Anatomic Variations From 120 Mental Nerve Dissections: Lessons for Transoral Thyroidectomy
| Autor: | Russell Arellano, Anthony Olinger, Sarah D. King, Quan-Yang Duh, Carolyn D. Seib, Insoo Suh, Victoria Gordon |
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| Rok vydání: | 2020 |
| Předmět: |
Natural Orifice Endoscopic Surgery
Mandibular Nerve medicine.medical_treatment High variability Thyroid Gland Mandible Mental foramen 03 medical and health sciences 0302 clinical medicine Cadaver Foramen Humans Medicine Human cadaver Vestibular system business.industry Dissection Anatomic Variation Thyroidectomy Anatomy Mental nerve medicine.anatomical_structure Mandibular Nerve Injuries 030220 oncology & carcinogenesis Endoscopic thyroidectomy 030211 gastroenterology & hepatology Surgery business |
| Zdroj: | Journal of Surgical Research. 256:543-548 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2020.07.018 |
| Popis: | Background Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a promising technique for eliminating a neck incision. A new risk of TOETVA is the potential for injury to the mental nerves during placement of three oral endoscopic ports. A better understanding of the variations in mental nerve anatomy is needed to inform safer TOETVA technique. Materials and methods We performed 120 dissections of mental nerve branches exiting the mental foramen in 60 human cadavers. Anatomic distances and relationships of the foramen to the midline were evaluated. Mental nerve branching patterns were studied and compared with previously reported classification systems to determine surgical safe zones free of nerve branches. Results The mean midline-to-mental foramen distance was 29.2 ± 3.3 mm, with high variability across individuals (18.8-36.8 mm). There were differences in this distance between the left and right foramina (29.8 ± 3.2 versus 28.8 ± 3.3 mm, P = 0.03). All mental nerve branches exiting the mental foramen distributed medially. The branching patterns were classified into eight distinct categories, three of which are previously undescribed. One of these novel patterns, occurring in 9.2% of cases, had a dense and wide clustering of branches traveling toward the midline. Conclusions The location of the mental foramen and mental nerve branching patterns demonstrate high variability. To avoid mental nerve injury in TOETVA, we identify a safe zone for lateral port placement lateral to the plane of the mental foramen. Placement and extension of the middle port incision should proceed with caution, as clustering of mental nerve branches in this area can frequently be present. |
| Databáze: | OpenAIRE |
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