THE ANATOMICAL RECORD 249:276–284 (1997)

Human Facial Muscles: Dimensions, Motor Endplate Distribution,

and Presence of Muscle Fibers With Multiple Motor Endplates
WOLFGANG HAPPAK,1* JI LIU,2 GEORG BURGGASSER,3 AMANDA FLOWERS,4
HELMUT GRUBER,4 AND GERHARD FREILINGER5
1Division of Plastic and Reconstructive Surgery, Department of Surgery,

University of Vienna, Vienna, Austria

2Department of Orthopedic Surgery, National University of Singapore, Singapore
3Department A, Eye Clinic, University of Vienna, Vienna, Austria
4Third Department of Anatomy, University of Vienna, Vienna, Austria
5KH Goldenes Kreuz, Vienna, Austria

ABSTRACT Background: Extrafusal muscle fibers of human striated

skeletal muscles are known to have a uniform innervation pattern. Motor
endplates (MEP) of the ‘‘en plaque’’ type are located near the center of
muscle fibers and distributed within the muscles in a narrow band. The
aim of this study was to evaluate the innervation pattern of human facial
muscles and compare it with that of skeletal muscles.
Methods: Ten facial muscles from 11 human cadavers were dissected, the
nerve entrance points located, and the dimensions measured. All muscles
were stained in toto for MEPs using Acetylcholinesterase (AChE) and
examined under the microscope to determine their location. Single muscle
fibers were teased to evaluate the stained MEPs.
Results: The length of the different facial muscles varied from 29 to 65
mm, which correlated to the length of the corresponding muscle fibers.
MEP zones were found on the muscles in the immediate vicinity of the
nerves’ entrance points and located eccentrically. Numbers and locations
varied from muscle to muscle. Three MEP zone distribution patterns were
differentiated: numerous small MEP zones were evenly spread over the
muscle, a predominant MEP zone and two to three small zones were
spread at random, and two to four MEP zones of equal size were randomly
scattered.
One MEP of the ‘‘en plaque’’ type was found in 73.8% of the muscle fibers
and two to five MEPs were found in 26.2%. The distances between the
multiple MEPs on one muscle fiber varied from 10 to 500 µm.
Conclusions: This study suggests that facial muscles differ from skeletal
muscles regarding distribution and number of MEPs. The eccentric
location of MEP zones and multiple MEPs suggests there is an indepen-
dent mechanism of neural regulation in the facial muscle system. Anat.
Rec. 249:276–284, 1997. r 1997 Wiley-Liss, Inc.

Key words: human facial muscles; dimensions; innervation pattern; mo-

tor zone; extrafusal muscle fibers; motor endplate; multifocal
innervation; Acetylcholinesterase (AChE)

Mammalian skeletal muscles are known to consist of
phasic extrafusal muscle fibers arranged in bundles of
various sizes. They are innervated by one motor axon
and bear one motor endplate (MEP) (Ogata, 1988;
Vrbová et al., 1995). Human skeletal muscles consist of
muscle fibers up to 18 cm in length, with a single MEP
in the middle of the fiber (Desmedt, 1958; Christensen,
1959; Schwarzacher, 1959; Aquilonius et al., 1984).
These MEPs are arranged in such a fashion that they
form a narrow band stretching across the central zone
of the skeletal muscles, described as a motor band
(Gray, 1989). Until recently, human facial muscles were
thought to be similar to the skeletal muscles of the
trunk and limbs. Varying studies on the facial nerve
(Fujita, 1934; Freilinger et al., 1987) and its branching
pattern (Davis et al., 1956; Bernstein and Nelson, 1984;
Katz and Catalano, 1987) as well as the number of
muscle fibers per motor unit (Feinstein et al., 1955),
*Correspondence to: Dr. Wolfgang Happak, Division of Plastic and
Reconstructive Surgery, Department of Surgery, Währinger Gürtel
18-20, A-1090 Vienna, Austria.
Received 17 July 1995; Accepted 7 April 1997

r 1997 WILEY-LISS, INC.

 MOTOR ENDPLATE DISTRIBUTION IN FACIAL MUSCLES
and histochemical and immunohistochemical character-
istics of facial muscles (Happak et al., 1988; Freilinger
et al., 1990; Stal, 1994), showed significant differences
from the skeletal muscles of the trunk and limbs. The
aim of this study was to determine the innervation
pattern of the facial muscle system, the location of the
motor bands in each different facial muscle, as well as
the position and number of MEPs on single muscle
fibers. This knowledge may lead to a better understand-
ing of the neural regulation and the emotional expres-
sion of human facial muscles.
MATERIALS AND METHODS
Eleven human cadavers (seven female and four male,
age 55–73, mean age 5 67) from body donors to
research and teaching (Department of Anatomy) were
used in this study. The cause of death was either acute
cardiovascular or pulmonary disease. Dissection was
carried out within 2 to 6 days postmortem.
Ten facial muscles (zygomaticus major and minor,
levator labii superioris, levator labii superioris alaeque
nasi, levator anguli oris, depressor anguli oris, depres-
sor labii inferioris, buccinator, orbicularis oculi, and
orbicularis oris) and the corresponding innervating
branches of the facial nerve were dissected. The length
and width of each muscle, except the orbicularis oris
muscle, was measured in situ using measurement
forceps. The terminal facial nerve branches were lo-
cated and the entrance points into the muscle deter-
mined and documented on a schematic diagram.
After removal from the cadavers, the muscles were
stretched to their original length and fastened on an
expanded polystyrene plate using pins. The muscles
were fixed for 1 hr with 10% formaldehyde and then
kept in 0.1 M cacodylate-buffer. Remaining pieces of
connective tissue and fat were removed. The MEPs
were stained for AChE by incubating the muscles for 6
hrs in the medium described by Koelle and Friedenwald
(1949), followed by further incubation in 1% ammo-
nium sulfide and finally postfixed in 3.6% formalde-
hyde. A control was set up using in vivo dissected sheep
rectus femoris muscles, which were stained following
the same procedure. Evaluation and further prepara-
tion of all muscles was carried out under the OP-
microscope (Zeiss Universal S3, Carl Zeiss, Oberko-
chen, Germany). The location of stained MEPs was
determined in each of the dissected muscles and docu-
mented on a schematic diagram.
The schematic diagrams, depicting nerve entrance
points and the position of MEP zones for each muscle,
were compared with each other. Finally, the positions of
the MEP zones were determined in each of the ten
dissected facial muscles by comparing the diagrams of
the corresponding muscles.
Initially, each muscle was dissected into bundles
containing up to 100 muscle fibers. These were then
further divided into smaller bundles, until it was
possible to examine each muscle fiber from its origin to
its insertion and determine the location of the MEPs.
Only those parts of muscle fibers showing AChE-
stained MEPs and myotendinous junctions were teased
out of the small bundles. The remaining parts of the
fibers where AChE activity was negative were removed
if they had not already broken. The relevant parts of
the teased fibers were placed on slides and cover-
277
slipped. Each specimen was examined under the micro-
scope. Those specimens were excluded from the final
examination and measurements where clear identifica-
tion and differentiation of the MEPs was impossible.
During teasing it is inevitable that some MEPs, as well
as muscle fibers, are destroyed and some MEPs are
hidden by artefacts or are projected over each other.
The MEPs of the remaining specimens were identi-
fied and photographed. Measurements were carried out
on the photographs using measurement forceps accord-
ing to the calibration bar for each magnification. The
length of each MEP and the distances between the
MEPs were determined on each of the teased muscle
fibers.
RESULTS
All facial muscles were flat in shape except the
orbicularis oris muscle. The zygomatic minor was the
only rectangular and the depressor labii inferioris the
only quadrilateral-shaped muscle. All other facial
muscles were of trapezoidal shape and converged from
a wider origin to a narrow insertion. In the zygomatic
major and levator labii superioris, the medial portions
of the muscle fibers were shorter than those on the
lateral side. The cranial portions of muscle fibers in the
buccinator muscle that were aligned horizontally were
shorter than its caudal portion. Table 1 shows the
length and width of each muscle. Each muscle was
innervated by several branches of the facial nerve and
corresponding blood vessels were rarely seen. Each
nerve branch divided into multiple smaller branches in
the distal 5–10 mm before entering the muscle.
Gross Anatomy and Dimensions
The zygomatic major and minor muscles originate
from the zygomatic arch. In the zygomatic major, the
laterally located larger portion of muscle fibers insert at
the modiolus at the angle of the mouth. Its smaller
medial portion and the zygomatic minor insert into
the orbicularis oris at the upper lip. The mean length of
the zygomatic major was 65.6 mm (6 3.8) and of the
zygomatic minor was 51.8 mm (6 7.4) (Table 1). The
zygomatic branches innervated each muscle with two to
four branches from its deep surface.
The levator labii superioris muscle originates from
the lower margin of the orbita at the maxilla and
inserts into the orbicularis oris at the upper lip. The
mean length was 47 mm (6 7.5). The levator labii
superioris alaeque nasi originates from the medial
angle of the orbital rim and fuses with the levator labii
superioris. The mean length was 61.6 mm (6 7.6). Both
muscles were innervated from their deep surface by two
branches emerging from the peripheral anastomosis
between the zygomatic and buccal branches.
The levator anguli oris muscle originates from the
canine fossa at the maxilla. It inserts into the orbicu-
laris oris at the upper lip and the modiolus. The
depressor anguli oris originates from the lower margin
of the mandible. It inserts into the orbicularis oris at
the lower lip and the modiolus. The levator anguli oris
muscle had a mean length of 42 mm (6 2.5) and the
depressor anguli oris muscle had a mean length of 48
mm (6 5.1). Both muscles were innervated from their
lateral margin by two branches. The branches emerged
278 W. HAPPAK ET AL.
TABLE 1. Dimensions of facial muscles
Muscle Max. length
Zygomaticus major 65.6 6 3.81
Zygomaticus minor 51.8 6 7.4
Levator labii superioris 47 6 7.51
Lev. lab. sup. alaeque nasi 61.6 6 7.6
Levator anguli oris 42 6 2.5
Depressor anguli oris 48 6 5.1
Depressor labii inferioris 29 6 4.9
Buccinator 56 6 7.43
Orbicularis oculi 65 6 5.65
Measurements of ten facial muscles in millimeters. Mean 6 SD of the in situ measured muscles. Each side of the
trapezoid-shaped muscles was measured.
1Lateral edge.
2Medial edge.
3Caudal edge.
4Cranial edge.
5Horizontal diameter.
6Vertical diameter.
from the peripheral anastomosis between the zygo-
matic and buccal branches and between buccal and
marginal mandibular branches, respectively.
The depressor labii inferioris muscle originates from
the anterior side of the mandible, adjacent to the
mental foramen. The muscle inserts at the modiolus
and blends into the inferior part of the orbicularis oris
and the skin of the lower lip. The muscle had a mean
length of 29 mm (6 4.9). The muscle was innervated by
several branches of the marginalis mandibular branch,
which accessed from the lateral side.
The buccinator originates from the maxilla, pterygo-
mandibular raphe, and mandible. The muscle fibers
converge to a plate of insertion at the angle of the
mouth and the modiolus. The mean muscle length was
56 mm (6 7.4). Numerous buccal branches innervated
the muscle from its superficial surface.
The orbicularis oculi muscle originates from the
medial palpebral ligament and has no direct attach-
ment to the bone. The concentrically aligned bundles of
muscle fibers were embedded in the septal structure of
the eyelid. The mean vertical diameter was 65 mm
(6 5.6) and the mean horizontal diameter was 60 mm
(6 9.6). The muscle was innervated by four or five
temporal branches and by two or three zygomatic
branches from its deep surface.
In contrast, the orbicularis oris muscle is the only
round-shaped muscle in the face. It has neither bony
nor tendinous origin. It was held in position by all the
inserting muscles mentioned above. The fibers contin-
ued within the orbicularis oris, becoming an integral
part of the muscle. The muscle was innervated from its
lateral side by two branches emerging from peripheral
anastomosis between the lower buccal and the mar-
ginal mandibular branches.
Motor Zone
All in toto stained human facial muscles, as well as
the control rectus femoris muscles from sheep, were
successfully stained for MEPs. Deeper portions of the
muscles were not satisfactorily stained, due to the
technique applied (Koelle and Friedenwald, 1949).
Examination of each facial muscle in toto, as well as
the separated muscle fiber bundles, showed a cluster-
Max. width Min. width at
Min. length at the origin the insertion
59.8 6 2.92 8.4 6 1.7 5.4 6 1
3.8 6 0.8
42 6 5.12 16.4 6 7 963
7.2 6 1.7 4.6 6 1
14 6 5.8 7.8 6 2
35.4 6 8.2 8.8 6 0.8
21.6 6 2
49.4 6 54 48.6 6 4.2 40.6 6 12.3
60 6 9.66
like distribution of MEPs that varied in size (Fig. 1).
Only one cluster of MEPs was determined on each of
the separated muscle fiber bundles. Its position differed
from bundle to bundle. However, the cluster of MEPs
was always located in an eccentric position and never in
the middle of the fiber bundle.
Great variability in the location of the clusters of
MEPs were observed when comparing the schematic
drawings of each facial muscle with its corresponding
muscle in the 11 human cadavers. The locations varied
from muscle to muscle between the origin and the
insertion. Determining an exact location for the clus-
ters of MEPs with regard to the muscles’ dimensions
was impossible, due to the diversity of their locations.
The locations of the MEP clusters and the previously
determined nerve entrance points were identical. On
each of the assessed muscles we determined several
round or oval-shaped MEP clusters which we therefore
called ‘‘motor zones.’’ The number of motor zones de-
pended on the number of terminal facial nerve branches
entering the muscle.
A predominant motor zone could not be found in
either the orbicularis oculi, orbicularis oris, or buccina-
tor muscle. The MEPs were evenly spread over the
muscles, either isolated or in a great number of small
motor zones (Fig. 2a).
The zygomatic major and minor muscles showed a
predominant motor zone located near the origin, in the
proximal third of the muscles. Two to three additional
small motor zones were found in an eccentric position,
in the proximal and distal third of the muscles (Fig. 2b).
The levator labii superioris, levator labii superioris
alaeque nasi, levator anguli oris, depressor anguli oris,
and depressor labii inferioris muscles showed two to
four large motor zones distributed over the muscle in
eccentric positions (Fig. 2c).
Only these three types of motor zone distributions
were distinguished in the ten evaluated facial muscles.
Muscle Fiber Length
The evaluated facial muscles were composed of
bundles, consisting of parallel muscle fibers. These
continued from origin to insertion without interruption.
 MOTOR ENDPLATE DISTRIBUTION IN FACIAL MUSCLES 279

Fig. 1. Cluster-like arrangement of AChE-stained MEPs. A typical

motor zone on a muscle fiber bundle of the zygomatic major muscle.
350X.

None of the muscles inserting in the orbicularis oris

muscle showed a tendinous insertion. The length of the
bundles and therefore the length of the individual
muscle fibers correlated with the length of the in situ
measured facial muscle (Table 1).
Motor Endplate
Several hundred muscle fiber bundles were exam-
ined from the different facial muscles to determine the
locations of the motor zones. According to the position of
the motor zones, the MEPs were located in an eccentric
position on each muscle fiber. The MEPs of the muscle
fibers could be clearly identified during further division
of the bundles. All the examined MEPs were of the ‘‘en
plaque’’ type (Figs. 3a,b, 4b,c). None of the examined
MEPs were of the ‘‘en grappe’’ type. No differences in
the staining intensity were observed between the hu-
man muscles dissected 2 to 6 days postmortem. The
staining intensity of the MEPs in the sheep muscles
was somewhat darker than that seen in the human
muscles. Examining the human muscle fibers in the
divided bundles, a great number of fibers were identi-
fied bearing more than one MEP. Fibers with more than
one endplate were seen in each of the ten facial
muscles. Many of these fibers were destroyed during
teasing due to the poorer quality of the material.
Finally, a total of 567 muscle fibers, with clearly visible
MEPs, were examined from the ten facial muscles.
In all, 418 fibers (73.8%) showed only one MEP, 121
fibers (21.3%) showed two MEPs, and 28 fibers (4.9%)
showed more than two MEPs.
The multiple MEPs, distributed on the fibers as
described above, were found within a distance of up to
500 µm (Figs. 3a,b, 4b,c,d). These fibers were differenti-
ated into three groups according to the distances be-
tween the multiple MEPs: 45% of the muscle fibers
showed MEPs within a distance of up to 50 µm (Fig. 4b);
48% showed MEPs within a distance of 50–200 µm
(Figs. 3a, 4c); and 7% of the muscle fibers showed MEPs
within a distance of more than 200 µm (Fig. 3b).
Four different MEP distributions were found on the
teased muscle fibers, depending on the number and
location of the MEPs:
Fig. 2. Schematic drawing of facial muscles showing the motor zone
locations, indicated by circular and oval grids. (a) Left M. orbicularis
oculi with MEPs evenly spread over the muscle. (b) Left M. zygomati-
cus major with a main motor zone located near the origin and two to
three additional small motor zones near the insertion. (c) Left M.
levator labii superioris with two to four large motor zones in eccentric
position.
● Single muscle fibers focally innervated by one MEP
(Fig. 4a).
● Single muscle fibers multifocally innervated by two
adjacent MEPs (Fig. 4b).
● Single muscle fibers multifocally innervated by two
MEPs located further apart (Figs. 3a,b).
● Single muscle fibers multifocally innervated by more
than two MEPs (Figs. 4c,d).
The focally innervated muscle fibers showed a MEP
length of 27.6 µm (6 6.3). Those muscle fibers multifo-
cally innervated by two MEPs showed a MEP length of
28.0 µm (6 5.4). Muscle fibers multifocally innervated
by three or more MEPs showed a MEP length of 25.2
µm (6 6.4).
Myotendinous and Myomyous Junctions
All muscle fiber bundles and teased single muscle
fibers were examined under the microscope for myoten-
dinous and myomyous junctions. AChE-stained myoten-
dinous junctions were found at the bony origin of the
muscle fibers but not at their insertion. However, in
280
Fig. 3. (a) Multifocally innervated muscle fiber of the M. levator labii superioris bearing two MEPs
within a distance of 200 µm. (b) Multifocally innervated muscle fiber of the M. zygomaticus major bearing
two MEPs within a distance of 500 µm. Magnification, see calibration bar.
spite of an intensive search for myomyous junctions no
further AChE-stained junctions could be found on the
muscle fibers. The single muscle fibers, therefore, con-
tinued from origin to insertion without interruption or
furcation.
DISCUSSION
According to Austrian law, all corpses must be cleared
by a pathologist before the body donors can be trans-
ferred to the Department of Anatomy for research and
teaching. This meant that the dissection of the body
donors used in this study could not be carried out until
2 to 6 days postmortem. The first stage of this study was
to determine the efficiency of the staining method on
MEPs described by Koelle and Friedenwald (1949).
Human cadaver muscles, which had been kept in cold
storage for several days postmortem, as well as fresh
sheep muscles were used. All the muscles’ MEPs were
successfully stained for AChE. Most authors using the
AChE staining method (Koelle and Friedenwald, 1949)
fix the muscles as described, immediately after removal
from the donor. Successful staining of MEPs up to 18 hr
postmortem was described by Dietert (1965). We were
able to successfully stain muscles up to 6 days postmor-
tem, provided the cadavers were refrigerated in the
morgue soon after death. It seems that AChE is more
stable than generally assumed and can be applied, like
other histochemical techniques (Eriksson et al., 1980;
Happak et al., 1988) up to 6 days postmortem. A control
was set up with sheep muscle to ensure the efficiency of
the applied staining technique. The sheep muscles were
stained simultaneously with the human specimens.
The consistency of the human muscle fibers was of
somewhat poorer quality, due to the onset of autolysis,
which made the teasing of whole fibers extremely
difficult. Consequently, a different approach was taken
to determine the position of MEPs on the muscle fibers
prior to teasing. The locations of the MEPs were
evaluated twice within the entire muscle, once in the
endplate zones and once in the divided bundles. This
approach facilitated the teasing procedure considerably
as it was then only necessary to tease and evaluate
small pieces of the fibers bearing MEPs.
W. HAPPAK ET AL.
It has been described that 21 paired facial muscles
are innervated by the facial nerve (Gray, 1989). The
current study deals only with the ten most important
facial muscles, responsible for facial movements and
emotional expression. Our foremost interest was to
acquire more information on their innervation pattern,
especially the clinical aspect of facial palsy and the
dynamic reconstruction with skeletal muscles. Further-
more, the technique of teasing muscle fibers is ex-
tremely time-consuming, so that we concentrated on
the most important muscles and excluded the remain-
ing 11 from this study.
It is generally assumed that a great number of
human skeletal muscles, as well as extraocular muscles,
have a well-defined neurovascular hillum. Long skel-
etal muscles (M. gracilis, M. sartorius), or flat skeletal
muscles (abdominal muscles) can be innervated by two
or more motor nerves with well-defined nerve entrance
points. In most of the skeletal muscles, the MEPs are
arranged as one or more (abdominal muscles) narrow
bands, stretching midway across the muscle fiber
bundles as one or more so-called ‘‘motor bands’’ (Gray,
1989). The neurovascular hillum is always found lo-
cated in the muscle at a considerable distance from the
motor band.
In contrast to the nerves innervating the skeletal
muscles of the trunk and limbs, the facial nerve already
divides in the parotid gland into multiple branches. It
forms an elaborate network of anastomosis and inter-
laced branches before finally entering the facial muscles
(Fujita, 1934; Davis et al., 1956; Bernstein and Nelson,
1984; May, 1986a; Katz and Catalano, 1987). Each
facial muscle was, however, innervated by multiple
terminal branches of the facial nerve without being
accompanied by the corresponding blood vessels. The
plexus of the facial nerve, as well as the route of each
terminal nerve branch to the muscle, was described by
Fujita (1934) and Freilinger et al. (1987). Our observa-
tions were in accordance with these findings and in
addition we found that each motor zone was always
positioned in the immediate vicinity of the entrance
point of the small, terminal facial nerve branch. There-
fore, no distance between the nerve entrances and the
 MOTOR ENDPLATE DISTRIBUTION IN FACIAL MUSCLES
Fig. 4. Teased single muscle fibers of different facial muscles showing
the AChE-stained MEPs of the different innervation patterns. (a)
Focally innervated muscle fiber of the zygomatic major muscle show-
ing one MEP. (b) Multifocally innervated muscle fiber of the buccina-
motor zones was observed as it is typically seen in the
skeletal muscles of the trunk and limbs.
Furthermore, we found round or oval-shaped cluster-
like arrangements of MEPs on the facial muscles,
varying in size, which we named ‘‘motor zones.’’ None of
the evaluated facial muscles displayed a motor band-
like MEP distribution. The orbicularis oculi muscle has
a great number of small MEP clusters that are evenly
spread over the muscle (Desmedt 1958). We found this
281
tor muscle with one nerve fiber and two MEPs. (c). Multifocally
innervated muscle fiber of the depressor angular oris muscle with
three MEPs and (d) the complete teased muscle fiber. Magnification,
see calibration bar.
type of motor zone distribution not only applied to the
orbicularis oculi muscle but also to the orbicularis oris
and buccinator muscles. These three muscles showed
similar distributions as described for the laryngeal
muscles by Rossi and Cortesina (1965). For the remain-
ing facial muscles, two unknown types of motor zone
distribution were determined, also according to the
number and size of the motor zones. Two muscles
showed a predominant motor zone with two to three
282 W. HAPPAK ET AL.
additional small motor zones and five muscles showed
two to four large motor zones. Except for the number
and size of motor zones in the facial muscles, no further
similarities could be differentiated. This, therefore,
enabled only a descriptive classification into the three
groups mentioned above.
When reviewing the facial nerve literature, espe-
cially the schematic drawings of Fujita (1934), it can be
considered that the great variability of the motor zone
distribution corresponds to the great variability of the
facial nerve route. The location of the motor zones was
seen to vary as the branching of the facial nerve varied
from specimen to specimen (Davis et al., 1956). There-
fore, the diversity of motor zones on the entire muscle
was such that no general statement can be made
concerning their exact positioning.
Comparable characteristics have already been de-
scribed for the different laryngeal muscles (Rossi and
Cortesina, 1965), which is another muscle system stem-
ming from the branchial arches (Gray, 1989). Here,
similar variability of eccentric motor zone distribution
was seen, such as a random distribution in the medial
two-thirds of the muscles (Rosen et al., 1983; De Vito et
al., 1985; Freije et al., 1986), a banded or Y-shaped
motor zone distribution (Freije et al., 1986, 1987) and
an arc-like patterned distribution (Gambino et al.,
1985). The facial muscles show a unique innervation
pattern unlike that seen in the skeletal muscles of the
trunk and limbs (Desmedt, 1958; Christensen, 1959;
Schwarzacher, 1959; Aquilonius et al., 1984). It appears
to be common among several muscles stemming from
the branchial arches.
Most of the authors who have examined human
skeletal muscle fibers have described a single MEP,
always positioned, with respect to the longitudinal axis,
in the middle of each muscle fiber (Desmedt, 1958;
Christensen, 1959; Schwarzacher, 1959; Aquilonius et
al., 1984; Carlson, 1986; Vrbová et al., 1995). This,
however, cannot be said for facial muscles, where one to
five MEPs were seen, always in an eccentric position on
a single muscle fiber.
Based on his electrophysiological results, Desmedt
(1958) postulated that the muscle fibers of the orbicu-
laris oculi muscle may have a ‘‘multiple innervation.’’
All facial muscles were also assumed to contain ‘‘multi-
ply innervated muscle fibers’’ (Coers, 1967). We were
able to find such muscle fibers in all ten human facial
muscles by using the AChE staining method for MEPs.
Nowadays, such ‘‘multiply innervated muscle fibers’’
with ‘‘en plaque’’ MEPs should be referred to as ‘‘multi-
focally innervated muscle fibers’’ (Zenker et al., 1990).
Namba et al. (1968) described that in human extraocu-
lar muscles, besides slow multiply innervated fibers
with ‘‘en grappe’’ MEPs, focally and multifocally inner-
vated twitch fibers with one or two ‘‘en plaque’’ MEPs
were also present.
Human laryngeal muscles mainly contain twitch
fibers with ‘‘en plaque’’ MEPs. Up to 80% of the fibers
were multifocally innervated (Rossi and Cortesina,
1965; Benediksen et al., 1981; De Vito et al., 1985;
Rossi, 1990). Benediksen et al. (1981) showed that most
of the multiple MEPs on the laryngeal muscle fibers
were positioned at distances between 100–200 µm.
Furthermore, they found a larger number of MEPs with
an even greater distance between the MEPs, up to 5000
µm. In contrast, our study shows that 45% of the facial
muscle fibers exhibited multiple MEPs within a dis-
tance of 50 µm. Approximately the same numbers of
facial muscle fibers (48%) were found with multiple
MEPs between 50 and 200 µm, and only a few muscle
fibers (7%) had multiple MEPs within a distance of up
to 500 µm. It therefore appears that muscles stemming
from the branchial arches, with multifocally innervated
muscle fibers, show great variability in their innerva-
tion pattern.
Studies by Rossi and Cortesina (1965), Benediksen et
al. (1981), and Rossi (1990) revealed that a great
number of laryngeal muscle fibers (70–80% vocalis,
50% cricothyroid and lat. cricoarytenoid, 5% posterior
cricoarytenoid) were multifocally innervated in the
current study 26% of the facial muscle fibers showed
more than one MEP. It seems that there is great
variability in the number of MEPs per muscle fiber in
the muscles stemming from the third and fourth bran-
chial arch (5–80%). Our method of preparation and
staining was chosen in order to evaluate the distribu-
tion, location, and size of MEPs whereby only the
superficial layers of the muscles were closely scruti-
nized. To establish the number of muscle fibers with one
MEP and the number of those with two or more MEPs
and give a precise ratio, it would be necessary to use a
different technique than the one applied here. Future
studies may answer this question.
Former studies by other authors concerning the
innervation of human skeletal muscles (Desmedt, 1958;
Christensen, 1959; Schwarzacher, 1959; Aquilonius et
al., 1984; Carlson, 1986; Wokke et al., 1990; Hessel-
mans et al., 1993) have shown that focal innervation of
muscle fibers with one MEP is the predominant type.
We conclude that multifocally innervated fibers would
have been found by these authors if present. Multifo-
cally innervated fibers are present in the facial muscle
as in the laryngeal muscles. Laryngeal muscles are
dependent on a specific neural regulation (Rossi, 1990).
It is reasonable to assume that the same is true for the
facial muscles, especially as both are capable of very
fine adjustments for speech, emotional expression, and
defence reflexes.
Studies on animal muscles (Barker and Ip, 1966;
Wernig et al., 1984) determined that the presence of
multiple MEPs may be due to MEP regeneration. This
was observed in 8.1% of the investigated fibers (Barker
and Ip, 1966). In contrast, 26% of facial muscles fibers
and up to 80% of laryngeal muscle fibers showed
multifocal innervation. Therefore, we would exclude
that all these fibers have been subjected to continuous
MEP regeneration. Furthermore, it seems to be rare in
humans (Wokke et al., 1990) and no author at present
has described regenerated or remodelled MEPs at a
distance up to 500 µm. In our opinion, the above-
mentioned specific neural regulation is responsible for
the multifocal innervation of muscle fibers and MEP
regeneration plays a minor role.
Few studies exist where the length of human ‘‘en
plaque’’ MEPs have been evaluated. The measured data
of MEP lengths from 18–27 µm (Namba et al., 1968;
Wokke et al., 1990; Hesselmans et al., 1993) are in
accordance with the evaluated facial MEP lengths of
25–27 µm.
 MOTOR ENDPLATE DISTRIBUTION IN FACIAL MUSCLES
It is apparent that the innervation of human facial
muscle fibers is complex. It is not yet known if multiple
endplates on a single facial muscle fiber are innervated
mono- or polyneuronally. The great number of anasto-
mosing nerve branches in the lateral face and the
plexus of the facial nerve (Fujita, 1934; Davis et al.,
1956; Bernstein and Nelson, 1984; Katz and Catalano,
1987) suggest that a polyneuronal innervation type
could be present in the facial muscles. Perhaps it is the
polyneuronal innervation which enables the facial
muscles to perform the fine adjustments necessary for
emotional expression. However, the employed tech-
nique cannot, at present, identify the innervation type
(Wokke et al., 1990).
Another reason for multifocally innervated extra-
fusal fibers could be the security of neurotransmission,
and quantitative or qualitative aspects of muscle fiber
innervation (Zenker et al., 1990; Vrbová et al., 1995) for
the regulation of fine adjustments for facial expression.
An acceptable physiological explanation for extrafusal
muscle fibers with multiple endplates in animals is still
needed (Zenker et al., 1990), therefore, further research
in this field is necessary in order to facilitate research
in humans.
Well-stained AChE-positive myotendinous junctions
were observed at the bony origin of the facial muscles,
as described by Schwarzacher (1960) for the skeletal
muscles. They were also expected to be found at the
insertion. However, we were unable to find myotendi-
nous junctions at the point of the described insertions
for the facial muscles. This may be due to insufficient
staining or the described insertions of these muscles
are elsewhere. Myomyous junctions were described in
several muscles for different animals and in the latissi-
mus dorsi muscle of man (Zenker et al., 1990). We were
unable to find myomyous junctions despite an intensive
search on the muscle fibers from origin to insertion. The
absence of myomyous junctions in the examined muscle
fibers suggests that the length of each single muscle
fiber directly correlates to the corresponding facial
muscle. The data described in Table 1 are consistent
with the results of previous studies on facial muscle
dimensions (Freilinger et al., 1987).
It can be concluded that the innervation pattern, of
the facial muscles, regulates muscle contraction by a
particular independent mechanism as postulated for
the laryngeal muscles by König and van Leden (1961)
and Rossi (1990) and may be true for a great number of
the muscles developing out of the branchial arches.
There is no doubt that the facial muscles are striated
muscles. However, great differences are apparent when
reviewing the data presented in comparison to the
striated skeletal muscles of the trunk and limbs.
The mechanism of neural control, responsible for
facial muscle function and emotional expression, is still
unknown (Conley, 1986). In facial paralysis, some of the
facial muscle function can be restored surgically. Never-
theless, as yet it has not been possible to restore
spontaneous emotional expression. Even in some cases
of idiopathic facial palsy, where no surgical treatment is
necessary, some deficit remains after regeneration (May,
1986b; Cole et al., 1991). It seems that the regenerating
nerve fibers are unable to regain the original complex
innervation pattern of the facial muscle system.
283
Even after reconstruction of facial palsy with a
cross-facial nerve graft and a free-muscle graft deficits
remain, which are especially seen when smiling. This
may not only be due to the decreased number of
regenerating motor units in the facial muscles (Ray-
ment et al., 1987) but it seems that it is also due to the
nature of the complex innervation pattern of the facial
muscles.
After successful reconstruction of the paralyzed face,
it is necessary for the patient to relearn how to use that
part of the face and coordinate the movements with the
healthy side (Frisch, 1991). This can only be achieved
on command, on purpose, and by discipline, but never
by spontaneous emotional reactions (Conley, 1986).
In summary, the data presented concerning the inner-
vation pattern of the facial muscles endeavors to pro-
vide a contribution toward a better understanding of
the mimetic functions. It may lead to the development
of new clinical methods for different diseases and
disorders of the facial nerve and the facial muscle
system, as well as for the treatment of facial palsy.
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