Rodriguez-Lorenzo Andres, Jensson David, Weninger Wolfgang J, Schmid Melanie, Meng Stefan, Tzou Chieh-Han John
Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; and Center of Anatomy and Cell Biology and Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Plast Reconstr Surg Glob Open. 2016 Dec 13;4(12):e1164. doi: 10.1097/GOX.0000000000001164. eCollection 2016 Dec.
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.
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.
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.
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.
面神经下颌缘支（MMN）损伤会导致下唇降肌麻痹和微笑不对称。若有可能，神经重建是首选方法；然而，在神经缺损较长或神经重建延迟的情况下，传统的神经修复可能难以实施或效果欠佳。在此，我们研究将颈阔肌运动神经（PMN）转移至MMN以恢复下唇功能的解剖学技术可行性，并展示了成功实施该神经转移的临床病例。
解剖10具成年新鲜尸体。测量内容包括MMN和PMN的分支数量、PMN从腮腺的最大解剖长度以及从腮腺前缘到面动脉的距离。评估PMN在与面动脉交叉水平直接与MMN吻合的可达性。我们对MMN和PMN分支进行了组织形态计量学分析。
所有解剖中MMN和PMN的解剖结构一致，MMN的平均分支数为1.5个，PMN为1.2个。PMN的平均最大解剖长度为46.5毫米，且在每种情况下都能与MMN无张力吻合。组织形态计量学分析表明，MMN每毫米平均有3866条有髓纤维，PMN有5025条。对该临床病例进行3年随访后，观察到MMN功能完全恢复，无需中枢再学习，且未因颈阔肌去神经支配导致功能或美学损害。
PMN至MMN转移是一种解剖学上可行的孤立性MMN损伤重建手术。在我们的患者中，通过直接神经吻合，由于PMN和MMN功能的协同作用以及供区并发症极少，下唇降肌实现了更快且完全的恢复，无需中枢再学习。
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