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Anatomical variations of the marginal mandibular nerve
Arthur Paredes Gatti1, Matheus Trovão Ribeiro2, Flávio Hojaij3
1Staff of the Head and Neck Surgery Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo, Brazil)
|December 5, 2024
Summary
The Marginal Mandibular Nerve (MMN) shows significant anatomical variation in branching and position, impacting surgical approaches. Understanding these variations is crucial to prevent inadvertent patient injuries during cervicofacial procedures.
Area of Science:
- Anatomy
- Surgical Neurology
- Medical Imaging
Background:
- The Marginal Mandibular Nerve (MMN), a branch of the Facial Nerve, exhibits considerable anatomical variability not always reflected in didactic descriptions.
- This variability in ramifications, positioning relative to the mandible, and anastomoses is critical for surgical planning in the cervicofacial region.
- Failure to account for MMN variations can lead to underestimated risks and iatrogenic injuries, resulting in patient motor deficits.
Purpose of the Study:
- To systematically analyze the anatomical variations of the Marginal Mandibular Nerve (MMN).
- To investigate MMN branching patterns, positioning relative to mandibular landmarks, and incidence of variations.
- To identify potential surgical challenges arising from MMN anatomical peculiarities.
Main Methods:
- A systematic literature review was performed, focusing on anatomical studies of the MMN published between 1981 and 2024.
- Studies included in vivo and cadaveric analyses quantifying MMN branches, their positioning, and anastomoses with other nerves.
- Data from 511 hemifaces were analyzed.
Main Results:
- Variations in MMN branching were common: 290 single, 160 double, 54 triple, and 7 quadruple branches were identified across 511 hemifaces.
- The average distance of the MMN superior to the lower mandibular border was 1.61 cm, and inferiorly was 2.53 cm.
- Anastomoses were observed between the MMN and branches of the Facial Nerve (buccal, cervical) and the Trigeminal Nerve.
Conclusions:
- The significant anatomical variability of the Marginal Mandibular Nerve (MMN) in terms of branching and positioning necessitates a re-evaluation of surgical strategies.
- Current surgical approaches may not adequately address the diverse MMN presentations, potentially contributing to reported motor deficits.
- Further research and enhanced surgical awareness of MMN variations are essential to minimize iatrogenic injuries.
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