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Surface Anatomy of the Middle Division of the Facial Nerve: Zuker's Point

Dorafshar, Amir H. M.B.Ch.B.; Borsuk, Daniel E. M.D., M.B.A.; Bojovic, Branko M.D.; Brown, Emile N. M.D.; Manktelow, Ralph T. M.D.; Zuker, Ronald M. M.D.; Rodriguez, Eduardo DeJesus D.D.S., M.D.; Redett, Richard J. M.D.

Plastic and Reconstructive Surgery: February 2013 - Volume 131 - Issue 2 - p 253–257
doi: 10.1097/PRS.0b013e3182778753
Reconstructive: Head and Neck: Original Articles

Background: The anatomy of the facial nerve and its branches has been well documented. The course of the extratemporal facial nerve, its anatomical planes, and the surface landmarks of the temporal division and marginal mandibular division are well known. However, the surface landmark of the middle division of the facial nerve has not been studied to date.

Methods: Eighteen hemifacial dissections in 10 fresh human cadavers were performed through a preauricular face-lift incision. An 18-gauge needle with brilliant green dye was used to mark the nerve through the skin before dissection. The exact location of the middle division branches of the facial nerve was documented in relation to the transcutaneous marking.

Results: The middle division branches of the facial nerve were found to lie at a mean of 2.3 mm from the tattooed point, with a range of 0 to 6 mm. A nerve branch was found directly tattooed by the needle seven of 18 times, inferior to the tattoo five of 18 times, and superior to the tattoo six of 18 times.

Conclusions: The zygomatic/buccal motor branch that innervates the zygomaticus major muscle can be reliably found at the midway point on a line drawn from the root of the helix and the lateral commissure of the mouth. This study will help guide surgeons to the middle division of the facial nerve as it applies to facial surgery.

Baltimore, Md.; and Toronto, Ontario, Canada

From The Johns Hopkins Medical Institute; the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; and The Hospital for Sick Children, University of Toronto.

Received for publication July 23, 2012; accepted August 20, 2012.

The first two authors contributed equally to the article.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Amir H. Dorafshar, M.B.Ch.B.; The Johns Hopkins Medical Institute, 601 North Caroline Street, Baltimore, Md. 21231,

©2013American Society of Plastic Surgeons