„Anatomiaebiomeccanicadelnervomandibolaremarginalecomefa3oridirischiochirurgici.„

RóbertKÉSMÁRSZKY1,PéterNAGY2,TamásMICSIK3,GergelyRÁCZ3,LizaPELYHE4,BeTnaPOGÁCSÁS4,RékaPOTSUBAY5,EszterBOGNÁR2,6

1BudapestUniversityofTechnologyandEconomics,FacultyofMechanicalEngineering,DepartmentofMechatronics,Op]csandMechanicalEngineering,H-1111Budapest,Hungary2IMEDIMLtd.3SemmelweisUniversity,1stDepartmentofPathologyandExperimentalCancerResearch,H-1085Budapest,Hungary4BudapestUniversityofTechnologyandEconomics,FacultyofMechanicalEngineering,DepartmentofMaterialsScienceandEngineering,H-1111Budapest,Hungary5SemmelweisUniversity,FacultyofMedicine,H-1085Budapest,Hungary6MTA–BMEResearchGroupforCompositeScienceandTechnology,H-1111Budapest,Hungary

41stCongressoConventusSocietasORLLa]na,Torino,Italy,2016

Thestudywasundertakenfollowingapprovalfromtheethicalcommi3ee(SemmelweisUniversity,RegionalandIns]tu]onalCommi3eeofScienceandResearchEthics;TUKEBNo.127/2014)andinaccordancewiththedeclara]onofHelsinki,usingtheNa]onalResearch,DevelopmentandInnova]onOffice–NKFIH,OTKAK-116189grant.

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Theaimofthepresenta]on:

I.   Toclinicallyandculturallyillustratetheimportanceofthemandibularbranchofthefacialnerve

II.   Topresenttheusualanatomy

III.TodemonstrateouranatomicalfindingsinaHungarianpopula]onrelatedtobiomechanicalforces

Palsy

Basilaryartery

Pons

Intracranial23-24mmIntratemporal29-40mm

Sigmoidsinus

VII.LSC

Stapes

Extratemporal

Temporo-facial

Cervico-facial

Stenon

SMAS

Massetermuscle

MMB

„Fan”Trunk

Pesanserinus

Zygoma Greatauricularnerve

Mandibularangle

MMB

Anastomosis

Davis1956

Tzafe3a,Terzis2010

Zygoma

Mandibula

Facialartery

XII.

Caro]ds

MMB Lingualartery

Submandibulargland

NeighbouringstructuresCollateralfromthebuccalbranch

Innervatedmainmuscles:m.depressorlabiiinferiorism.depressoranguliorism.mentalis

MMB

Tympanicmembrane

Chordatympani

XII.

MaintypesinourstudyI.:1branch

MMB

Pathologicallymphnode

Greatauricularnerve

Submandibulargland

XII.

MaintypesinourstudyIII.:2branches

MMB

MaintypesinourstudyII.:Collateral

Loop

MaintypesinourstudyIV.:Loop

Arcades

MMB

MaintypesinourstudyV.:

MMB

Retromandibularvein

Anastomosis

Buccalbranch

Complexitywithotherstructures:

Mechanicallesions

MICROTRAUMA,ISCHAEMIATHERMAL,ELECTRICALEDEMA,CICATRISATIONCRUSH,TRANSSECTION,TRACTION

TheHouse-Brackmanngradingsystem

I.Normalfacialfunc]oninallareasII.Slightweaknessoncloseinspec]onIII.Obvious,notdisfiguringdifference,nofunc]onaldefficitIV.Obviousweakness+/-disfiguringasymmetryV.Onlybarelypercep]blemo]onVI.Nomo]onHouseJW,BrackmannDE.Facialnervegradingsystem.OtolaryngolHeadNeckSurg1985;93(2):146-147

SunderlandIV. SunderlandV.

IATROGENY5,6-7%

•  Oral&maxillofacialsurgery40%•  Paro]dectomy25%•  Otosurgery17%•  Cosme]csurgery11%•  Other7%

MayM,KleinSR.Differen]aldiagnosisoffacialnervepalsy.OtolaryngolClinNorthAm.1991;24(3):613-45.HohmanMH,HadlockTA.E]ology,diagnosisandmanagementoffacialpalsy:2000pa]entsinafacialnervecenter.Laryngoscope2014;124(7):283-93.HohmanMH,BhamaPK,HadlockTA.Epidemiologyofiatrogenicfacialnerveinjury:adecadeofexperience.Laryngoscope2014;124(1):260-65.

RESULTS•  31corpses,55hemifaces

•  13Male(11included)18Female(allincluded)

•  L:9R:10(altogether19HF) L:18R:18(altogether36HF)

•  58-94y,m:76,69y 60-90y,m:73,73y

•  Nondissected:haemorrhage,autolysis, ]menotallowed

70BRANCHES

No. %all %allMMB

hemifaces branches (55) (70)

•  1 41 74.54 58,57

•  2 13 23,63 37,14

•  3 1 1,81 4,28

70BRANCHES

No. % %

M/F(19/36) L/R(38/32no.branches) (ofincludedhemifaces) (ofallbr.ofthegivenside)

•  1 41 73.68/75 44.73/75

•  2 13 26.31/22.22 47.36/25

•  3 1 0/2.77 7.89/0

Horizontalorigin64,28%

VoErRiTg78,57%IiCnAl

µ↑inmales

Course65,71%

6COLLATERALS

8,57%ofallspecimens

83,33%:16,66%=female:male

66,66%tobuccalarea

16,66%tocervicalarea

16,66%frombuccalbranch

ANASTOMOSIS

14,28%ofallMMB(loopincluded)8.57%ofallMMB(withoutloop)60%female80%lex No.%/70 M/F L/R• M-M 2 2,85 female lex• M-C 1 1,42 male lex• M-B 4 5,71 50-50% lex•  2xM-B1 1,42 female lex• Mloop4 5,71 1/3 2/2

CONCLUSIONS

•  1branchispresentinthemajorityofcases,/1,27MMB/hemifaceinthisstudy/

•  Doubleortriplebranchingismorefrequentonthelex

•  Usuallyoriginatesbehindthemandibula,overtheleveloftherim

•  Inframandibularoriginismorefrequentinmales

•  Submandibularcourseinabout2/3ofthecases

•  Collaterals&anastomosismayoccur,especiallyinfemales

•  TheanatomyoftheMMB&neighbouringstructuresisunstable

•  Otherpathologiesmaybeassociated