Vascular and Nerve Relations of the Marginal Mandibular Nerve of the Face: Anatomy and Clinical Relevance.

BACKGROUND: The marginal mandibular nerve of the facial nerve is frequently injured during corrective and cosmetic surgery. Recent or emerging techniques such as the injection of filler materials, botulinum toxin, allotransplantation of composite tissues of the face, placement of chin implants, and submental cryolipolysis require in-depth knowledge of this nerve. The studies to date are not in agreement regarding the number of branches of the marginal mandibular nerve and its relationship with the vasculature and other nerves. METHODS: This study involved 62 half-heads from cadavers. RESULTS: In 22.6 percent of the cases, the marginal mandibular nerve of the facial nerve was a single branched entity and lateral to the pedicle, with respect to the facial artery and the facial vein. In 16 cases (29 percent), the marginal mandibular nerve had two branches. In 12.9 percent of the cases, the marginal mandibular nerve gave rise to three branches. In 17 cases (35.48 percent), the marginal mandibular nerve gave rise to between four and more than 10 branches, thereby forming a plexus at its end. Analysis of this collection of cases revealed that the marginal mandibular nerve was more consistently lateral to the facial vein than to the facial artery. The marginal mandibular nerve exhibited connections with other branches of the facial nerve and branches of the trigeminal nerve. CONCLUSIONS: The facial vein had a more consistent relationship with the marginal mandibular nerve than the facial artery. This study provides the anatomical bases of substitution, proprioception, and clinical variations in injuries of the marginal mandibular nerve and in their prognosis.

Breast implant infections after surgical reconstruction in patients with breast cancer: assessment of risk factors and pathogens over extended post-operative observation.

BACKGROUND: Infection is a severe potential complication of breast implant positioning in women with cancer. There still is some degree of uncertainty regarding optimal antibiotic prophylaxis regimens, infecting pathogens, and risk factors associated with infection during long-term followup of these patients. METHODS: We performed a systematic clinical review to assess infecting microorganisms and risk factors among patients undergoing reconstructive procedures for breast cancer between January 2005 and February 2007. A randomly selected group of infection-free patients treated over the same time span was considered as a control. RESULTS: Among 240 women undergoing implant procedures performed and followed up as outpatients, 16 patients with prosthetic infections were observed (infection rate 6.7%). Infection was recorded within six months from surgery in 94% of the cases, with an overall mean time to infection of 95 days. The time interval between surgery and infection did not support a diagnosis of hospital-acquired infection in most cases. Gram-negative microorganisms were identified in seven cases. A higher proportion of patients with implant infection underwent radiotherapy or chemotherapy after surgery for advanced tumors compared with the control patients without infection. CONCLUSIONS: Extended post-operative surveillance is indicated, at least for the first six months after breast implant placement, particularly for women who need radiotherapy or chemotherapy after implant surgery. Gram-negative bacilli may be involved more often in late infections than otherwise expected. This finding may influence initial empiric antibiotic treatment.

Factors affecting symmetrization of the contralateral breast: a 7-year unilateral postmastectomy breast reconstruction experience.

Although a number of studies compare different techniques of breast reconstruction, information documenting the factors that affect breast symmetry after unilateral mastectomy and reconstruction seems to be scarce. A statistical analysis of 606 patients undergoing unilateral mastectomy and breast reconstruction performed during a 7 year period was undertaken in an endeavor to identify these factors. Patients were classified according to time of reconstruction, method of reconstruction, type of implant, and mastectomy type. Contralateral procedures included mastopexy, augmentation, and reduction mammaplasty. Delayed reconstruction more frequently required a symmetrization than an immediate reconstruction. The percentage of contralateral procedures was higher for implant reconstructions than for autologous reconstructions, and the type of mastectomy was significantly associated with the symmetrization procedure. The findings showed that non-skin-sparing mastectomy (non-SSM) needed symmetrization surgery more frequently than did SSM procedures. The data suggest a preoperative collaboration and case study between oncologic and plastic surgeons to apply, when possible, SSM with immediate implant breast reconstruction, resulting in fewer symmetrization procedures and the best aesthetic follow-up result. These factors need to be considered when mastectomy and reconstruction are planned in order to optimize the aesthetic result together with the development of breast surgery specialty units.