Anat Cell Biol.  2023 Sep;56(3):313-321. 10.5115/acb.23.040.

Anatomical knowledge of zygomatico-buccal plexus in a cadaveric study

• Uruwan S
• Rungsawang C
• Sareebot T
• Tansatit T

• KMID: 2546327
• DOI: http://doi.org/10.5115/acb.23.040

Abstract

The details of the facial nerve pattern were clearly explained in the parotid gland (PG), lateral area of the face, and periorbital areas to prevent the unexpected outcome of medical intervention. However, it remains unclear whether information about the zygomatico-buccal plexus (ZBP) in the masseteric and buccal regions. Therefore, this study aimed to help clinicians avoid this ZBP injury by predicting their common location. This study was conducted in forty-two hemifaces of twenty-nine embalmed cadavers by conventional dissection. The characteristics of the buccal branch (BB) and the ZBP were investigated in the mid-face region. The results presented that the BB gave 2–5 branches to emerge from the PG. According to the masseteric and buccal regions, the BB were arranged into ZBP in three patterns including an incomplete loop (11.9%), a single-loop (31.0%), and a multi-loop (57.1%). The mean distance and diameter of the medial line of the ZBP at the corner of the mouth level were 31.6 (6.7) and 1.5 (0.6) mm respectively, while at the alar base level were 22.5 (4.3) and 1.1 (0.6) mm respectively. Moreover, the angular nerve arose from the superior portion of the ZBP at the alar base level. The BB formed a multiloop mostly and showed a constant medial line of ZBP in an area approximately 30 mm lateral to the corner of the mouth, and 20 mm lateral to the alar base. Therefore, it is recommended that physicians should be very careful when performing facial rejuvenation in the mid-face region.

Keyword

Buccal branch; Zygomatico-buccal plexus; Facial rejuvenation

Figure

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  Fig. 1 The location of the emerging point of the BB is sporadically distributed throughout the anterior border of the PG. Then, it branched and arranged into the ZBP in masseteric and buccal regions, and presented the medial line of the ZBP branched into small twigs to innervate muscles around the mouth and nose. BB, buccal branch; ZBP, zygomatico-buccal plexus; TB, temporal branch; ZB, zygomatic branch; BB1, first buccal branch; BB2, second buccal branch; BB3, third buccal branch; MMB, marginal mandibular branch; CB, cervical branch; AN, angular nerve; PG, parotid gland; PD, parotid duct; MM, masseter muscle; LLS, levator labii superioris muscle; OO, orbicularis oculi muscle; OOr, orbicularis oris muscle; DAO, depressor anguli oris muscle; red arrowhead, the medial line of the ZBP; yellow arrowhead, small twigs of the BB; blue arrow, ZB gave branch to connect the BB; FHL, Frankfort’s horizontal line; midFHL, midpoint of the FHL; ATL, anterior tragal line; red circle, emerging point of the BB.

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  Fig. 2 The area for investigation the pattern of ZBP (red area). ZBP, zygomatico-buccal plexus; SAC, supra-alar crest; CM, the corner of the mouth; midFHL, midpoint of the Frankfort’s horizontal line. TB, temporal branch; ZB, zygomatic branch; BB1, first buccal branch; BB2, second buccal branch; BB3, third buccal branch; PG, parotid gland; PD, parotid duct; LLS, levator labii superioris muscle; OO, orbicularis oculi muscle; OOr, orbicularis oris muscle; red arrowhead, the medial line of the ZBP.

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  Fig. 3 Three patterns of the ZBP; incomplete (A, a), single (B, b), and multi-loop patterns (C, c). ZBP, zygomatico-buccal plexus; SAC, supra-alar crest; CM, corner of the mouth; PD, parotid duct; FA, facial artery; FV, facial vein; red arrowhead, ZBP; BB1, first buccal branch; BB2, second buccal branch; BB3, third buccal branch; LLS, levator labii superioris muscle; OOr, orbicularis oris muscle; ZMj, zygomaticus major muscle.

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  Fig. 4 The origin and location of the AN that arose from superior part of the ZBP. ZBP, zygomatico-buccal plexus; AN, angular nerve; PD, parotid duct; LLS, levator labii superioris muscle; OO, orbicularis oculi muscle; red arrowhead, the origin of the AN; FV, facial vein; FA, facial artery.

Reference

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