The mandibular lingula, historically termed the spine of Spix, represents a critical anatomical landmark in oral and maxillofacial surgery. This comprehensive review synthesises findings from major studies spanning 25 years (2000-2025), encompassing 11,937 + mandibular sides across 19 + populations from six continents. The lingula serves as the primary landmark for inferior alveolar nerve blocks (IANB), sagittal split ramus osteotomy, and various orthognathic procedures. Significant morphological variations exist, with five distinct shapes documented: triangular, truncated, nodular, assimilated, and the recently described bridge/M-shaped morphology (Stipo et al., 2022). A critical methodological bias is evident: dry bone studies predominantly report triangular shapes (39%), while Cone-Beam Computed Tomography (CBCT) studies reveal a nodular predominance (50.6%) in many populations. The internal oblique or mylohyoid ridge has emerged as a reliable alternative landmark (95.7% visibility) and yields superior IANB success rates (97.3%) compared with traditional methods (∼85%). Furthermore, the antilingula is critically evaluated and found to have limited value as a sole landmark. However, it may serve as a supplementary guide when used with appropriate posterior safety margins. This review establishes evidence-based, population-specific surgical protocols, emphasizes the unreliability of traditional assumptions regarding bilateral symmetry, and includes critical appraisal of recent data regarding age-related mandibular remodelling. Comprehensive meta-analytic data representing 4694 subjects provides the most comprehensive morphometric reference values currently available.

This review aims to provide an applied surgical–anatomical synthesis of the buccal fat pad, harmonise the commonly used extension nomenclatures, and summarise the principal neurovascular structures at risk, major clinical applications, and representative pathologies relevant to current surgical practice. A narrative, anatomy-oriented review was conducted using cadaveric, imaging-based (CT/MRI), and surgical literature. The evidence was organised thematically around extension anatomy, fascial boundary planes, neurovascular relationships, and procedure-related surgical risk. Two main extension frameworks, the 4-extension and 6-extension models, were identified, and their correlation improves anatomical orientation and comparability across studies. Key structures at risk include the parotid (Stensen’s) duct, buccal branches of the facial nerve, and the buccal and transverse facial vessels, all of which show variable relationships to the buccal fat pad. Safer surgery depends on accurate plane selection, limited dissection, and gentle mobilisation rather than forceful traction to reduce haemorrhagic and neural complications. The review also outlines clinically relevant pathology, including traumatic herniation or pseudoherniation and tumour or tumour-like lesions involving the buccal fat pad. An integrated applied-anatomical framework of the buccal fat pad, combining extension mapping with neurovascular risk awareness, may improve operative planning and support safer, more predictable aesthetic and reconstructive procedures.

Background/Objectives: The trigeminal (CN V) and facial (CN VII) nerves are conventionally taught as separate pathways, yet extensive peripheral anastomoses form sensorimotor plexuses throughout the face. These communications provide the anatomical substrate for proprioception in facial muscles that paradoxically lack muscle spindles and Golgi tendon organs. This review aims to synthesise the anatomical, histological, and clinical evidence on these interconnections and to evaluate their implications across surgery, radiology, neurology, and dentistry. Methods: PubMed/MEDLINE, Scopus, and Google Scholar were searched for cadaveric dissection studies, Sihler whole-mount staining investigations, immunohistochemical analyses, quantitative axonal mapping studies, and clinical case series addressing trigeminal–facial communications and their diagnostic significance. Results: Twenty peripheral anastomoses were systematically identified and mapped, with prevalence ranging from reported-constant in multiple cadaveric series (auriculotemporal–facial trunk; mental–marginal mandibular) to variable (29–86%, depending on trigeminal division and method; V2 by cadaveric dissection, V1 by Sihler staining). Immunohistochemical evidence supports sensorimotor fibre interchange, and recent axonal mapping has revealed that the extracranial facial nerve is a mixed nerve containing motor, sympathetic, and afferent components. Clinically, these anastomoses are implicated in spontaneous facial recovery, trigeminal motor branch transfers, perineural tumour spread, local anaesthesia effects, synkinesis, and Ramsay Hunt syndrome. Conclusions: Available anatomical and histological evidence is consistent with the view that the trigeminal and facial nerves form a functionally integrated unit, though the functional significance of specific communications remains method-dependent. Recognition of these communications is relevant for surgeons, radiologists, neurologists, and dental practitioners managing facial conditions.