Send to

Choose Destination
Aesthetic Plast Surg. 2018 Oct;42(5):1394-1398. doi: 10.1007/s00266-018-1164-4. Epub 2018 Jun 4.

Deoxycholic Acid and the Marginal Mandibular Nerve: A Cadaver Study.

Author information

Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA.
Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA.
Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA.
Department of Anatomy and Neuroscience, University of Kentucky, Lexington, KY, USA.
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.



One of the rare but serious complications observed with deoxycholic acid administration is damage to the marginal mandibular nerve. In this study, we evaluated if deoxycholic acid directly induces histologic damage to fresh cadaveric marginal mandibular nerve.


A segment of marginal mandibular nerve was harvested from 12 hemifaces of 6 fresh cadavers. The nerve specimen was exposed to either 0.9% sterile saline for 24 h, deoxycholic acid (10 mg/ml) for 20 min, or deoxycholic acid (10 mg/ml) for 24 h. The nerve specimens were then fixed in glutaraldehyde for a minimum of 24 h. Toluidine blue stained sections were evaluated for stain intensity using light microscopy and color deconvolution image analysis. Supraplatysmal fat was harvested as a positive control and exposed to the same treatments as the marginal mandibular nerve specimens, then evaluated using transmission electron microscopy.


Toluidine blue staining was less in the marginal mandibular nerve exposed to deoxycholic acid when compared to saline. The specimen exposed to deoxycholic acid for 24 h showed less toluidine blue staining than that of the nerve exposed to deoxycholic acid for 20 min. Transmission electron microscopy of submental fat exposed to deoxycholic acid revealed disruption of adipocyte cell membrane integrity and loss of cellular organelles when compared to specimens only exposed to saline.


Deoxycholic acid (10 mg/ml) damages the marginal mandibular nerve myelin sheath in fresh human cadaver specimens. Direct deoxycholic acid neurotoxicity may cause marginal mandibular nerve injury clinically.


This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .


Deoxycholic acid; Marginal mandibular nerve; Submental fat


Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center