The nerve to the mylohyoid as a donor for facial nerve reanimation procedures: a cadaveric feasibility study

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Facial nerve injury with resultant facial muscle paralysis is disfiguring and disabling. Reanimation of the facial nerve has been performed using different regional nerves. The nerve to the mylohyoid has not been previously explored as a donor nerve for facial nerve reanimation procedures.


Five fresh adult human cadavers (10 sides) were dissected to identify an additional nerve donor candidate for facial nerve neurotization. Using a curvilinear cervicofacial skin incision, the nerve to the mylohyoid and facial nerve were identified. The nerve to the mylohyoid was transected at its point of entrance into the anterior belly of the digastric muscle. Measurements were made of the length and diameter of the nerve to the mylohyoid, and this nerve was repositioned superiorly to the various temporofacial and cervicofacial parts of the extracranial branches of the facial nerve.

All specimens had a nerve to the mylohyoid. The mean length of this nerve available inferior to the mandible was 5.5 cm and the mean diameter was 1 mm. In all specimens, the nerve to the mylohyoid reached the facial nerve stem and the temporofacial and cervicofacial trunks without tension. No gross evidence of injury to surrounding neurovascular structures was identified.


To the authors' knowledge, the use of the nerve to the mylohyoid for facial nerve reanimation has not been explored previously. Based on the results of this cadaveric study, the use of the nerve to the mylohyoid may be considered for facial nerve reanimation procedures.

Abbreviation used in this paper:V3 = mandibular division of the trigeminal nerve.

Article Information

Address reprint requests to: R. Shane Tubbs, Ph.D., Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South ACC 400, Birmingham, Alabama 35233. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Photographs showing the stages of the dissection procedure on the left side in a cadaver. Note the left ear for reference. A: Cadaveric neck and face region showing the initial skin incision and dissection to the platysma for access to the facial nerve and nerve to the mylohyoid. B: Deeper dissection demonstrating the exposed facial nerve (the parotid gland has been removed) and laterally retracted submandibular gland. C: Further dissection of the facial nerve and nerve to the mylohyoid (M). These nerves have been colored for clarity. The proximal nerve to the mylohyoid is crossed anteriorly by the facial vein and artery as it travels approximately midway between the mandible and submandibular gland (S). Observe the large parotid duct (P) crossing horizontally with branches of the facial nerve in the middle of the photograph.

  • View in gallery

    Photograph and illustrations of the relocation of the nerve to the mylohyoid. A: Cadaveric neck and face region from Fig. 1C after the dissection and relocation of the nerve to the mylohyoid (M) to the more superiorly placed facial nerve. B: Schematic drawing indicating the relocation (arrow) of the nerve to the mylohyoid (yellow circle) to the branches of the facial nerve (red circle). C: Schematic drawing from Fig. 2B with additions showing a proposed skin incision (dotted line) and the proximity of other nerves commonly used for facial nerve reanimation procedures. The hypoglossal nerve is seen interposed between the mylohyoid and hyoglossus muscles (deep to the nerve to the mylohyoid), and the spinal accessory nerve is seen entering the deep surface of the sternocleidomastoid muscle.



Adour KKKlein JCBell DN: Trigeminal neurotization of paralyzed facial musculature. Modification of the Lexer-Rosenthal surgical procedure. Arch Otolaryngol 105:13161979


Asaoka KSawamura YNagashima MFukushima T: Surgical anatomy for direct hypoglossal-facial nerve side-to-end “anastomosis. J Neurosurg 91:2682751999


DeLacure MDSasaki CTPetcu LG: Spontaneous trigeminal-facial reinnervation. Arch Otolaryngol Head Neck Surg 116:107910811990


Fournier HDDenis FPapon XHentati NMercier P: An anatomical study of the motor distribution of the mandibular nerve for a masseteric-facial anastomosis to restore facial function. Surg Radiol Anat 19:2412441997


Frommer JMele FAMonroe CW: The possible role of the mylo-hyoid nerve in mandibular posterior teeth sensation. J Am Dent Assoc 85:1131171972


Frydman WLHeffez LBJordan SLJacob A: Facial muscle reanimation using the trigeminal motor nerve: an experimental study in the rabbit. J Oral Maxillofac Surg 48:129413041990


Hoffman WY: Reanimation of the paralyzed face. Otolaryngol Clin North Am 25:6496671992


Lifchez SDMatloub HSGosain AK: Cortical adaptation to restoration of smiling after free muscle transfer innervated by the nerve to the masseter. Plast Reconstr Surg 115:147214822005


Parnes SMStromenger NSilver SGoldstein JC: Alternate innervations of facial musculature. Arch Otolaryngol 108:4184211982


Spira M: Anastomosis of masseteric nerve to lower division of facial nerve for correction of lower facial paralysis. Preliminary report. Plastic Reconstr Surg 61:330334


Tan ST: Anterior belly of digastric muscle transfer: a useful technique in head and neck surgery. Head Neck 24:9479542002


Woodburne RTBurkel WE: Essentials of Human Anatomy ed 8New YorkOxford University Press1988


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