Preservation of Marginal Mandibular Nerve by Direct Visualization during Neck Dissection

Abstract

Introduction : The marginal mandibular branch of the facial nerve is frequently at risk of injury during neck dissection surgery, causing visible cosmetic deformity and functional problems to the patient. The aim of the study was to assess whether there is any difference in incidence of marginal mandibular nerve palsy, level 1b lymph node yield and operating time between patients in whom the nerve is dissected by traditional methods (Hayes Martin) and where the nerve is directly visualised and dissected.

Materials and methods: retrospective review of 45 patients (56 neck dissections) of oral cancer undergoing neck dissection as part of their surgery.

Results: patients in whom the marginal mandibular nerve is directly visualised and dissected have a statistically significant decreased incidence of post-operative marginal mandibular nerve palsy and higher level 1b lymph node yield than in patients where the nerve is protected by traditional methods, without any significant difference in operating time.

Conclusion: directly visualising the marginal mandibular nerve and dissecting it off the surgical field gives better cosmetic and functional results, as also nodal clearance, in patients undergoing neck dissection for oral cancer, without significantly increasing operating time.

Keywords:

neck dissection; oral cancer; marginal mandibular nerve; Hayes Martin method