dissection of the arterial supply of the lips: an anatomical and analytical approach

Previous investigators have not described some of the new anatomic variations or provided quantitative and analytical data of the arterial anatomy of the lips in as much depth as in this study. Dissections of 14 different facial sides of cadavers were done. Through investigating the arterial supply of the upper and lower lips, measurements were performed and statistically analyzed. The main arterial supply of the upper lip was from the superior labial artery (SLA, mean external diameter, 1.8 mm [SD, 0.74 mm]); in addition, the subalar and septal branches contributed to its vascularization. The origin of the SLA was above the labial commissure in 78.6%. The subalar branch was not found but replaced by the alar artery that arose from the infraorbital artery in 1 specimen. The main arterial supply of the lower lip was derived from 3 branches of the facial artery, the inferior labial artery (mean external diameters, 1.4 mm [SD, 0.31 mm]) and the horizontal and vertical labiomental arteries. The inferior labial artery originated mostly below the labial commissure in 42.9% and formed a common trunk with the SLA in 28.6%. The horizontal labiomental artery was present in all, but vertical labiomental artery was absent in 21.4% of specimens. Overall, observed anatomic variations were classified into types I to VIII. Significant relations between the demographic variables and measured parameters were reported including the correlation coefficient among evaluated parameters. In conclusion, this study provides various information that aids in creating new flaps and supports the vascular base for clinical procedures in reconstructive surgery of the lip.     

Innervation of the procerus muscle

The aim of this study is to elucidate innervation of the procerus muscle, which is attributed mainly to transverse lines on the radix nasi and indirectly to glabella frown line. Twenty-three hemifaces of Korean adult cadavers were dissected. In all specimens, the procerus muscle was supplied by the buccal branch of the facial nerve, which coursed infraorbitally. The number of the buccal branches varied: three in 47.8%, two in 47.8%, and one in 4.4% of the specimens. The buccal branch crosses the intercanthal line (nasion to the medial canthus) at approximately lateral one third. The nerve entrance was within a circle with a diameter of 5 mm and its center located 9 mm lateral and 10 mm superior from nasion. It was about a midpoint of lateral half of intercanthal line and lower one third between the intercanthal line and tangential line of the supraorbital rim. The anatomical knowledge might be contributive to depletion of transverse lines on the nasal bridge and function of the procerus muscle.