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

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