The Marginal Mandibular Branch Of The Facial Nerve

It is cosmetically important to preserve the marginal mandibular branch of the facial nerve. The mandibular nerve courses just deep to the superficial layer of the cervical fascia but superficial to both the anterior facial vein and artery. Identification of the nerve is time consuming and may require nerve stimulation for the novice surgeon to confirm the exact location of this thin branch of the facial nerve.

Marginal Mandibular Branch

Figure 5-7 Lateral view of the dissection of the sternocleidomastoid muscle on the right side. The fascia is incised over the posterior border of the muscle and dissected forward. The great auricular nerve has been preserved. Note the external jugular vein ligated at the posterior border of the sternocleidomastoid muscle and above the clavicle. SC, sternocleidomastoid muscle; F, fascia dissected from the sternocleidomastoid muscle; ga, great auricular nerve; ej, external jugular vein.

Figure 5-7 Lateral view of the dissection of the sternocleidomastoid muscle on the right side. The fascia is incised over the posterior border of the muscle and dissected forward. The great auricular nerve has been preserved. Note the external jugular vein ligated at the posterior border of the sternocleidomastoid muscle and above the clavicle. SC, sternocleidomastoid muscle; F, fascia dissected from the sternocleidomastoid muscle; ga, great auricular nerve; ej, external jugular vein.

It is much easier, and equally safe, to identify, ligate, and divide the anterior facial vein at the inferior border of the submandibular gland. The superior ligature, which is left long, is reflected superiorly with a hemostat (Fig. 5-8). Although the mandibular nerve is usually not seen during this maneuver, it will be automatically reflected superiorly with the skin flap, thus preventing its injury.

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