Anatomosurgical study of the marginal mandibular branch of the facial nerve for submandibular surgical approach

The purpose of this study was to estimate the distance from the mandibular marginal branch of the facial nerve to the inferior margin of the mandible in order to determine the best and safest location to approach the posterior mandibular region. Forty-five hemi-faces of 27 Brazilian adult cadavers were dissected and the distance between the mandibular marginal branch and the inferior margin of the mandible was measured. The number of marginal branches and anastomoses with other branches of the facial nerve was also recorded. The evaluation of the anatomic pieces showed 1 to 3 branches of the marginal mandibular branch, anastomoses with the buccal and cervical branches of the facial nerve and distances between 1.3 cm to +1.2 cm from the inferior margin of the mandible. In 57.7% of the cases, the nerve passed superiorly and along the length of the inferior margin of the mandible. Based on the findings of the present anatomosurgical study, it may be recommended an incision 3 cm below the inferior margin of the mandible associated to a careful dissection in planes and flap retraction. This is expected to reduce the risk of neuropraxia of the marginal mandibular nerve making the submandibular incision a safe approach.