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Relationship Of The Marginal Mandibular Nerve To The Retaining Ligaments Of The Lower Face/b>
Franziska Huettner, MD PhD, Cemile N. Ozturk, MD, Steven Rueda, MD, Can Ozturk, MD, James E. Zins, MD.
Cleveland Clinic, Cleveland, OH, USA.

PURPOSE: Although the marginal mandibular nerve (MMN) lies deep to the platysma, inadvertent violation of this thin muscle can lead to nerve injury. Previous descriptions focused mainly on proximal nerve anatomy. We attempted to clarify the distal facial anatomy and relationship of the structures, including the mandibular osseocutaneous ligament (MOCL), platysma mandibular ligament (PML), MMN, and depressor anguli oris muscle (DAO) to provide a guide for dissection in facelift surgery.
METHODS: Facial dissections were performed in 18 cadaver hemifaces. The MOCL, PML, MMN branches, DAO, and facial vessels were identified. Fixed points including the gonial angle and lower mandibular border were used to define the locations of the facial ligaments to each other and to the MMN branch in the vertical and horizontal planes respectively. 95% confidence regions were then created.
RESULTS:The MOCL was identified in all 18 cadaver hemifaces, whereas the PML was only present in 14 out of 18 cases. The mean length, width, and depth of the MOCL were 13.9, 3.7, and 5.7 mm, and 22.9, 3.7, and 6.2 mm for the PML, respectively. Within a 95% confidence interval the MOCL and PML (origins) were located 57.0 ± 3.0 and 50.2 ± 4.9 mm from the gonial angle (horizontal distance), and 9.5 ± 1.0 and 1.5 ± 1.0 mm from the lower mandibular border (vertical distance), respectively. The MOCL and PML (ends) were located 69.3 ± 3.0 and 70.9 ± 5.4 mm from the gonial angle, and 9.7 ± 1.9 and 1.3 ± 1.0 mm from the lower mandibular border, respectively. The MOCL was located on average 8.6 mm superior to the PML.The MMN had an average of 2.1 branches. The branch point locations were variable in relation to the facial vessels and to the MOCL. The course of the terminal MMN branch was always superior to the MOCL with a distance of 9.4 ± 1.4 mm, and deep to the DAO.
CONCLUSION: Inadvertent penetration of the platysma superior to the MOCL is more likely to lead to MMN injury than inferior violation. A clear understanding of the 3 dimensional anatomy of the lower face is the best strategy of minimizing facial nerve injury.


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