Motor Nerve to the Masseter: A Pediatric Anatomic Study and the “3:1 Rule”

Publication date: Available online 31 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Minh-Bao Mundschenk, Neil S. Sachanandani, Gregory H. Borschel, Ronald M. Zuker, Alison K. Snyder-Warwick
BackgroundThe motor nerve to the masseter (masseteric nerve) provides a robust local neural source for facial reanimation and nerve transfer. Its intraoperative identification is well-described in adults. The purpose of this study was to determine the location of the motor nerve to the masseter in the pediatric population using surgical landmarks.MethodsIntraoperative measurements were taken in pediatric patients undergoing facial reanimation from June 2014 to June 2015. The location of the masseteric nerve in relation to the tragus, zygomatic arch, and superficial muscular aponeurotic system (SMAS) was recorded.Results12 hemifaces were studied; the mean age of patients was 10.7 ± 4.9 years. On average, the masseteric nerve was located 3.0 ± 0.3 cm anterior to the tragus, 0.99 ± 0.2 cm inferior to the zygomatic arch, and 1.28 ± 0.8 cm deep to the SMAS.ConclusionThe position of the masseteric nerve in the pediatric population is similar to that in adults. The 3:1 rule holds true in children, wherein the motor nerve to the masseter can be found 3 cm anterior to the tragus and 1 cm inferior to the zygomatic arch. This aids intraoperative nerve identification during facial reanimation and nerve transfer procedures.



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