Defining the Safe Entry Point in Deep Plane Facelifting with Novel Landmark for the Buccal Branch of the Facial Nerve

Ryan Medhurst; Cory Tremblay; Kristina Marrelli; Corliss Best; Lorraine Jadeski; Matthew Brace

doi:10.1097/GOX.0000000000005749

Defining the Safe Entry Point in Deep Plane Facelifting with Novel Landmark for the Buccal Branch of the Facial Nerve

Plast Reconstr Surg Glob Open. 2024 Apr 17;12(4):e5749. doi: 10.1097/GOX.0000000000005749. eCollection 2024 Apr.

Authors

Ryan Medhurst¹, Cory Tremblay², Kristina Marrelli¹, Corliss Best³, Lorraine Jadeski¹, Matthew Brace⁴

Affiliations

¹ From the Department of Human Health and Nutritional Sciences, Human Anatomy Laboratory, University of Guelph, Ontario, Canada.
² Department of Medicine, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada.
³ Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada.

Abstract

Background: In deep facial surgery, accurate preoperative landmarking of branches of the facial nerve is helpful in avoiding inadvertent facial nerve injury. The objective of our study was to determine the accuracy at which the intersection point of two bisecting lines that join facial surface landmarks can be used to accurately locate the buccal branch(es) of the facial nerve, specifically at the deep plane entry point (ie, intercept landmark).

Methods: Thirty-three cadavers were dissected to determine the position of the buccal rami relative to the intercept.

Results: Buccal rami crossed the intercept in 12.12% of specimens (0 mm from intercept, n = 4). Buccal rami passed superiorly in 66.67% of specimens (3.71 ± 3.28 mm from intercept, n = 7) and inferiorly in 21.21% of specimens (2.44 ± 0.92 mm from intercept, n = 7). Noteworthy, buccal rami were located within 1 cm of the intercept landmark with 96.97% accuracy (32/33 cadavers).

Conclusions: These data suggest that this novel intercept (1) reliably locates the buccal branch of the facial nerve as it courses distal to the parotid gland, and (2) helps define a "safe zone" for entry into the deep plane where the likelihood of encountering the facial nerve is extremely low.