The five terminal branches of the facial nerve supply all muscles of facial expression. The marginal mandibular branch is the most commonly injured during parotidectomy and neck dissection due to its inferior position and thin coverage. The temporal branch injury produces brow ptosis from frontalis paralysis. Buccal branch injury reduces smile symmetry. The House-Brackmann scale grades facial nerve function from I (normal) to VI (complete paralysis).
| Origin | Facial nerve exits the stylomastoid foramen and immediately enters the parotid gland where it divides |
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The marginal mandibular branch runs along or just below the inferior border of the mandible — it is vulnerable during submandibular gland excision, mandibular angle ORIF, and facelift. Temporary paresis is common after parotidectomy (30-50%) but permanent dysfunction from careful technique is less than 2%. Intraoperative nerve monitoring with electromyographic recording of facial muscles guides safe nerve dissection.
Facial nerve injury during neck or mandibular surgery producing lower lip asymmetry managed with physiotherapy and reinnervation for permanent cases.
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