Topographic anatomy of the nerve to masseter: An anatomical and clinical study

Background: The use of the motor nerve to masseter has proved to be a reliable and sensible solution in facial reanimation as a donor for free muscle transfer. In this paper we describe the topographic anatomy of the nerve to masseter and our original technique for its quick and safe harvesting. Methods: This anatomical study is based on the dissection of the nerve to masseter in 17 embalmed cadaverous sites and is focused on the anatomical relations between the nerve and the surrounding structures. Also buccal and zygomatic branches of the facial nerve were dissected and assessed and the resulting data are compared. Results: The nerve to masseter has a predictable track inside the muscle which can be identified topographically within a square area under the zygomatic arch. This area is different between males and females and its accuracy has been tested on six patients at the Canniesburn Unit. Conclusions: The nerve to masseter emerges in a very predictable point from the mandibular notch - immediately below the zygomatic arch - to run within the muscle belly. The approach here described allows safer and faster harvesting of the nerve to masseter with minimal dissection through the muscle. (c) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.