New surgical technique improves donor nerve localization in facial reanimation

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Image: PD

1. The masseteric nerve bisects the subzygomatic triangle and is an important donor nerve for facial reanimation procedures.  

2. The subzygomatic triangle is bounded by the inferior border of the zygomatic arch, a vertical line through the anterior border of the temporomandibular joint, and the frontal branch of the facial nerve.

The masseteric nerve plays a vital role as a donor nerve for facial reanimation procedures. However, the surgical anatomy of the nerve has remained ill-defined, with only average physical measurements to guide surgeons. Further, these values may be inaccurate due to variability in patient age, size, ethnicity, and gender. This study sought to define surgical anatomy relative to the masseteric nerve and thus allow surgeons to quickly and accurately identify the nerve without the need for intraoperative measurements. The strengths of this study lie in its diverse patient population and variety of surgical procedures performed. These facets lend credence to the generalizability of the subzygomatic triangle for use in assorted surgical situations. However, the small sample size of only 21 subjects weakens the authors’ claim that the masseteric nerve holds a constant relation to the subzygomatic triangle. Additionally, the authors report the mean time to visualization of the masseteric nerve utilizing the subzygomatic triangle technique but they do not compare this statistic with a control procedure, thus precluding any conclusions regarding the effects of this new approach on surgical efficiency.

Click to read the study in Plastic and Reconstructive Surgery

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Image: PD

1. The masseteric nerve bisects the subzygomatic triangle and is an important donor nerve for facial reanimation procedures.  

2. The subzygomatic triangle is bounded by the inferior border of the zygomatic arch, a vertical line through the anterior border of the temporomandibular joint, and the frontal branch of the facial nerve. 

This [cadaveric and clinical case series] study involved three parts. First, wide dissections were performed on five fresh-frozen cadaver to expose the masseteric nerve. During these dissections, a novel anatomic triangle termed the subzygomatic triangle was identified and defined as the space enclosed by the inferior border of the zygomatic arch, a vertical line through the anterior border of the temporomandibular joint, and the frontal branch of the facial nerve. Following this, dissections of five additional cadaveric heads were then performed using the subzygomatic triangle technique devised earlier. The second set of dissections allowed for easy visualization of the masseteric nerve with minimal blunt dissection of the masseter muscle. Finally, the clinical application portion of the study included 11 patient cases where the masseteric nerve was located using the subzygomatic triangle technique and utilized for facial reanimation. The mean time for identification of the masseteric nerve in this group was 10.2 minutes.

In sum: The masseteric nerve plays a vital role as a donor nerve for facial reanimation procedures. However, the surgical anatomy of the nerve has remained ill-defined, with only average physical measurements to guide surgeons. Further, these values may be inaccurate due to variability in patient age, size, ethnicity, and gender. This study sought to define surgical anatomy relative to the masseteric nerve and thus allow surgeons to quickly and accurately identify the nerve without the need for intraoperative measurements. The strengths of this study lie in its diverse patient population and variety of surgical procedures performed. These facets lend credence to the generalizability of the subzygomatic triangle for use in assorted surgical situations. However, the small sample size of only 21 subjects weakens the authors’ claim that the masseteric nerve holds a constant relation to the subzygomatic triangle. Additionally, the authors report the mean time to visualization of the masseteric nerve utilizing the subzygomatic triangle technique but they do not compare this statistic with a control procedure, thus precluding any conclusions regarding the effects of this new approach on surgical efficiency.

Click to read the study in Plastic and Reconstructive Surgery 

By Devin Miller and Mimmie Kwong

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