Dr DiBernardo is a Clinical Associate Professor, Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA.
Aesthet Surg J. 2021 Jan 25;41(2):218-223. doi: 10.1093/asj/sjaa184.
Aging skin and increased skin laxity is a prevalent concern of patients. Nonsurgical treatments, such as radiofrequency, are increasing in popularity due to decreased pain, downtime, and scarring. ThermiRF (Thermi, Irving, TX) is a subdermal radiofrequency treatment for tightening skin. When applying radiofrequency treatments to the neck, it is important to avoid ablating the marginal mandibular nerve and causing nerve trauma.
The purpose of this study was to locate and record the position of the marginal mandibular nerve in 72 patients undergoing subdermal radiofrequency skin tightening, to determine how often the nerve correlates to its textbook anatomic position.
Marginal mandibular nerves were located with a nerve stimulator and marked with the subject in both upright and recumbent positions. Photographs were taken and the nerve position in relation to the mandible was recorded.
The marginal mandibular nerve was in its correct anatomic position above the mandible in 18% of patients. Nerve position did not shift between the upright and recumbent positions. Only 10% of patients had left-right nerve symmetry.
To avoid nerve injuries, nerve mapping prior to nonablative radiofrequency treatment is recommended. The marginal mandibular nerve is not always in its correct anatomic position or symmetric to the opposing side. Its location cannot be assumed from the textbook anatomic position or from a single-side mapping.
皮肤老化和皮肤松弛增加是患者普遍关注的问题。由于疼痛减轻、停机时间缩短和疤痕减少，射频等非手术治疗越来越受欢迎。ThermiRF（Thermi，Irving，TX）是一种用于收紧皮肤的皮下射频治疗。当将射频治疗应用于颈部时，重要的是要避免消融下颌缘神经并造成神经创伤。
本研究的目的是定位并记录 72 名接受皮下射频皮肤收紧治疗的患者的下颌缘神经的位置，以确定神经与其教科书解剖位置的相关性。
使用神经刺激器定位下颌缘神经，并在患者直立和仰卧位时对其进行标记。拍摄照片并记录神经相对于下颌骨的位置。
下颌缘神经在 18%的患者中位于下颌骨上方的正确解剖位置。神经位置在直立和仰卧位之间没有变化。只有 10%的患者左右神经对称。
为了避免神经损伤，建议在进行非消融性射频治疗之前进行神经定位。下颌缘神经并不总是处于正确的解剖位置或与对侧对称。不能从教科书的解剖位置或单侧定位来假设其位置。
