High variability of facial muscle innervation by facial nerve branches : a prospective electrostimulation study

  • Objectives: To establish the anatomical variations of the extratemporal part of the facial nerve and to bridge the gap in knowledge between anatomy and physiology through systematic stimulation of the exposed facial nerve and its branches during parotidectomy to evaluate the alignment of the branches to functionally important facial movements.
  • Study Design: Single-center prospective observational clinical study. Methods: Seven patients whose peripheral FN branching was exposed during parotidectomy under FN monitoring received a systematic electrostimulation of each branch starting with 0.1 mA and stepwise increase to 2 mA with a frequency of 3 Hz. The electrostimulation and the facial movements were video recorded simultaneously and evaluated independently offline by two investigators.
  • Results: Frontal and eye region were exclusively supplied by the temporofacial division while Mouth and the neck region were exclusively supplied by the cervicofacial division. The nose and zygomatic region showed Functional overlap. A Uniform functional allocation of specific peripheral facial nerve branches to a specific mimic movement was not possible
  • Conclusions: Anatomical and functional high variability is a common phenomenon of peripheral facial nerve., 2-channel or even 4-channel monitoring during parotid surgery might be not reliable., Future bionic devices to restore facial nerve function needs further specification.

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