Skin reference point for the zygomatic branch of the facial nerve innervating the orbicularis oculi muscle (anatomical study)

Direct access to the zygomatic branch of the facial nerve in the parotid is less invasive and more selective than first dissecting the nerve trunk and then finding the branches. The aim of this study was to confirm the point of reference on the skin which would give direct access to the zygomatic branch for the orbicularis oculi muscle. The skin reference point studied was on the intertragic notch/external canthus line, 2.5 cm in front of the intertragic notch. Ten fresh cadavers, and thus 20 sides of faces were dissected. The zygomatic branch of the facial nerve innervating the orbicularis oculi muscle was accessed directly. The dissection was extended to temporofacial and cervicofacial branches and then to the trunk of the facial nerve by a retrograde path in the parotid. Twenty dissections of the parotid area confirmed the validity of the anatomical reference point of the zygomatic branch for the orbicularis oculi muscle considered. The simplicity and reliability of this landmark is important in clinical practice and has numerous potential applications in surgery for rehabilitation of facial paralysis associated with VII healthy and VII affected neurorraphies, in facial paresis for superneurotizations and in traumatology.