Anatomy and Cell Biology

Korean Association of Anatomists (대한해부학회)
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Anatomical knowledge of zygomatico-buccal plexus in a cadaveric study

  • Sukanya Uruwan (Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital) ;
  • Chalermquan Rungsawang (Preclinical Department, Faculty of Medicine, Siam University) ;
  • Tawiwan Sareebot (Department of Biomedical Engineering, College of Health Sciences, Christian University of Thailand) ;
  • Tanvaa Tansatit (Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital)
  • Received : 2023.02.07
  • Accepted : 2023.03.21
  • Published : 2023.09.30
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Abstract

The details of the facial nerve pattern were clearly explained in the parotid gland (PG), lateral area of the face, and periorbital areas to prevent the unexpected outcome of medical intervention. However, it remains unclear whether information about the zygomatico-buccal plexus (ZBP) in the masseteric and buccal regions. Therefore, this study aimed to help clinicians avoid this ZBP injury by predicting their common location. This study was conducted in forty-two hemifaces of twenty-nine embalmed cadavers by conventional dissection. The characteristics of the buccal branch (BB) and the ZBP were investigated in the mid-face region. The results presented that the BB gave 2-5 branches to emerge from the PG. According to the masseteric and buccal regions, the BB were arranged into ZBP in three patterns including an incomplete loop (11.9%), a single-loop (31.0%), and a multi-loop (57.1%). The mean distance and diameter of the medial line of the ZBP at the corner of the mouth level were 31.6 (6.7) and 1.5 (0.6) mm respectively, while at the alar base level were 22.5 (4.3) and 1.1 (0.6) mm respectively. Moreover, the angular nerve arose from the superior portion of the ZBP at the alar base level. The BB formed a multiloop mostly and showed a constant medial line of ZBP in an area approximately 30 mm lateral to the corner of the mouth, and 20 mm lateral to the alar base. Therefore, it is recommended that physicians should be very careful when performing facial rejuvenation in the mid-face region.

Keywords

Acknowledgement

We would like to express my deepest gratitude to the cadaver who sacrificed their body for medical education. This research was supported by the 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship.

References

  1. Bendella H, Spacca B, Rink S, Stoffels HJ, Nakamura M, Scaal M, Heinen H, Guntinas-Lichius O, Goldbrunner R, Grosheva M, Angelov DN. Anastomotic patterns of the facial parotid plexus (PP): a human cadaver study. Ann Anat 2017;213:52-61. 
  2. Hovland N, Phuong A, Lu GN. Anatomy of the facial nerve. Oper Tech Otolaryngol Head Neck Surg 2021;32:190-6. 
  3. Liu AT, Yu DZ, Chen G, Dang RS, Zhang YF, Zhang WJ, Liu BL, Jiang H. Profiling of innervations of mimetic muscles in fresh human cadavers using a modified Sihler's technique. Muscle Nerve 2010;42:88-94. 
  4. Al-Shaikh KMS, Mutwakil M, Ahmed M, Zaghloul S. Anatomical study of the facial nerve. World J Zool 2015;10:267-73. 
  5. Hwang K. Surgical anatomy of the lower eyelid relating to lower blepharoplasty. Anat Cell Biol 2010;43:15-24. 
  6. Kehrer A, Engelmann S, Ruewe M, Geis S, Taeger C, Kehrer M, Prantl L, Tamm E, Bleys RRLAW, Mandlik V. Anatomical study of the zygomatic and buccal branches of the facial nerve: application to facial reanimation procedures. Clin Anat 2019;32:480-8. 
  7. Jirawatnotai S, Kaewpichai K, Tirakotai W, Mothong W, Kaewsema A, Sriswadpong P. Nerve to the zygomaticus major muscle for facial reanimation surgery: a cadaveric study for branching patterns and axonal count. Asian J Neurosurg 2020;15:516-20. 
  8. Yoshioka N, Rhoton AL. Atlas of the facial nerve and its related structures. Thieme Publishers; 2015. p. 128. 
  9. Kehrer A, Engelmann S, Bauer R, Taeger C, Grechenig S, Kehrer M, Prantl L, Tamm ER, Bleys RLAW, Mandlik V. The nerve supply of zygomaticus major: variability and distinguishing zygomatic from buccal facial nerve branches. Clin Anat 2018;31:560-5. 
  10. Dorafshar AH, Borsuk DE, Bojovic B, Brown EN, Manktelow RT, Zuker RM, Rodriguez ED, Redett RJ. Surface anatomy of the middle division of the facial nerve: Zuker's point. Plast Reconstr Surg 2013;131:253-7. 
  11. Condie D, Tolkachjov SN. Facial nerve injury and repair: a practical review for cutaneous surgery. Dermatol Surg 2019;45:340-57. 
  12. Gordin E, Lee TS, Ducic Y, Arnaoutakis D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofac Trauma Reconstr 2015;8:1-13. 
  13. Dhiwakar M, Khan ZA. Sacrificing the buccal branch of the facial nerve during parotidectomy. Head Neck 2016;38:1821-5. 
  14. Lam AQ, Tran Phan Chung T, Tran Viet L, Do Quang H, Tran Van D, Fox AJ. The anatomic landmark approach to extratemporal facial nerve repair in facial trauma. Cureus 2022;14:e22787. 
  15. Stankevicius D, Suchomlinov A. Variations in facial nerve branches and anatomical landmarks for its trunk identification: a pilot cadaveric study in the Lithuanian population. Cureus 2019;11:e6100. 
  16. Alomar OSK. New classification of branching pattern of facial nerve during parotidectomy: a cross sectional study. Ann Med Surg (Lond) 2021;62:190-6. 
  17. Thuku FM, Butt F, Guthua SW, Chindia M. An anatomic study of the facial nerve trunk and branching pattern in an African population. Craniomaxillofac Trauma Reconstr Open 2018;2:e31-7. 
  18. Myint K, Azian AL, Khairul FA. The clinical significance of the branching pattern of the facial nerve in Malaysian subjects. Med J Malaysia 1992;47:114-21. 
  19. Hendi A. Transient buccal nerve paresis. Dermatol Surg 2008;34:258-60. 
  20. Kwak HH, Park HD, Youn KH, Hu KS, Koh KS, Han SH, Kim HJ. Branching patterns of the facial nerve and its communication with the auriculotemporal nerve. Surg Radiol Anat 2004;26:494-500. 
  21. Martinez Pascual P, Maranillo E, Vazquez T, Simon de Blas C, Lasso JM, Sanudo JR. Extracranial course of the facial nerve revisited. Anat Rec (Hoboken) 2019;302:599-608. 
  22. Choi Y, Kim IB. Refined concept of motor supply to the medial periorbital area relevant to periorbital surgery. Plast Reconstr Surg 2022;150:647-57. 
  23. Erbil KM, Uz A, Hayran M, Mas N, Senan S, Tuncel M. The relationship of the parotid duct to the buccal and zygomatic branches of the facial nerve; an anatomical study with parameters of clinical interest. Folia Morphol (Warsz) 2007;66:109-14. 
  24. Choi Y, Kang HG, Nam YS, Kang JG, Kim IB. Facial nerve supply to the orbicularis oculi around the lower eyelid: anatomy and its clinical implications. Plast Reconstr Surg 2017;140:261-71. 
  25. Ye P, Feng XL, Yang ZH, Li GP, Sun J, Wu HX, Chen SC. The anatomy of the temporal and zygomatic branches of the facial nerve: application to crow's feet wrinkles. J Craniofac Surg 2021;32:878-82. 
  26. Eltohami Y, Huang SF, Suleiman A. Origin of the buccal branch of facial nerve and anastomosis of the facial nerve branches. J Clin Case Stud 2019;4:1-5. 
  27. Hwang K, Cho HJ, Battuvshin D, Chung IH, Hwang SH. Interrelated buccal fat pad with facial buccal branches and parotid duct. J Craniofac Surg 2005;16:658-60. 
  28. Farahvash MR, Yaghoobi A, Farahvash B, Farahvash Y, Hadadi Abiyaneh S. The extratemporal facial nerve and its branches: analysis of 42 hemifacial dissections in fresh Persian (Iranian) cadavers. Aesthet Surg J 2013;33:201-8. 
  29. Tsai CH, Ting CC, Wu SY, Chiu JY, Chen H, Igawa K, Lan TH, Chen CM, Takato T, Hoshi K, Ko EC. Clinical significance of buccal branches of the facial nerve and their relationship with the emergence of Stensen's duct: an anatomical study on adult Taiwanese cadavers. J Craniomaxillofac Surg 2019;47:1809-18. 
  30. Sun Y, Liu L, Han Y, Xu L, Zhang D, Wang H. The role of great auricular-facial nerve neurorrhaphy in facial nerve damage. Int J Clin Exp Med 2015;8:12970-6. 
  31. Halepas S, Chen XJ, Ferneini EM. Thread-lift sutures: anatomy, technique, and review of current literature. J Oral Maxillofac Surg 2020;78:813-20. 
  32. Tsai YT, Zhang Y, Wu Y, Yang HH, Chen L, Huang PP, Wang CH. The surgical anatomy and the deep plane thread lift of the buccal fat pad. Plast Reconstr Surg Glob Open 2020;8:e2839.