The platysma is a superficial muscle located in the neck overlapping the sternocleidomastoid muscle. It is innervated by the cervical branch of facial nerve. The platysma is a potential candidate for use in free muscle transfer for facial reanimation around the eye due to its lack of muscle bulk. It has been used extensively in intraoral reconstruction. The purpose of this study is to demonstrate the possibility of using platysma free flap through detailing the precise neurovasculature of the platysma in relation to two bony landmarks: the mental protuberance and the angle of the mandible. Measurements were done using calipers to measure the shortest distance from the edge of the insertion of each vessel or nerve to the mark of the mental protuberance or angle of the mandible on the platysma. Measurements were taken to 6 old male German cadavers, 4 Caucasian from Umm Al-Qura University, Saudi Arabia and 20 cadavers' specimens and jars from Human Anatomy and Embryology department, Zagazig University. Our results show there are close proximity to the cervical branch of the facial nerve and the blood vessels of platysma would be attached to the superficial temporal branches and the nerve of platysma attached to an ipsilateral branch of the facial nerve.
Keywords: Platysma; Neurovasculature; Facial Nerve; Muscle Transfer; Mandible.
The authors extend their sincere thanks and appreciation to the Deanship of Scientific Research and Graduate Studies at Umm Al-Qura University for funding this work through a research project under approval number (HAPO-02-K-012-2026-04-3322).
Ethics approval: Approval was taken from Umm Al-Qura University, Saudi Arabia (HAPO-02-K-012-2026-04-3322) and Zagazig University, Egypt.
Conflict of interest: None.
The platysma is a superficial muscle in the neck that covers the sternocleidomastoid muscle. It has its origin at the pectoral and deltoid muscles and has an insertion point on the clavicle and at the end of the mouth and lower region of the cheek [1]. It is innervated by the cervical branch of facial nerve. The role of the platysma muscle is to draw down and laterally the corner of the mouth and to open the mouth to a certain extent. Platysma receives a number of arteries as a blood supply. Above the muscle is supplied by the submental branch of the facial artery and below by a branch of the transverse cervical artery. Branches of the superior thyroid artery supply the muscle anteriorly and the posterior cervical triangle supply with the branches of the occipital and posterior auricular arteries [2]. Venous drainage is accomplished through the external jugular vein which is usually located at the posterior part of the muscle [1]. In addition the anterior jugular veins, submental vein and anterior communicating veins also contribute to the venous drainage [3].
The platysma muscle is of a great importance in research due to its role in facial reanimation of people with facial paralysis. Facial paralysis is weakness of the facial muscles as a result of dysfunctional or damaged facial nerve and the most common type is Bell's palsy brought about most likely by a viral infection. Past literature has demonstrated that platysma muscle has been utilized in cheek, parotid, ear [4], tracheoesophageal reconstruction and intra-oral reconstruction. The methods of reanimation can be divided into the static and dynamic ones. The enhancement of the face symmetry is done by the aid of facial soft tissue suspension (static technique) and cross transfer of the facial nerve (primary neurorrhaphy of the facial nerve), nerve transfer, cross facial nerve grafting and muscle transfer [5]. However, only dynamic techniques provide a functional outcome. Plastic surgery around the orbit is still a challenge to facial reanimation. Previously temporalis was used for dynamic eyelid animation and it was found to provide increased tone of the eyelid but it failed to improve blinking [6]. The other non-invasive methods including the upper eyelid weight loading offered passive lid closure that results in corneal protection. But there is no restoration of blinking. Thus, scientists suggest the platysma muscle as a potential candidate of facial reanimation around the orbit of the eye. The platysma is the best suited as it can be replaced by like tissue with like tissue, it matches well in terms of facial colour and is made of thin layer of muscle [7]. This study attempts to explore the neurovasculature of the platysma, and determine whether there exist a window of the platysma that can be utilized in facial reanimation.
Facial paralysis is treated by carrying out facial reanimation procedures. Facial paralysis is an impairment of voluntary motor activity of any of the structures supplied by cranial nerve VII, the facial nerve. The resultant weakness of the musculature of the face impacts verbal communication and oral competence, as well as protection of the cornea, ocular globe and vision [8]. The aetiology of facial paralysis has a number of causes such as congenital facial paralysis (e.g. Moebius syndrome), inflammatory diseases (e.g. Bell's Palsy), traumatic (e.g. iatrogenic damage during parotidectomy), tumours (e.g. Acoustic neuromas) and neuromuscular diseases (e.g. Myasthenia Gravis). The most common acquired facial paralysis is the inflammatory disease, Bell's palsy, a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. The palsy is believed to have the potential to be caused by herpes simplex virus infection and is caused by inflammation of the facial nerve [9].
Facial reanimation has the potential to enhance facial symmetry, oral competence, eye closure and regain voluntary facial movements. Reanimation techniques can be divided into static and dynamic. The soft tissues of the face are held in a static position to create facial symmetry, correct lagophthalmos and decrease the lower lid laxity [10]. Dynamic techniques, unlike the non-dynamic techniques, offer a functional result. Primary neurorrhaphy of the facial nerve, nerve transfer, cross facial nerve grafting and muscle transfer (regional or free transfer) are dynamic reanimation techniques [5]. Although primary neurorrhaphy is the most effective in this case it is not always feasible e.g. in the case of tumour excision, proximal nerve stump removed, or the distal motor plates atrophied. In such cases, it is possible to use muscle transfers. This may be either in the form of regional muscle or free muscle transfer. There are a number of regional muscle transfers, which can be done and result in immediate reanimation [11]. Although there are techniques, like temporalis transfer, to reanimate the mouth and generate a voluntary smile [12]. There are relatively few techniques to reanimate the area around the eye other than some form of static reanimation like weight loading on the upper eyelid. Weight loading of upper eyelid offers passive lift closure and is used in early stages to offer corneal protection to prevent complication like blindness [13]. Although these non-contact methods defend the eye against the aftermaths of facial paralysis, it fails to give a functional result and bring back the blinking of the eye. A variety of other muscles have been used as free muscle transfer since the original description of the first facial paralysis transfer using the gracilis muscle by Harii in 1976 [14]. The most frequent is the gracilis muscle, pectoralis minor and latissimus dorsi.
PK Nu],fA OEBPS/s2-methods.xhtmlBefore the beginning of the study, an approval was taken from Umm Al-Qura University, Saudi Arabia carrying the following number (HAPO-02-K-012-2026-04-3322). In addition, an approval was taken to use 20 cadavers' specimens and jars from Human Anatomy and Embryology department, Zagazig University, Egypt for study the external features of the platysma and its neurovascular supply.
The platysma was dissected from total 6 old male German cadavers of ages 84 and 88 with no craniofacial abnormalities. The cadavers were placed in the supine position with the head facing forwards. Both sides were dissected starting with an incision along the midline of the neck, from the mental protuberance to the suprasternal notch. Then, a horizontal incision was made from the mental protuberance following the line of the mandible and finishing behind the lobule. Subsequently, another horizontal incision was made from the suprasternal notch to the acromioclavicular notch, remaining superior to the clavicle. The skin was then reflected posteriorly to reveal the platysma muscle. Next, the platysma was dissected starting from the midline and moving laterally.
The platysma was also dissected from the remaining 4 Caucasian old cadavers (mean age at death: 84; range 68-92; 2 females, 2 males; with no craniofacial abnormalities). Both sides of the cadaver were used and dissected in the supine position with the head facing forwards. An incision to the depth of platysma was made along the midline of the neck, from the mental protuberance to the suprasternal notch. A horizontal incision was made from the mental protuberance to pass to the angle of the mandible and finish behind the lobule, remaining superior to the mandible. A further horizontal incision was made from the suprasternal notch to the acromioclavicular joint, remaining superior to the clavicle. A skin flap was created in the posterior direction to expose the platysma beneath. Dissection of the platysma then began at the midline moving laterally. At the most superior edge a portion of fascia if necessary was dissected with the platysma to allow for marking of the mental protuberance and angle of the mandible. An incision was made on the platysma at the mental protuberance and the angle of the mandible through which a thread was tied to mark these points for future measuring. The mental protuberance was identified as the depressed centre on either side of the mental tubercles at the midline of the mandible. The measured point on the angle of the mandible was defined as the most inferior and posterior palpable bony edge felt at the angle of the mandible. The inferior border of the platysma was identified and cut by its connection with the clavicle and surrounding fascia. During reflection of the platysma if a structure was suspected of being a blood vessel or nerve, a coloured thread was attached to either end prior to dissecting the structure so as to allow for vessel tracing and correct identification of the branch's origin to later occur. Following removal of the platysma, calipers were used to measure the shortest distance from the edge of the insertion of each vessel or nerve to the mark of the mental protuberance or angle of the mandible on the platysma. Measurements were also taken to record the distance of the nerve to surrounding vessels.
During dissection, incisions were made to mark the point of the angle of the mandible (A) and the mental protuberance (B). On this specimen the cervical branch of the facial nerve can be seen at point 1. Point 2 marks the closest venous tributary, a tributary to the facial vein, and point 3 marks the closest arterial branch, a branch of the facial artery (Plate 2, Figs. A-D). Following removal of the platysma, calipers were used to measure the shortest distance from the edge of the insertion of each vessel or nerve to the mark of the mental protuberance or angle of the mandible on the platysma. In all instances the nerve supply arose from the cervical branch of the facial nerve. In two specimens the nerve branched prior to entry. In these instances, the largest nerve was taken to be the dominant nerve and used for measurements. In one platysma specimen (Cadaver 7, left side) the suspected nerve was not identified during dissection. The specimen was as such invalidated and removed from the results.
| Cadaver number | Nerve Branch | Angle of Mandible (mm) | Mental Protuberance (mm) |
|---|---|---|---|
| Cadaver 1, Right | Cervical branch of the facial nerve | 11 | 70 |
| Cadaver 1, Left | Cervical branch of the facial nerve | 14 | 67 |
| Cadaver 2, Right | Cervical branch of the facial nerve | 14 | 76 |
| Cadaver 2, Left | Cervical branch of the facial nerve | 12 | 77 |
| Cadaver 3, Right | Cervical branch of the facial nerve | 17 | 83 |
| Cadaver 3, Left | Cervical branch of the facial nerve | 11 | 88 |
| Cadaver 4, Right | Cervical branch of the facial nerve | 9 | 80 |
| Cadaver 4, Left | Cervical branch of the facial nerve | 13 | 70 |
| Cadaver 5, Right | Cervical branch of the facial nerve | 16 | 79 |
| Cadaver 5, Left | Cervical branch of the facial nerve | 14 | 70 |
| Cadaver 6, Right | Cervical branch of the facial nerve | 13 | 81 |
| Cadaver 6, Left | Cervical branch of the facial nerve | 11 | 90 |
| Cadaver 7, Right | Cervical branch of the facial nerve | 12 | 77 |
| Cadaver 7, Left | Invalid | x | x |
| Cadaver 8, Right | Cervical branch of the facial nerve | 7 | 72 |
| Cadaver 8, Left | Cervical branch of the facial nerve | 11 | 76 |
| Cadaver 9, Right | Cervical branch of the facial nerve | 5 | 77 |
| Cadaver 9, Left | Cervical branch of the facial nerve | 12 | 89 |
| Cadaver 10, Right | Cervical branch of the facial nerve | 16 | 74 |
| Cadaver 10, Left | Cervical branch of the facial nerve | 18 | 95 |
| Mean ± Standard deviation | - | 12.421 ± 3.167 | 78.474 ± 7.486 |
| Cadaver number | Closest arterial branch | Angle of Mandible (mm) | Mental Protuberance (mm) | Cervical Branch (mm) |
|---|---|---|---|---|
| Cadaver 1, Right | Submental artery, Facial artery | 20 | 65 | 20 |
| Cadaver 1, Left | Facial artery | 24 | 55 | 27 |
| Cadaver 2, Right | Submental artery, Facial artery | 26 | 64 | 24 |
| Cadaver 2, Left | Facial artery | 28 | 48 | 30 |
| Cadaver 3, Right | Facial artery | 25 | 58 | 26 |
| Cadaver 3, Left | Facial artery | 27 | 40 | 30 |
| Cadaver 4, Right | Facial artery | 24 | 53 | 26 |
| Cadaver 4, Left | Submental artery, Facial artery | 21 | 53 | 20 |
| Cadaver 5, Right | Submental artery, Facial artery | 25 | 53 | 23 |
| Cadaver 5, Left | Facial artery | 21 | 50 | 35 |
| Cadaver 6, Right | Facial artery | 26 | 51 | 21 |
| Cadaver 6, Left | Facial artery | 20 | 45 | 25 |
| Cadaver 7, Right | Submental artery, Facial artery | 7 | 58 | 6 |
| Cadaver 7, Left | Invalid | x | x | x |
| Cadaver 8, Right | Submental artery | 29 | 46 | 15 |
| Cadaver 8, Left | Facial artery | 10 | 60 | 14 |
| Cadaver 9, Right | Facial artery | 22 | 46 | 20 |
| Cadaver 9, Left | Facial artery | 15 | 70 | 17 |
| Cadaver 10, Right | Submental artery | 12 | 54 | 9 |
| Cadaver 10, Left | Submental artery, Facial artery | 14 | 65 | 15 |
| Mean ± Standard deviation | - | 20.842 ± 6.218 | 54.421 ± 7.721 | 21.211 ± 7.186 |
| Cadaver number | Closest venous tributary | Angle of Mandible (mm) | Mental Protuberance (mm) | Cervical Branch (mm) |
|---|---|---|---|---|
| Cadaver 1, Right | Facial vein | 13 | 72 | 13 |
| Cadaver 1, Left | Facial vein | 20 | 77 | 17 |
| Cadaver 2, Right | Facial vein | 19 | 69 | 21 |
| Cadaver 2, Left | Facial vein | 20 | 62 | 20 |
| Cadaver 3, Right | Facial vein, Central vein, External jugular vein, Anterior jugular vein | 21 | 63 | 27 |
| Cadaver 3, Left | Facial vein | 20 | 65 | 27 |
| Cadaver 4, Right | Facial vein, Anterior Jugular vein | 21 | 87 | 27 |
| Cadaver 4, Left | Facial vein, Central vein, External jugular vein | 15 | 70 | 26 |
| Cadaver 5, Right | Facial vein | 18 | 58 | 21 |
| Cadaver 5, Left | Facial vein | 20 | 55 | 26 |
| Cadaver 6, Right | Facial vein, Central vein, External jugular vein | 16 | 66 | 21 |
| Cadaver 6, Left | Facial vein | 20 | 72 | 25 |
| Cadaver 7, Right | Central vein, External jugular vein, Suprascapular vein | 21 | 71 | 23 |
| Cadaver 7, Left | Invalid | x | x | x |
| Cadaver 8, Right | Facial vein, Central vein, External jugular vein, Anterior jugular vein | 26 | 72 | 10 |
| Cadaver 8, Left | Facial vein, Central vein, External jugular vein | 19 | 65 | 16 |
| Cadaver 9, Right | Central vein | 13 | 68 | 11 |
| Cadaver 9, Left | Facial vein, Central vein, External jugular vein | 5 | 62 | 18 |
| Cadaver 10, Right | Facial vein, Central vein, External jugular vein | 36 | 81 | 21 |
| Cadaver 10, Left | Facial vein, Anterior Jugular vein | 27 | 72 | 22 |
| Mean ± Standard deviation | - | 19.474 ± 6.107 | 68.789 ± 7.487 | 20.631 ± 5.193 |
Subcision is mentioned to be an effective cure for atrophic acne scars, especially the rolling type in the lower face and neck [15]. Past research indicates that optimal skin levels for subcision are in deep dermis and at the dermosubcutaneous junction. A rounded blade appears to be a better choice to avoid unintentional movement [16]. One serious issue in large-scale subcision is disrupting the neurovasculature of the platysma muscle, which connects the fascia to the dermis and acts as steady support for facial stability and expression [17]. Physicians must possess thorough knowledge of anatomy to avoid detaching these structures [18,19].
The clinical significance of this research is in favor of a flap of the platysma muscle for facial reanimation around the upper face and eye. The thickness of the platysma resembles the orbicularis oculi muscle, supporting the hypothesis that it can restore functions around the orbit [20]. An excised section of platysma can be anchored to the temporalis fascia and superior/inferior orbicularis oculi (partially bisected trouser graft) so that contraction pulls backward to close the eye [3,20].
In dynamic reanimation, the blood vessels can be attached to a branch of the superficial temporal artery and the nerves attached to an ipsilateral facial nerve branch or via a cross-facial nerve graft in unilateral facial paralysis [21-23]. In 71% of specimens, the nearest arterial supply originated from the facial artery, and 29% from the submental artery. Venous drainage was observed in 71% to drain into the facial vein and 29% in the central vein [24,25]. A 40mm x 50mm section harvested near the angle of the mandible is adequate to encompass the primary neurovascular supply for free muscle transfer.
PK Nu]-{ OEBPS/s5-conclusion.xhtmlThere is close proximity between the cervical branch of the facial nerve and the primary blood vessels supplying the platysma muscle. For facial reanimation around the orbit, the platysma vessels can be anastomosed to superficial temporal branches and its nerve joined to an ipsilateral facial nerve branch or cross-facial graft, offering an optimal thin muscle flap for eyelid closure.
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eISSN 2321-4287 · pISSN 2321-8967
Volume 14 · Issue 2 · Pages 9546–9558 · June 2026
Research Article
1Department of Anatomy and Embryology, Faculty of Medicine, Zagazig University, Egypt.
2Department of Anatomy, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia.
3Department of Basic Medical Sciences, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
4Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
Corresponding author: Dr. Naser A. ElSawy, Department of Anatomy and Embryology, Faculty of Medicine, Zagazig University, Egypt. ORCID: 0000-0002-6189-0196, E-Mail: elsawynaser@gmail.com
Received: 22 March 2026 · Revision received: 10 April 2026 · Accepted: 09 May 2026 · Published: 05 June 2026