Annamaneni Ravi Chander Rao, Reddy Mukunda D, Srikanth R, Moturi Sridhar, Komuravelly Arpitha, Sadam Srinivasa Rao, Kanth V Shashi, Rao V Bhadra
Consultant, Department of Plastic Surgery, Care Hospitals , Hyderabad, A.P., India .
Professor and HOD, Department of Plastic Surgery, Nizams Institute of Medical Sciences , Hyderabad, A.P., India .
J Clin Diagn Res. 2014 Apr;8(4):NC04-7. doi: 10.7860/JCDR/2014/7708.4302. Epub 2014 Apr 15.
Facial palsy is a common problem encountered in clinical practice. These patients suffer serious functional, cosmetic & psychological problems with impaired ability to communicate. Functional problems around the eye are usually a first priority for the patient with facial palsy.The nerve to masseter as a direct nerve transfer to the zygomatic branch of facial nerve to reinnervate viable facial muscles within a year after the onset of paralysis has been scarcely reported. This study was contemplated to evaluate the feasibility of neurotisation of zygomatic branch of facial nerve with masseteric nerve branch of the trigeminal nerve Objectives: Establishing the anatomic relationship of masseteric nerve to masseteric muscle, determining feasibility of neurotisation of zygomatic branch of facial nerve using the nerve to the masseter and establishing fascicular correlation of the donor and the recipient nerves.
Ninteen hemi-faces in ten fresh cadavers (6 Male and 4 Female)were dissected in a forensic morgue and access was by a standard preauricular incision and anterior skin flap is elevated in a subcutaneous plane. Facial nerve and its two main divisions are dissected in its full A*/extratemporal course. Zygomatic branch dissected upto zygomatic arch and the nerve to the masseter is identified within the masseter muscle, dissected proximodistally to isolate it. Feasibility of transfer of this masseteric nerve to the zygomatic branch without using nerve graft is determined. At the completion of dissection, the ends of both nerves are sent for HPE analysis to determine fascicular anatomy and count.
The dissection of massteric nerve was done taking into consideration of 3 axes, that is anteroposterior (x), vertical (y) axes and mediolateral(z) for locating the nerve and for standardization of the dissection. The nerve was cut and stored in glutaraldehyde solution and subjected to histopathologic examination after fixing and staining with Haematoxilin-eosin stain. Donor masseter neve has 7-10 fascicles. Recipient zygomatic branch has 2-3 fascicles. And the buccal branch has 5-6 fascicles.
The use of the nerve to masseter offers a simpler ipsilateral alternative for neurotisation of the facial nerve branches in patients who have an early facial nerve paralysis.
面瘫是临床实践中常见的问题。这些患者存在严重的功能、美容及心理问题，沟通能力受损。眼部周围的功能问题通常是面瘫患者的首要关注点。将咬肌神经作为直接神经转移至面神经颧支，以在面瘫发作后一年内重新支配存活的面部肌肉，这方面的报道很少。本研究旨在评估用三叉神经咬肌神经分支对面神经颧支进行神经移植的可行性。目的：确定咬肌神经与咬肌的解剖关系，确定使用咬肌神经对面神经颧支进行神经移植的可行性，并建立供体和受体神经的束状相关性。
在法医停尸房对10具新鲜尸体（6例男性和4例女性）的19个半侧面部进行解剖，采用标准的耳前切口，在皮下平面掀起前皮瓣。对面神经及其两个主要分支在其全程/颞外段进行解剖。将颧支解剖至颧弓，在咬肌内识别咬肌神经，并向近端和远端解剖以分离它。确定不使用神经移植物将该咬肌神经转移至颧支的可行性。解剖完成后，将两根神经的末端送去进行苏木精-伊红染色病理分析，以确定束状解剖结构和数量。
咬肌神经的解剖是考虑三个轴进行的，即前后（x）、垂直（y）轴和内外侧（z）轴，用于定位神经并使解剖标准化。将神经切断并保存在戊二醛溶液中，固定并用苏木精-伊红染色后进行组织病理学检查。供体咬肌神经有7 - 10个束。受体颧支有2 - 3个束。颊支有5 - 6个束。
对于早期面神经麻痹的患者，使用咬肌神经为面神经分支的神经移植提供了一种更简单的同侧替代方法。
