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Minimizing risk to the integrity of the facial nerve is a critical measure of surgical success in temporomandibular joint (TMJ) surgeries. The surgeon must have a keen understanding of the regional anatomy combined with a planned dissection to protect the facial nerve in their approach to the joint [1]. Facial nerve injury may have devastating effects on the patient esthetically and functionally due to impairment of the frontalis and/or orbicularis oculi muscles. According to Liu et al., the most current review of the literature reveals that the incidence of facial nerve injury in conjunction with open TMJ surgery ranges from 12.5 to 32% [2]. The chapter will provide a review on the anatomy of the facial nerve, procedures leading to potential injury, recognition of injury, and multiple methods of management.