MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE
108 INSTITUTE OF CLINICAL MEDICAL AND
PHARMACEUTICAL SCIENCES
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BUI MAI ANH
ANATOMICAL RESEARCH AND CLINICAL
APPLICATIONS OF MASSETER NERVE IN INTERMEDIATE
DURATION FACIAL PARALYSIS TREATMENT
Speciality: Odonto-Stomatology
Code: 62720601
ABSTRACT OF MEDICAL PHD THESIS
Hanoi – 2019
Thesis is completed at:
108 INSTITUTE OF CLINICAL MEDICAL AND
PHARMACEUTICAL SCIENCES
Supervisor:
1. Prof.PhD. Nguyen Tai Son
Reviewer:
1.
The thesis will be defended infront of the Institute-level Council of Thesis
Assessment met at:108 Institute of Clinical Medical and Pharmaceutical
Sciences at ...... h .......in 2019
The thesis can be found at:
1. National Library of Vietnam
2. Library of 108 Institute of Clinical Medical and Pharmaceutical Sciences
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INTRODUCTION
The injury of the nerve VII due to various causes makes paralysis of
facial muscles. The functions of facial muscles play an important role in
communication. The injury of the nerve VII also causes some functional
effects such as eye protection function. There are many studies offering
different methods of surgey to reduce facial deformity, but each method of
surgery is effective only on each patient and donor nerve that was intervened
by surgery .
Facial nerve injury at an early stage of less than 2 years has the ability
to be restored by direct surgical intervention. However, the use of adjacent
nerves only resolves the problem of active facial vibrations and is not identical
to the healthy half-face.
Facial nerve graft has been studied by many authors for a long time.
However, this method is still limited. Masseteric nerve surgery is used to
replace the old method with positive results.
In Vietnam, surgery for facial paralysis treatment has been carried out for a
long time. However, there has not been any study on surgery and applications
of masseteric nerve in a systematic way, so we conduct research on the topic
”Anatomical research and clinical applications of masseter nerve in
intermediate duration facial paralysis treatment” for the following
purposes:
1. Course of masseteric nerve anatomy.
2. Evaluate results of the applications of masseteric nerve in surgical
treatment of intermediate durationfacial paralysis.
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Chapter 1
OVERVIEW
1.1. Masseteric nerve
The nerve that regulates masseter musclemovement is called
masseteric nerve (MN), a branch from the anterior trunk of mandibular nerve.
- Branching: According to some studies, MN has branching in some
cases.
- Location: According to Kun Hwang, MN is located at 33 ± 5.6 mm
from the lower limit of masseter muscleon the longitudinal line 1/3 before the
masseter muscle and 47 ± 5.5 mm from the lower limit on the vertical line 1/3
after.
- Microscopic anatomy: Through microscopic anatomical results, it
can be seen that the number of MN axons is much larger than other nerves,
which is one of the good conditions for recovering nerve transmission when it
is used as a source.
1.2. Surgical methods to restore facial muscles by the time of paralysis
1.2.1. Acute facial paralysis (paralysis time <3 weeks)
- Purpose: release pressure for the nerve VII or nervous joint, transplantation
to restore function of facial muscles.
- Methods:
+ Direct neuronal joint: apply to all cases of the nerve broken for injury,
surgery with condition of 2 nerve endings after the excision with organization
defect under 1cm
+ One-sidedness facial nerve segmentation graft: apply when injured nerve
deficiency is 1cm or more.
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1.2.2. Intermediate durationfacial paralysis (from 3 weeks to 2 years)
- Methods: Surgery for one-sidedness facial nerve graftor nervous graft
through the circuit.
- Facial nerve transition: The nerve often used is: nerve XII, masseteric nerve.
Transfer of nerves XII-VII: usually joined at the end - on the side and joined
to the main body of the nerve VII. Transfer of masseteric nerve – branch of
the nerve VII mouth on the side of the paralysis: usually linked to the end of
microsurgery of the MN branch and the nerve VII mouth branche.
1.2.3. Chronic facial paralysis(> 2 years)
- Methods:
+ Local muscle transfer surgery: the muscle often used is a temporal muscle
with the condition that the trigeminal nerve is not injured.
+ Micro-surgical transfer surgery: in cases where the transfer of local muscles
is difficult or has not the desired results, the free muscle transfer is a good
choice. Free muscles are commonly used: slim muscles, large back muscles,
small chest muscles, and muscles in form of big toe.
1.3. Situation of applications of masseteric nerve in facial paralysis
treatment
1.3.1. Masseteric nerve transfer in intermediate durationfacial paralysis
treatment (<2 years)
Intermediate durationfacial paralysishas the ability to restore the nerve
VII transmission to recover the movement of the muscles clinging to face skin,
it is very positive because at this time the muscles clinging to face skin is not
degenerated, not atrophied.
With studies using nervous sources to recover the nerve VII
transmission from MN, many reports show very positive results even up to 24