The masseteric nerve is a branch of the anterior division of the mandibular nerve (V3) that passes laterally through the mandibular notch to supply the masseter muscle from its deep surface. It also gives a small branch to the temporomandibular joint capsule. Together with the deep temporal nerves, it provides motor supply to the muscles of mastication from the anterior V3 division.
The masseteric nerve is used in facial reanimation surgery as a reliable donor motor nerve for free muscle transplantation in long-standing facial palsy, where the cross-facial nerve graft may provide insufficient axons. Direct coaptation of the masseteric nerve to the facial nerve or to the motor nerve of a free gracilis flap provides a strong, reliable motor input for smile reconstruction, with the tradeoff that patients bite to smile initially, although cortical adaptation occurs over time.
In patients with long-standing facial palsy or proximal facial nerve destruction, the masseteric nerve is co-opted as a motor source for gracilis free muscle transfer or direct facial nerve repair, providing reliable innervation with 80% success in restoring a voluntary smile, though with initial bite-activated motion.
Trauma, tumour, or surgical injury to the mandibular notch or infratemporal fossa can damage the masseteric nerve and deep temporal nerves together, producing weakness of jaw closure that may be subtle unless bilateral.
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