Anatomische Auffindbarkeit und Möglichkeiten des Transfers des Nervus massetericus zur Gesichtsreanimation

Zusammenfassung

Hintergrund Der Nervus massetericus (NM) kommt häufig als Spendernerv zur Reanimation des Nervus facialis zur Anwendung. Neben bereits etablierten Techniken gewinnt der NM-Transfer vor allem aufgrund der Einzeitigkeit des Verfahrens und des rekonstruktiven Potenzials zunehmend an Bedeutung. Ziel dieser anatomischen Arbeit und der angeschlossenen Fragenbogenstudie war die Evaluation vorbeschriebener Identifikationsmethoden und der Eignung des NM zum direkten Nerventransfer, sowie die Erhebung des Stellenwertes des NM-Transfers in der täglichen klinischen Praxis.

Material und Methodik Es wurde die beidseitige Dissektion 25 nativ-gefrorener Köpfe (n=50; 13 weiblich, 12 männlich) von Körperspenden mit begleitender Vermessung des NM durchgeführt. Im Rahmen einer an etablierten Zentren für Fazialischirurgie im deutschsprachigen Raum vollzogenen Fragenbogenstudie wurden mittels der Software SurveyMonkey klinische Erfahrungswerte des NM-Transfers erhoben. Die gewonnenen Daten wurden mit Microsoft Excel deskriptiv-statistisch analysiert und in numerischen Tabellen sowie Boxplots dargestellt.

Ergebnisse Durch die Orientierung an anatomischen Landmarken wie dem Arcus zygomaticus und der Incisura mandibulae konnte der NM in 100% der Fälle aufgefunden werden. Die durchschnittliche Länge ab dem Austritt unterhalb des Arcus zygomaticus bis zum Eintritt in den M. masseter betrug 22 mm und stellte die zur Transposition verfügbare Länge dar. In 94% der Fälle war die Koaptation des NM mit dem Ramus zygomaticus damit spannungsfrei möglich. Die Umfrageergebnisse zeigten, dass der NM als wichtiger Spendernerv bei motorischen Transfers angesehen wird und der NM-Transfer nunmehr weitestgehend als Standardverfahren etabliert ist.

Diskussion In Übereinstimmung mit bestehender Literatur konnte der NM zuverlässig in Projektion auf die Incisura mandibulae aufgefunden werden und war überwiegend zur spannungsfreien Koaptation mit dem Ramus zygomaticus geeignet. Unterschiede zu bisherigen Arbeiten zeigten sich hingegen bei der zur Transposition verfügbaren Länge des Nervs sowie bei der Häufigkeit seiner Aufteilung in mehrere Äste vor dem Eintritt in den Musculus masseter. Die im DACH-Raum derzeit favorisierte Methode zur Fazialisrekonstruktion stellt nach wie vor das Cross-Face Nerve Grafting (CFNG) dar, der NM-Transfer ist allerdings u. a. aufgrund der geringen Hebestellenmorbidität und kurzen Regenerationszeit als Alternative oder auch Ergänzung klinisch bereits gut etabliert.

Abstract

Background The masseteric nerve (MN) is often used as a donor nerve for facial reanimation. In addition to already established techniques, MN transfer is rapidly gaining importance, mainly due to the single-stage approach of the procedure and its reconstructive potential. This anatomical study and the associated questionnaire study aimed to evaluate the established methods for identification of the MN and its suitability for direct nerve transfer as well as to assess the importance of MN transfer in the daily clinical routine.

Material and methodology Bilateral dissection of 25 fresh-frozen head specimens (n=50; 13 female, 12 male) was performed with accompanying measurement of the MN. In a questionnaire study conducted at established centres for facial surgery in German-speaking countries, clinical experience data of MN transfer was collected using the SurveyMonkey software. The data obtained was statistically analysed using Microsoft Excel and presented in numerical tables and boxplots.

Results Using anatomical landmarks such as the zygomatic arch and the mandibular notch for orientation, the MN was found in 100% of cases. Its average length from the emerging point below the zygomatic arch towards its entry into the masseter muscle was measured to be 22 mm and was the length available for nerve transposition. Tension-free coaptation of the MN with the zygomatic branch was possible in 94% of cases. The questionnaire showed that the MN is considered an important donor nerve for motor nerve transfers and that MN transfer is now largely established as a standard procedure.

Discussion In accordance with previously published studies, the MN was reliably found at the height of the mandibular notch and, in the vast majority of cases, was suitable for tension-free coaptation with the zygomatic branch. Differences to the existing literature, however, can be seen in the length of the nerve available for nerve transposition and the frequency of its division into several branches before entering the masseter muscle. In German-speaking countries, Cross-Face Nerve Grafting (CFNG) is still the preferred method for facial reanimation surgery. However, MN transfer is also well established by now, both as an alternative and a supplement to other techniques, possibly due to its low donor site morbidity and short time to regeneration.

Schlüsselwörter

N. massetericus - N. massetericus-Transfer - Nerventransfer - Fazialisparese - Pathologie - Gesichtsreanimation

Keywords

Masseteric Nerve - Masseteric Nerve Transfer - Nerve Transfer - Facial Nerve Palsy - Facial Reanimation

Publication History

Received: 06 February 2024

Accepted: 18 March 2024

Article published online:
21 May 2024

• Literatur

• 1 Murphey AW, Clinkscales WB, Oyer SL. Masseteric Nerve Transfer for Facial Nerve Paralysis: A Systematic Review and Meta-analysis. JAMA Facial Plast Surg 2018; 20: 104-110
• 2 Pinkiewicz M, Dorobisz K, Zatoński T. A Comprehensive Approach to Facial Reanimation: A Systematic Review. J Clin Med 2022; 11
• 3 Hontanilla B, Olivas J, Cabello Á. et al. Cross-Face Nerve Grafting versus Masseteric-to-Facial Nerve Transposition for Reanimation of Incomplete Facial Paralysis: A Comparative Study Using the FACIAL CLIMA Evaluating System. Plast Reconstr Surg 2018; 142: 179E-191E
• 4 Buendia J, Loayza FR, Luis EO. et al. Functional and anatomical basis for brain plasticity in facial palsy rehabilitation using the masseteric nerve. J Plast Reconstr Aesthet Surg 2016; 69: 417-426
• 5 Urban MJ, Eggerstedt M, Varelas E. et al. Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis. Facial Plast Surg aesthetic Med 2022; 24: 10-17
• 6 Coombs CJ, Ek EW, Wu T. et al. Masseteric-facial nerve coaptation--an alternative technique for facial nerve reinnervation. J Plast Reconstr Aesthet Surg 2009; 62: 1580-1588
• 7 Borschel GH, Kawamura DH, Kasukurthi R. et al. The motor nerve to the masseter muscle: an anatomic and histomorphometric study to facilitate its use in facial reanimation. J Plast Reconstr Aesthet Surg 2012; 65: 363-366
• 8 Murphey AW, Clinkscales WB, Oyer SL. Masseteric Nerve Transfer for Facial Nerve Paralysis: A Systematic Review and Meta-analysis. JAMA Facial Plast Surg 2018; 20: 104-110
• 9 Collar RM, Byrne PJ, Boahene KDO. The subzygomatic triangle: rapid, minimally invasive identification of the masseteric nerve for facial reanimation. Plast Reconstr Surg 2013; 132: 183-188
• 10 Fournier HD, Denis F, Papon X. et al. An anatomical study of the motor distribution of the mandibular nerve for a masseteric-facial anastomosis to restore facial function. Surg Radiol Anat 1997; 19: 241-244
• 11 Brenner E, Schoeller T. Masseteric Nerve: a Possible Donor for facial Nerve Anastomosis?. Clin Anat 1998; 11: 396-400
• 12 Joo W, Yoshioka F, Funaki T. et al. Microsurgical anatomy of the trigeminal nerve. Clin Anat 2014; 27: 61-88
• 13 Mundschenk MB, Sachanandani NS, Borschel GH. et al. Motor nerve to the masseter: A pediatric anatomic study and the „3:1 rule“. J Plast Reconstr Aesthet Surg 2018; 71: 54-56
• 14 Copelli C, Manfuso A, Aragona T. et al. Anatomic landmarks for masseteric nerve identification: Anatomic study for a new reference point. J Plast Reconstr Aesthetic Surg JPRAS 2021; 74: 1101-1160
• 15 Poddar R, Bhattacharya A, Sinha I. et al. An Anatomical study for localisation of Zygomatic branch of Facial nerve and Masseteric nerve - An aid to nerve coaptation for facial reanimation surgery: A cadaver based study in Eastern India. Indian J Plast Surg Off Publ Assoc Plast Surg India 2017; 50: 74-78
• 16 Kaya B, Apaydin N, Loukas M. et al. The topographic anatomy of the masseteric nerve: A cadaveric study with an emphasis on the effective zone of botulinum toxin A injections in masseter. J Plast Reconstr Aesthet Surg 2014; 67: 1663-1668
• 17 Hontanilla B, Marré D. Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system. Plast Reconstr Surg 2012; 130: 662-672
• 18 Bianchi B, Ferri A, Ferrari S. et al. The masseteric nerve: a versatile power source in facial animation techniques. Br J Oral Maxillofac Surg 2014; 52: 264-269
• 19 Hadlock TA, Malo JS, Cheney ML. et al. Free gracilis transfer for smile in children: the Massachusetts Eye and Ear Infirmary Experience in excursion and quality-of-life changes. Arch Facial Plast Surg 2011; 13: 190-194
• 20 Eisenhardt SU, Thiele JR, Stark GB. et al. Comparison of cross face nerve graft with masseteric nerve as donor nerves for free functional muscle transfers in facial reanimation surgery. Handchirurgie, Mikrochirurgie, Plast Chir 2013; 45: 223-228
• 21 Spira M. Anastomosis of masseteric nerve to lower division of facial nerve for correction of lower facial paralysis. Preliminary report. Plast Reconstr Surg 1978; 61: 330-334
• 22 Abing H, Pick C, Steffens T. et al. Reanimation of the Smile with Neuro-Vascular Anastomosed Gracilis Muscle: A Case Series. Diagnostics (Basel, Switzerland) 2022; 12: 1282
• 23 Lenz Y, Kiefer J, Dietrich F. et al. Pre-operative masseter muscle EMG activation during smile predicts synchronicity of smile development in facial palsy patients undergoing reanimation with the masseter nerve: A prospective cohort study. J Plast Reconstr Aesthet Surg 2019; 72: 505-512
• 24 Kollar B, Weiss JBW, Kiefer J. et al. Functional Outcome of Dual Reinnervation with Cross-Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis. Plast Reconstr Surg 2023;
• 25 Morley SE. Combining an end to side nerve to masseter transfer with cross face nerve graft for functional upgrade in partial facial paralysis-an observational cohort study. J Plast Reconstr Aesthet Surg 2021; 74: 1446-1454
• 26 Bianchi B, Copelli C, Ferrari S. et al. Facial animation in children with Moebius and Moebius-like syndromes. J Pediatr Surg 2009; 44: 2236-2242
• 27 Cardenas-Mejia A, Palafox D. Facial reanimation surgery in Möbius syndrome: Experience from 76 cases from a tertiary referral hospital in Latin America. Ann Chir Plast Esthet 2018; 63: 338-342
• 28 Fisher MD, Zhang Y, Erdmann D. et al. Dissection of the masseter branch of the trigeminal nerve for facial reanimation. Plast Reconstr Surg 2013; 131: 1065-1067
• 29 Cotrufo S, Hart A, Payne AP. et al. Topographic anatomy of the nerve to masseter: an anatomical and clinical study. J Plast Reconstr Aesthet Surg 2011; 64: 1424-1429
• 30 Cheng A, Audolfsson T, Rodriguez-Lorenzo A. et al. A reliable anatomic approach for identification of the masseteric nerve. J Plast Reconstr Aesthetic Surg JPRAS 2013; 66: 1438-1440