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High-frequency ultrasound (HFUS) effectively identifies the masseteric nerve, crucial for facial paralysis surgery. This imaging technique offers precise anatomical detail, improving surgical planning and safety for patients requiring free muscle flaps.

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Anatomy

Background:

  • The masseteric nerve is a key target for neurotizing free muscle flaps in cases of irreversible long-term facial paralysis.
  • Existing preoperative skin-marking techniques for the masseteric nerve have limitations, including variability and inability to visualize the nerve.
  • A need exists for a reliable preoperative method to identify the masseteric nerve and its anatomical course.

Purpose of the Study:

  • To validate a high-frequency ultrasound (HFUS) technique for preoperative identification of the masseteric nerve.
  • To assess the accuracy and reliability of HFUS in visualizing the masseteric nerve and its anatomical relationships.

Main Methods:

  • An observational study was conducted involving systematic HFUS examinations of 64 hemifaces in healthy volunteers.
  • A subset of participants underwent HFUS-guided needle electrostimulation to validate the ultrasound imaging.
  • Statistical analysis included Cohen kappa coefficient to assess agreement between HFUS and electrostimulation.

Main Results:

  • High-frequency ultrasound successfully identified the masseteric nerve in 96.9% of hemifaces.
  • HFUS demonstrated almost perfect agreement with direct needle stimulation (Cohen kappa = 0.95).
  • The study detailed the nerve's location within the masseter muscle and its relationship to surrounding structures.

Conclusions:

  • High-frequency ultrasound is a reliable method for preoperative masseteric nerve identification.
  • HFUS provides surgeons with crucial, individualized anatomical information, enhancing surgical planning and safety for facial paralysis reconstruction.