title: Relationship between facial nerve damage and transbuccal trocar placement: an anatomical cohort study.
abstract: The surgical treatment of ramus and mandibular angle fractures is typically performed by intraoral and transbuccal approaches. As these approaches may result in nerve damage, this anatomical study was performed to establish the relationship between the transbuccal trocar position and the likelihood of inducing facial nerve damage. Twenty dissections of the parotid regions were performed after a simulation of surgical approaches aimed at addressing mandibular condylar and angle fractures. Two trocar tubes, ramic and angular, were inserted and left in position throughout the dissection. This procedure allowed the qualitative relationship between the various tube positions and facial nerve damage to be analyzed. The potential risk of contact between the ramic trocar and the facial nerve branches was 90%, while the angular trocar was in contact in 45% of cases. There was no contact with the trunk, cervicofacial division, or temporofacial division of the facial nerve. The contacts occurred at the level of secondary division branches, particularly pronounced for superior and inferior buccal branches, despite the absence of macroscopically visible trauma. Based on these findings, it is proposed that trocars should be used in procedures aimed at addressing subcondylar or angle fractures of the mandible.
authors.affiliation: Department of Maxillofacial Surgery, Purpan Hospital, Toulouse, France; Laboratory of Anatomy Purpan, Faculty of Medicine, Toulouse, France.
authors.forename: B
authors.initials: B
authors.lastname: Lerhe
authors.affiliation: Department of Otolaryngology, King Khalid University College of Medicine, Saudi Arabia.
authors.forename: S
authors.initials: S
authors.lastname: Alshehri
authors.affiliation: Department of Maxillofacial Surgery, Purpan Hospital, Toulouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Delanoe
authors.affiliation: Department of Maxillofacial Surgery, Purpan Hospital, Toulouse, France; Laboratory of Anatomy Purpan, Faculty of Medicine, Toulouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Lauwers
authors.affiliation: Department of Maxillofacial Surgery, Purpan Hospital, Toulouse, France; Laboratory of Anatomy Purpan, Faculty of Medicine, Toulouse, France. Electronic address: lopez.r@chu-toulouse.fr.
authors.forename: R
authors.initials: R
authors.lastname: Lopez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D002102:Cadaver; D005154:Facial Nerve / Q000033:anatomy & histology*; D020220:Facial Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D008875:Middle Aged
keywords: facial nerve; mandibular fracture; osteosynthesis; trocar