Intra-surgical optimized identification of masseteric nerve for central facial nerve neurorrhaphy: A retrospective study

Ahmed Abdelkarim; Fabiana Allevi; Federico Bolognesi; Filippo Tarabbia; Mohamed Elyounsi; Mohamed Abdelrahim; Essam A Abda; Mohamed El-Shazly; Federico Biglioli

doi:10.1016/j.jcms.2023.08.010

Intra-surgical optimized identification of masseteric nerve for central facial nerve neurorrhaphy: A retrospective study

J Craniomaxillofac Surg. 2023 Sep;51(9):580-585. doi: 10.1016/j.jcms.2023.08.010. Epub 2023 Aug 15.

Authors

Ahmed Abdelkarim¹, Fabiana Allevi², Federico Bolognesi³, Filippo Tarabbia⁴, Mohamed Elyounsi⁵, Mohamed Abdelrahim⁶, Essam A Abda⁷, Mohamed El-Shazly⁸, Federico Biglioli⁹

Affiliations

¹ Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy; Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt. Electronic address: ahmed.abdelkarim@med.aun.edu.eg.
² Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy. Electronic address: fabiana.allevi@gmail.com.
³ Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy. Electronic address: federico.bolognesi5@unibo.it.
⁴ Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy. Electronic address: filippotarabbia@gmail.com.
⁵ Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt. Electronic address: mohamed_elyounsi@aun.edu.eg.
⁶ Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt. Electronic address: mohamed.abdelrehem1@med.aun.edu.eg.
⁷ Rheumatology Rehabilitation and Physical Medication Department, Assiut University Hospital, Assiut, Egypt. Electronic address: essamabda@hotmail.com.
⁸ Plastic and Reconstructive Surgery Department, Assiut University Hospital, Assiut, Egypt. Electronic address: elshazly@aun.edu.eg.
⁹ Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Via di Rudinì 8, Milan, Italy. Electronic address: federico.biglioli@unimi.it.

PMID: 37598067
DOI: 10.1016/j.jcms.2023.08.010

Abstract

It is the aim of the study to provide a detailed intraoperative assessment of the masseteric nerve and the facial branch of the smiling muscles complex through the same superficial musculoaponeurotic system (SMAS) incision. This observational retrospective study aimed to define the straightest and safest surgical route to identify the facial nerve for the smiling muscles complex and the masseteric nerve, using distance from the tragus and zygomatic arch as anatomical landmarks. 30 patients were included in the study. The mean distance from the tragus to the masseteric nerve was 40.03 mm, the mean distance from the zygomatic arch was 12.24 mm, and the mean depth from the SMAS was 10.84 mm. Data were consistent, with little variation. The distance from the zygoma was found to be higher in male patients. There was a positive correlation between the depth to the nerve and the distance from the zygoma, but no correlation between body mass index and the other parameters studied. Within the limitations of the study it seems that the proposed standardized direct approach to the masseteric nerve is a reproducible technique that may be used to increase the safety of the procedure, reduce the operating time, and decrease the amount of dissection and related postoperative scarring, thereby fostering positive results.

Keywords: Facial nerve palsy; Masseteric nerve identification; Nerve transfer for facial nerve reanimation.