Monday, April 9, 2007

The nerve to the mylohyoid as a donor for facial nerve reanimation procedures: a cadaveric feasibility study

(J Neurosurg 106:677–679, 2007)



Coordinator said...

The authors report a starightforward anatomical study examining the feasibility of using the mylohyoid branch of the trigeminal nerve as a transfer for facial nerve reinnervation. They found this nerve to be an acceptable donor to the facial nerve and/or one of its divisions.

Common alternatives when the proximal stump of the facial nerve is not available include the hypoglossal nerve, cervical plexus, and branch to the masseter(trigeminal nerve).

Why would one preferably opt for the mylogyoid branch? The authors discuss that the masseteric branch or hypoglossal nerve are not optimal donors because they may cause unwanted facial movements during chewing or speaking. It is uncertain if similar co-contractions after mylohyoid nerve transfer will also occur, speciifcally when the jaw is depressed. They also discuss that with hypoglossal and masseteric transfers the jaw either needs to clenched (masseter) or tongue pressed to the side of the mouth (hypoglossal) to initiate a smile. This often true, however, are these initiation movements worse then potentially having to depress the jaw to smile, which may look more awkward? Finally, the mylohyoid branch was quoted to have about 2000 myelinated axons, while the facial has about 7000. Is this enough? Probably considering it is a "pure" motor nerve, however, properly coapting this much smaller nerve to the parent facial may be difficult. The mylohyoid branch may be more appropriate for selective reinnervation of facial nerve divisions.

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