Overview
Surgery through the mouth to reach the buccal fat pad, deep midface and temporal fascia is increasingly common, but the course of the buccal nerve from this angle was not well defined. The authors dissected 16 half-faces from 8 embalmed adult donors through a medial intraoral approach. They traced the nerve, recorded its relation to nearby structures, measured 5 distances with digital calipers, and tested agreement between observers.
Findings
- 16 hemi-faces from 8 embalmed adult body donors.
- The buccal nerve consistently descended along the front of the temporalis tendon.
- It pierced the tendon in 12.5% of hemi-faces.
- It ran lateral to the pterygoid extension of the buccal fat pad and medial to its anterior lobe, forming a distinct corridor.
- In the buccal space it followed a uniform downward and forward course below the linea alba.
- Mean distance to the lateral pterygoid lamina: 14.1 ± 1.2 mm.
- Mean distance to the parotid duct papilla: 18.9 ± 2.4 mm horizontal, 16.6 ± 2.4 mm vertical.
- Agreement between observers was excellent (ICC 0.970-0.998).
What it means for a patient
- Buccal fat removal and other procedures done through the mouth pass near the buccal nerve.
- The authors give measured reference points that may help surgeons avoid it and lower the risk of sensory problems.
- Limits: 8 embalmed donors only, no living patients, and no data on actual injury rates.
Why this paper matters
It maps the buccal nerve from the inside of the mouth, the view used in buccal fat and deep midface surgery, and gives distances surgeons can use as reference points.
Terms
- Buccal nerve: a sensory nerve to the cheek and inner cheek lining.
- Buccal fat pad: a deep fat pad in the cheek.
- Intraoral approach: surgery through an incision inside the mouth.
- Temporalis tendon: the tendon of the chewing muscle at the temple, which attaches to the jaw.
- Parotid duct papilla: the small bump inside the cheek where the saliva duct opens.
- Linea alba: here, a pale line inside the cheek where the teeth meet.
- Hemi-face: one side of the face.
- Intraclass correlation coefficient (ICC): a measure of how closely different observers agree; 1 is perfect.