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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 516-520
DOI: 10.4103/ajns.AJNS_90_20
Original Article

Nerve to the zygomaticus major muscle for facial reanimation surgery: A cadaveric study for branching patterns and axonal count

Supasid Jirawatnotai
Department of Surgery, Plastic and Reconstructive Surgery Unit, Lerdsin Hospital, Bangkok
,
Kitipong Kaewpichai
Department of Surgery, Plastic and Reconstructive Surgery Unit, Lerdsin Hospital, Bangkok
,
Wuttipong Tirakotai
1   Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Wilaiwan Mothong
2   Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen
,
Atitaya Kaewsema
3   Department of Anatomy, Peripheral Nerve Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok
,
Papat Sriswadpong
Department of Surgery, Plastic and Reconstructive Surgery Unit, Lerdsin Hospital, Bangkok
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Background: In facial reanimation surgery, higher donor facial nerve axonal load yields a superior outcome. Nerves supplying the zygomaticus major muscle are primary donors for the grafting procedure; however, their topography has not been studied in detail. This study identified potential donor nerves by quantifying axon loads of the zygomaticus major muscle through histological analysis of cadaveric specimens. Materials and Methods: Forty-three hemifaces from 26 fresh human cadavers were studied. Branching patterns of nerves were classified according to their shapes. All branches of interest were sectioned and stained for an axon count. The potential donors were mapped into each tributary of nerves supplying the zygomaticus major. Results: Branching patterns were categorized into five types: Y-type (28%), X-type (28%), H-type (19%), E-type (14%), and F-type (11%). The mean number of axons in the most superiorly and proximally located main branches was 1387.33 ± 406.59 in Y-type, 1021.42 ± 187.79 in X-type, 1222.75 ± 193.82 in H-type, 1496.17 ± 364.567 in E-type, and 1353.40 ± 256.07 in F-type (P > 0.05). A topographic relation between facial nerves supplying the zygomaticus major muscle and their mean axonal load was illustrated. The zygomatic/buccal branches were found within 5 mm from Zuker's point in 100% of X-, Y-, H-, and E-type and 75% of F-type specimens. Conclusions: Most proximal facial nerve branches supplying the zygomaticus major, arising at the anterior border of a parotid gland, contained over 900 axons in all five branching types. The primary subbranches may be used in selected cases if donor weakness is a concern. Further, our study provides evidence that demonstrates the precision of Zuker's point.

Key-words:

Axons - facial nerve - nerve grafting - zygomaticus major

Financial support and sponsorship

Nil.




Publication History

Received: 15 March 2020

Accepted: 12 May 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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