Management of the marginal mandibular nerve during and after neck dissection
- 1 April 2019
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Otolaryngology & Head and Neck Surgery
- Vol. 27 (2), 104-109
- https://doi.org/10.1097/moo.0000000000000523
Abstract
Marginal mandibular nerve palsy (MMNP) is often an understated complication after neck dissection. This article reviews literature regarding anatomic landmarks that help define marginal mandibular nerve (MMN) during neck dissection, oncologic safety of surgical maneuvers, implications of MMNP, and reconstructive options. A thorough knowledge of anatomy of the nerve can aid in its preservation. Course, branching pattern and communications of MMN are extremely variable. The Hayes Martin method classically described to preserve the nerve may not be oncologically safe in patients with prefacial nodal involvement. MMNP significantly affects quality of life after neck dissection. Cause, timing, and degree of neural damage play an important role in determining diagnostic and therapeutic options to correct the deformity resulting from MMNP. Owing to treatment-related factors, functionality of local structures may be compromised, which limits available reconstructive options for the surgeon. This should favor a shift of management option toward more conservative procedures in patients treated for head and neck cancer. When oncologically safe, the MMN must always be preserved. The patient perceived deformity resulting from MMNP is significantly higher than clinician-detected rate. In select patients who are affected by significant smile asymmetry, multiple dynamic and static corrective procedures can be offered.Keywords
This publication has 48 references indexed in Scilit:
- Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort studyBMJ Open, 2013
- Anatomic Variations of the Marginal Mandibular NerveIndian Journal of Surgical Oncology, 2012
- Marginal mandibular branch of the facial nerve: An anatomical studyIndian Journal of Plastic Surgery, 2010
- Outcomes of Mini-Hypoglossal Nerve Transfer and Direct Muscle Neurotization for Restoration of Lower Lip Function in Facial PalsyPlastic and Reconstructive Surgery, 2009
- Prognostic Value of Electroneurography and Electromyography in Facial PalsyThe Laryngoscope, 2008
- A simple nerve dissecting technique for identification of marginal mandibular nerve in radical neck dissectionJournal of Surgical Oncology, 2007
- Perifacial Lymph Node Metastasis in the Submandibular Triangle of Patients With Oral and Oropharyngeal Squamous Cell Carcinoma With Clinically Node-Positive NeckThe Laryngoscope, 2006
- Preservation of the Marginal Mandibular Branch of the Facial Nerve Using a Plexus Block Nerve StimulatorThe Laryngoscope, 2006
- Perivascular–submandibular lymph node metastasis in squamous cell carcinoma of the tongue and floor of mouthEuropean Journal of Surgical Oncology, 2004
- SURGICAL ANATOMY OF THE MANDIBULAR RAMUS OF THE FACIAL NERVE BASED ON THE DISSECTION OF 100 FACIAL HALVESPlastic and Reconstructive Surgery, 1962