„Anatomia e biomeccanica del nervo mandibolare marginale come fa3ori di rischio chirurgici.„ Róbert KÉSMÁRSZKY 1 , Péter NAGY 2 , Tamás MICSIK 3 , Gergely RÁCZ 3 , Liza PELYHE 4 , BeTna POGÁCSÁS 4 , Réka POTSUBAY 5 , Eszter BOGNÁR 2,6 1 Budapest University of Technology and Economics, Faculty of Mechanical Engineering, Department of Mechatronics, Op]cs and Mechanical Engineering, H-1111 Budapest, Hungary 2 IMEDIM Ltd. 3 Semmelweis University, 1 st Department of Pathology and Experimental Cancer Research, H-1085 Budapest, Hungary 4 Budapest University of Technology and Economics, Faculty of Mechanical Engineering, Department of Materials Science and Engineering, H-1111 Budapest, Hungary 5 Semmelweis University, Faculty of Medicine, H-1085 Budapest, Hungary 6 MTA–BME Research Group for Composite Science and Technology, H-1111 Budapest, Hungary 41 st Congresso Conventus Societas ORL La]na, Torino, Italy, 2016
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„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
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