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. 2020 Nov;130(11):2708-2713.
doi: 10.1002/lary.28500. Epub 2020 Jan 11.

Facial Nerve Branching Patterns Vary With Vascular Anomalies

Lingga Adidharma  1 , Randall A Bly  2   3 , Hailey A Theeuwen  1 , Robert N Holdefer  4 , Jefferson Slimp  4 , Greg A Kinney  4 , Vicente Martinez  4 , Kathryn B Whitlock  2 , Jonathan A Perkins  2   3
Affiliations

Facial Nerve Branching Patterns Vary With Vascular Anomalies

Lingga Adidharma et al. Laryngoscope. 2020 Nov.

Abstract

Objectives: At our institution, in vivo facial nerve mapping (FNM) is used during vascular anomaly (VAN) surgeries involving the facial nerve (FN) to create an FN map and prevent injury. During mapping, FN anatomy seemed to vary with VAN type. This study aimed to characterize FN branching patterns compared to published FN anatomy and VAN type.

Study design: Retrospective study of surgically relevant facial nerve anatomy.

Methods: VAN patients (n = 67) with FN mapping between 2005 and 2018 were identified. Results included VAN type, FN relationship to VAN, FNM image with branch pattern, and surgical approach. A Fisher exact test compared FN relationships and surgical approach between VAN pathology, and FN branching types to published anatomical studies. MATLAB quantified FN branching with Euclidean distances and angles. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) analyzed quantitative FN patterns amongst VAN types.

Results: VANs included were hemangioma, venous malformation, lymphatic malformation, and arteriovenous malformation (n = 17, 13, 25, and 3, respectively). VAN FN patterns differed from described FN anatomy (P < .001). PCA and HCA in MATLAB-quantified FN branching demonstrated no patterns associated with VAN pathology (P = .80 and P = .91, one-way analysis of variance for principle component 1 (PC1) and priniciple component 2 (PC2), respectively). FN branches were usually adherent to hemangioma or venous malformation as compared to coursing through lymphatic malformation (both P = .01, Fisher exact).

Conclusions: FN branching patterns identified through electrical stimulation differ from cadaveric dissection determined FN anatomy. This reflects the high sensitivity of neurophysiologic testing in detecting small distal FN branches. Elongated FN branches traveling through lymphatic malformation may be related to abnormal nerve patterning in these malformations.

Level of evidence: NA Laryngoscope, 130:2708-2713, 2020.

Keywords: Anatomy, facial plastic surgery, facial nerve mapping, vascular anomaly, electroneurophysiology.

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References

BIBLIOGRAPHY

    1. Lowry TR, Gal TJ, Brennan JA. Patterns of use of facial nerve monitoring during parotid gland surgery. Otolaryngol Head Neck Surg 2005;133:313-318.
    1. Sood AJ, Houlton JJ, Nguyen SA, Gillespie MB. Facial nerve monitoring during parotidectomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015;152:631-637.
    1. Bly RA, Holdefer RN, Slimp J, et al. Preoperative facial nerve mapping to plan and guide pediatric facial vascular anomaly resection. JAMA Otolaryngol Head Neck Surg 2018;144:418-426.
    1. International Society for the Study of Vascular Anomalies. ISSVA classification for vascular anomalies. Overview table. Vascular anomalies. Vascular tumors ISSVA classification of vascular tumors. Available at: https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf. Published April 2014. Updated May 2018.
    1. Sadick M, Wohlgemuth WA, Huelse R, et al. Interdisciplinary management of head and neck vascular anomalies: clinical presentation, diagnostic findings and minimal invasive therapies. Eur J Radiol Open 2017;4:63-68.

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