Intraoral anatomy of the buccal nerve for buccal fat pad and facelift procedures

Abstract

Background Intraoral approaches to the buccal fat pad, deep midface, and temporal fascia are increasingly used in aesthetic surgery. However, the buccal nerve (BN) remains incompletely defined from this perspective, limiting understanding of procedure-related complications. Objectives To investigate the course and morphometry of BN using an intraoral approach relevant to contemporary facial surgery. Methods Sixteen hemi-faces from eight embalmed adult body donors were dissected via a medial intraoral approach. BN was traced from its emergence between the heads of the lateral pterygoid muscle through the pterygomandibular and buccal spaces. Relationships to the temporalis tendon, buccal fat pad (BFP), buccinator, parotid duct papilla, and pterygoid lamina were documented. Five clinically relevant distances were measured with digital calipers. Interobserver reliability was assessed using intraclass correlation coefficients. Results BN consistently descended along the anterior temporalis tendon, with a tendon-piercing variant in 12.5% of hemi-faces. It coursed lateral to the pterygoid extension of the BFP and medial to the anterior lobe of BFP, forming a distinct corridor. Within the buccal space, BN followed a uniform anteroinferior course inferior to the linea alba. Mean distances were 14.1 ± 1.2 mm to the lateral pterygoid lamina and 18.9 ± 2.4 mm (horizontal) and 16.6 ± 2.4 mm (vertical) to the parotid duct papilla. Reliability was excellent (ICC: 0.970–0.998). Conclusions This study defines the intraoral anatomy of BN and provides practical landmarks that may enhance surgical safety and reduce sensory complications in buccal, midface, and temporal procedures.