Vantaggi
Based on my personal experience, those who are willing to put in the effort to gain the confidence of management will be empowered and encouraged to bring in new ideas, implement change and improve the way the company does business. I have had the chance to carry out my own initiatives and ideas, try out new strategies, tools, etc. If you are willing to put in the work (and accept that it is up to you to get management's trust) you will have a meaningful role in the organization and make a real impact on business. Something you couldn't do at a large multinational company.
Svantaggi
There is no trust from senior management by default, it has to be earned. If you come from an American style - we hired you because you are an expert, do whatever you want from day one - culture, you will find that you clash with the leadership team regularly on very operational things. You must keep in mind that this is a family owned company, which had 20 employees for most of it's life. The owners built this from the ground up. It is their baby. They will expect you to prove you can be trusted with their baby before they give you control. If you feel this sounds daunting or tiresome, this may not be the place for you.