The relationship of the marginal mandibular nerve to the mandibular osseocutaneous ligament and lesser ligaments of the lower face.

BACKGROUND An in-depth understanding of the nuances of facial anatomy is the best means of preventing complications during facelift surgery. An appreciation of the operative details is complicated not only by the complexity of the anatomy but also by the variability in the nomenclature used. OBJECTIVES The authors have attempted to clarify these issues by detailing the relationships of the ligaments of the lower face both to each other and to the marginal mandibular nerve. METHODS The mandibular ligament, the platysma mandibular ligament, and the marginal mandibular nerve were identified in 22 cadaver halves. The gonial angle, and the lower mandibular border were used as perpendicular reference lines. RESULTS The mean length, height, and depth of the mandibular ligament and the platysma mandibular ligament were calculated. The mean distance of the mandibular ligament from the gonial angle along the mandibular border was also noted:it was always located superior to the platysma mandibular ligament. The marginal mandibular "danger zone" was identified a quarter of the length of the mandibular body along the lower jaw border. Finally variability in nomenclature of the lower face ligaments was clarified. CONCLUSIONS A topographic map of the structures of surgical importance in the lower face was constructed in the hope that this will prevent surgical errors during facelift surgery.