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The possibility of the complication of facial paralysis during facial plastic surgery, though discussed thoroughly in the preoperative consultation, should rarely occur in the hands of the experienced surgeon. Aggressive undermining techniques used for browlifting, rhytidectomy, and suction-assisted lipectomy increases the risk for facial nerve injury. Timely review of the extraparotid anatomy of the facial nerve, most importantly the temporofrontal and mandibular branches, is important. In this article, we will review recent studies of facial nerve anatomy and their clinical relevance.
The branches of the marginal mandibular nerve (usually two or three), after exiting the parotid gland, run deep to the platysma. After crossing the facial vessels, the branches ascend and become more superficial before innervating the lip depressors. Liebman et al (Arch Otolaryngol Head Neck Surg. 1988;114:179-181) elucidated the distal course of the nerve relative to the tissue planes lateral to the lip. They found the nerve to lie
Extraparotid Facial Nerve Anatomy. Arch Otolaryngol Head Neck Surg. 1989;115(6):664–665. doi:10.1001/archotol.1989.01860300018009
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