Evaluation of the forAge Age-at-Death Estimation Program Using Pubic Symphyseal Surface in a Korean Population

The forAge program estimates the age-at-death of human pubic symphysis using 3-dimensional scans. It was developed by Dennis E. Slice and Bridget F. B. Algee-Hewitt, and utilizes three distinct scores: the Slice and Algee-Hewitt (SAH) score, bending energy (BE), and ventral curvature (VC). However, these scores and age estimation regression equation were obtained through European American pubic symphysis. Changes in the pubic symphysis surface are evaluated as one of the most reliable indicators for estimating age, but in connection with this, using Korean materials, changes in the pubic symphysis surface and the actual changes are evaluated. There is no bar where the relationship between ages is grasped, and there are cases where a methodology developed for a specific group is applied to a Korean group. Changing the pubic symphysis surface by aging was evaluated as one of the most reliable indicators for estimating age. However, there is no study conducted on the relationship between changes in the pubic symphysis and actual age and applied the age estimation method for a specific population among Korean population. The purpose of this study is to compare the difference between the actual age and the estimated age in Korean to see if the forAge program is applicable to other population of different ancestral origin. One hundred and four modern Korean pubic symphyseal surfaces (47 to 96 years old) were used in this study. Through the pubic symphyseal surface 3-dimensional images, age-at-death was estimated via prediction equation and new regression lines using SAH, VC, and BE scores. Firstly, the estimated age via prediction equation using the first version of SAH score was lower than the actual age according to all pubic symphyseal surfaces for those older than 56. With aging, the difference between the actual age and estimated age became markedly larger. Secondly, the estimated ages via the new regression lines using VC, the second version of SAH score, and BE were shown a similar pattern to the previous prediction equation. The current study explored the applicability of a quantitative method using pubic symphyseal surface for age estimation in a modern Korean population. This study showed the forAge program cannot be applied to a modern Korean population, as they present relatively low correlations with the actual age-at-death.

A novel histologic description of the fibrous networks in the lid-cheek junction and infraorbital region

The aim of this study was to identify the anatomical feature of retaining ligament and fat compartment on the lower eyelid and infraorbital region using a histological method, and to investigate clear definitions for them which could be used generally in the clinical area. Eighteen specimens from eight fresh Korean cadavers were stained with Masson trichrome or hematoxylin and eosin. The ligamentous and fascial fibrous tissue were clearly identified. The ligamentous fibrous tissue which traversed in the superficial and deep fat layer was skin ligament and orbicularis retaining ligament (ORL). The fascial fibrous tissue enclosed the orbicularis oculi muscle (OOc) and circumferencial adipose tissue. Based on the ligamentous and fascial structure, three fat compartments, septal, suborbicularis oculi and infraorbital fat compartment, could be identified. The OOc attached to orbital rim and dermis by ORL and skin ligament, and the muscle fascicle and fat fascicle provided the connection point to the ORL and skin ligament as enclosing all muscle and fat tissue. The combination of the force made by the skin ligament in the lower eyelid and ORL may decide the level and form of the infraorbital grooves.

Why Do Nasolabial Folds Appear? Exploring the Anatomical Perspectives and the Role of Thread-Based Interventions

The classification of nasolabial folds into three types, each with distinct causative factors and mechanisms, is explored. Age-related changes in facial skin and connective tissues are examined in detail, revealing variations across different facial regions due to variances in tissue firmness and thickness. The innovative 'Reverse Technique,' involving cog threads to enhance tissue traction and effectiveness in thread-lifting procedures, is introduced. Detailed technical guidelines, anatomical considerations, and safety measures are provided, emphasizing the importance of identifying optimal vectors and fixing points to achieve maximum lifting effects while minimizing potential risks, particularly those associated with vascular structures. Additionally, the 'Cross Technique using volumizing thread' is discussed, designed to smooth tissue boundaries and rejuvenate sagging areas. Facial anatomy, including the positioning of arteries and ligaments, is underscored as essential for ensuring the safety and efficacy of procedures. In conclusion, this review stands as a comprehensive guide for practitioners, offering insights into innovative thread-lifting methods and their applications in addressing nasolabial folds. The primary focus is on achieving optimal aesthetic results while prioritizing patient safety.

Anatomical Considerations for the Injection of Botulinum Neurotoxin in Shoulder and Arm Contouring

The utilization of botulinum neurotoxin in the field of body contouring is on the rise. Body contouring procedures typically focus on specific muscle groups such as the superior trapezius, deltoid, and lateral head of the triceps brachii. The authors propose identifying optimal injection sites for botulinum neurotoxin to achieve desired aesthetic contouring of the shoulders and arms. The authors conducted a modified Sihler's staining method on specimens of the superior trapezius, deltoid, and lateral head of the triceps brachii muscles, totaling 16, 14, and 16 specimens, respectively. The neural distribution exhibited the most extensive branching patterns within the horizontal section (between 1/5 and 2/5) and the vertical section (between 2/4 and 4/4) of the superior trapezius muscle. In the deltoid muscle, the areas between the anterior and posterior deltoid bellies, specifically within the range of the horizontal 1/3 to 2/3 lines, showed significant intramuscular arborization. Furthermore, the middle deltoid muscle displayed arborization patterns between 2/3 and the axillary line. Regarding the triceps brachii muscle, the lateral heads demonstrated arborization between 4/10 and 7/10. The authors recommend targeting these regions, where maximum arborization occurs, as the optimal and safest points for injecting botulinum toxin.

A novel description of the supporting system of the orbicularis oculi muscle in the infraorbital area: Tear trough muscle fiber

BACKGROUND

The aim of this study was to elucidate the anatomical structures of supporting system of the infraorbital area.

MATERIALS AND METHODS

Forty-four hemifaces from eleven Korean and eleven Thai cadavers were used to dissect the infraorbital area. Based on the dissection and previous histologic results, they were analyzed.

RESULTS

The orbicularis oculi muscle (OOc) had two portions (palpebral and orbital portion) and four subparts (pretarsal, preseptal, prezygomatic, and premaxillary part). The elliptical muscle fiber of OOc was supported by circumferential connective tissue including skin ligament, orbicularis retaining ligament, zygomatic ligament, and zygomatic cutaneous ligament. The vertical muscle fiber, the tear trough muscle fiber, and medial muscular band directly attached to the skin.

CONCLUSION

Full of subcutaneous tissue in the tear trough groove, strong attachment to the bone by tear trough ligament and to the skin by tear trough muscle fiber would multiply result in the tear trough on the face.

Anatomical consideration of ultrasonography-guided intraoral injection for temporal tendinitis

Temporal tendinitis is characterized by acute inflammation often resulting from mechanical stress, such as repetitive jaw movements associated with jaw opening and closing and teeth clenching. Treatment for temporal tendinitis typically involves the administration of local anesthetic or corticosteroid injections. However, the complex anatomical structure of the coronoid process, to which the temporalis tendon attaches, located deep within the zygomatic arch, poses challenges for accurate injections. In this study, we aimed to establish guidelines for the safe and effective treatment of temporal tendinitis by using intraoral ultrasonography (US) to identify the anatomical structures surrounding the temporalis tendon and coronoid process. US was performed using an intraoral transducer on 58 volunteers without temporomandibular joint disease. The procedure involved placing the transducer below the occlusal plane of the maxillary second molar. Measurements were taken for the horizontal distance from the anterior border of the coronoid process, observed at the midpoint (MP) of the US images, and the depth of the coronoid process and temporalis muscle from the oral mucosa. The anterior border of the coronoid process was visualized on all US images and classified into three observed patterns at the MP: type A (anterior to the MP, 56.2%), type B (at the MP, 16.1%), and type C (posterior to the MP, 27.7%). The temporalis muscle was located at a mean depth of 3.12 ± 0.68 mm from the oral mucosa. The maxillary second molar is an intraoral landmark for visualizing the anterior border of the coronoid process. The new location information obtained using intraoral US could help identify the safest and most effective injection sites for the treatment of temporal tendinitis.

A Phase II Trial Evaluating Rapid Mid-Treatment Nodal Shrinkage to Select for Adaptive Deescalation in p16+ Oropharyngeal Cancer Patients Undergoing Definitive Chemoradiation

PURPOSE/OBJECTIVE(S)

The purpose of this study is to determine if rapid mid-treatment nodal shrinkage (RMNS) can identify patients with p16+ oropharyngeal cancer (OPC) who can be safely deescalated with reduced dose chemoradiation therapy (CRT). The primary endpoint was 2-year progression free survival (PFS).

MATERIALS/METHODS

Inclusion criteria were as follows: T1-3, N1, M0 (AJCC 8th edition) p16+ OPC with <10 pack-year smoking history. All patients were initially planned for standard dose CRT (70 Gy) and weekly cisplatin. Patients were evaluated with a CT scan at week 4 for RMNS, defined as >40% nodal volumetric reduction from baseline. If RMNS was achieved, they proceeded to deescalated CRT (60 Gy). If not, they received standard CRT. Biomarker correlates were collected at baseline and week 4 of CRT including plasma TTMV (tumor tissue modified viral) HPV DNA and MRI diffusion weighted imaging (DWI). Univariate logistic regression analyses (UVA) were performed to evaluate predictors of RMNS. Odds ratios with 95% CI are reported, using a p<0.05 for statistical significance with a two-sided test. Wilcoxon rank sum tests were used to evaluate differences between the two groups using p < 0.05, 2-sided) for statistical significance. All statistical procedures were performed using R () with no adjustments for multiple testing.

RESULTS

Thirty-six patients were enrolled: median age: 60 years; 81% male; primary site: 36% base of tongue, 53% tonsil, 11% both; T-stage: 39% T1, 50% T2, 11% T3; N-stage: 100% N1; any smoking history: 58% yes, 42% no; 67% (n = 24) had RMNS and received deescalated CRT while the remaining proceeded to standard CRT. At a median follow-up of 32.4 months, 2-year PFS between the standard and deescalated groups were 91.7% vs 90.9%, respectively (p = 0.97). All patients with recurrence underwent successful salvage treatment with 2-year OS 100% for all patients. On UVA, rapid TTMV HPV DNA clearance (baseline to week 4) (OR 12.0 [1.65-250], p = 0.034), lower MRI diffusivity (ADC) at baseline (OR 0.79 [0.61-0.97], p = 0.042) and week 4 (OR 0.76 [0.60-0.91], p = 0.009), and higher MRI diffusional kurtosis at baseline (OR 1.09 [1.01-1.21], p = 0.051) and week 4 (OR 1.24 [1.09-1.52], p = 0.009) were significantly associated with RMNS. When comparing the deescalated and standard cohorts, the mean baseline and week 4 MRI ADC were significantly lower and week 4 MRI diffusional kurtosis was significantly higher in the deescalated group.

CONCLUSION

In this phase II study, rapid mid-treatment nodal shrinkage appeared to select favorable risk p16+ oropharynx cancer patients for treatment de-escalation. Rapid clearance of TTMV HPV DNA at week 4 as well as MRI DWI biomarkers of low ADC and high diffusional kurtosis values were correlated with RMNS. A larger study is planned to incorporate RMNS and biomarkers for further treatment de-escalation. Additional trial information is available at ClinicalTrials.gov (Identifier: NCT03215719).

A Pilot Study of Head and Neck Cancer Patients Treated Daily with an Intraoral Photobiomodulation (PBM) Device while Undergoing IMRT Demonstrates Tolerability, Safety, and Preliminary Efficacy for Reducing the Impact of Oral Mucositis

PURPOSE/OBJECTIVE(S)

Radiotherapy (RT) when given for head and neck cancer (HNC) causes acute and chronic adverse events (AEs). Oral mucositis (OM) is a significant AE and can impact cancer treatment (interruptions and/or early termination), increase opioid usage, impact diet (dysgeusia, dysphagia, inadequate nutritional intake), and cause depression. Pharmacological options are limited; however supportive care treatment guidelines (MASCC, WALT) recommend photobiomodulation (PBM) therapy for the prevention/treatment of OM. PBM is the use of non-ionizing light in the visible and near-infrared light spectra to modulate biological systems, such as wound healing. Current PBM protocols for OM prevention involve laser-based treatments using spots that are technique sensitive and time consuming. The (Sponsor) Phototherapy System uses an LED-based intraoral mouthpiece to deliver a dosage of 6 J/cm2 to the entire oral cavity, soft palate, uvula, retromolar trigone, and portions of the oropharynx in a daily 10-minute treatment. Per sponsor protocol, this medical device is used daily in the radiation therapy clinic without proximate physician supervision.

MATERIALS/METHODS

A pilot study was performed at 7 centers (5 academic) to assess feasibility. HNC participants receiving chemotherapy and IMRT with a minimum of 30Gy to greater than one oral site received a 10-min PBM treatment prior to daily RT. Pain medications and mouthwashes were permitted. PBM treatment was delivered at the radiation clinic throughout the entire duration of IMRT. Device safety (daily) and OM (weekly) evaluations were completed, and participant status was reviewed for primary and secondary outcomes at week six. OM was graded according to the Oral Mucositis Index (OMI), NCI, and RTOG scales.

RESULTS

A total of 40 patients were enrolled, 3 withdrew consent and 3 did not complete 80% of PBM treatments. A total of 1227 of 1271 study treatments were completed in full and no device-related adverse events were reported. At week 6: Participants averaged of 8.74/60 on the OMI; NCI/RTOG grades ranged from 0-3. Grade distribution was 0 (1/1), 1 (5/5), 2 (9/8), 3 (19/20) respectively. A total of 52% of salivary flow was retained. Participants reported they could swallow solids for 24.3/30 treatments (avg). Thirteen of 34 patients retained the ability to swallow solids throughout.

CONCLUSION

PBM has been recommended to prevent/treat OM; however, current options are technique sensitive and time consuming for physicians. The (Sponsor) Phototherapy System shows encouraging results in a pilot cohort, is well tolerated for daily treatments in a clinic setting and is safe without apparent device-related adverse events. This device presents a promising alternative for PBM delivery and is currently being evaluated for safety and efficacy in a double-blind randomized clinical trial (NCT03972527).

Three-dimensional micromorphology of human midpalatal suture and pterygomaxillary articular complex

BACKGROUND

Sutures exist in the craniofacial area, and the pattern of maturation and synostosis of facial sutures is largely unknown.

METHODS

For a comprehensive understanding of the three-dimensional circummaxillary suture micromorphology, human midpalatal suture (MPS) and pterygomaxillary articular complex from eight subjects' (five males, three females, 72-88 years old) autopsies were longitudinally scanned with microcomputed tomography. Additional histology was performed for hematoxylin and eosin staining. Sutural micromorphology was assessed by interdigitation index (II), obliteration index (OI) and obliteration number. Intergroup comparisons were performed with Kruskal-Wallis and Mann-Whitney U with Bonferroni correction (α = 0.005). Correlation with anteroposterior and craniocaudal gradients was assessed with Spearman's correlation test (α = 0.05).

RESULTS

Maxillary region of MPS presented a higher II 1.50 (0.61) and obliteration number per slice 8 (9) (P < 0.005). OI was increased in palatomaxillary 35% (47%) followed by pterygopalatine suture 25% (49%) (P < 0.005). The II and OI of the MPS exhibited only a weak anteroposterior gradient, with relatively low correlations. Obliteration areas were found sporadically along the entire MPS.

CONCLUSIONS

Based on these findings, it is conceivable that the success of nonsurgical maxillary expansion largely depends on individual variations in sutural morphology and maturation rather than appliance design.

The Deep Temporal Arteries: Anatomical Study with Application to Augmentations Procedures of the Temple

The aim of this study was to determine the anatomical features of the deep temporal arteries (DTAs) and thereby provide clinical information for the temple augmentation procedure. Forty-two adult hemifaces from 15 Korean and 6 Thai cadavers (12 males, 9 females; mean age at death, 79.6 years) with no history of trauma or surgical procedure on the temple area were used for anatomical study. A detailed dissection was performed to identify the locations of the anterior and posterior deep temporal arteries (ADTA and PDTA) with reference to the vertical plane passing through the zygomatic tubercle. Fifty-eight healthy Korean participants (31 males and 27 females; mean age, 24.7 years) were included in the ultrasonographic study. The distance from the bone to the DTAs was measured at the level of the zygomatic tubercle (H_Zt ) and the eyebrow (H_Eb ). The DTAs were not found within 7.2-12.6 mm posterior to the zygomatic tubercle; instead, the locations varied widely at the H_Eb . The distances between the bone and the ADTA were 1.7 ± 1.2 mm (mean ± SD) and 1.3 ± 0.8 mm, and those between the bone and the PDTA were 2.1 ± 1.2 mm and 2.0 ± 1.4 mm at H_Zt and H_Eb , respectively. Our findings indicate that at H_Zt , the area 1 cm posterior to the zygomatic tubercle may be a safe area for deep temple augmentation procedures. However, because the distribution patterns of the DTAs at H_Eb and depth of the DTAs are variable, additional care is required to minimize the risks of the procedure.

Face painting as an anatomical learning tool based on individual ultrasonographic examination

Considering the shift to online education during the COVID-19 pandemic, new and easily accessible educational videos and content on clinical anatomy are necessary. This study utilized numerous references and data on the anatomy of Asian facial muscles and blood vessels to accurately depict human anatomy through face painting. It aimed to provide clinicians accurate educational video content on anatomy to help prevent possible complications during noninvasive facial and surgical procedures. A 26-year-old Korean-Chinese male volunteer was used as a face painting model. The location of the blood vessels of the face was confirmed through ultrasonography images using a real-time two-dimensional B-mode. The model's face was painted by an artist majoring in anatomy. To reveal most anatomical structures on both sides of the face, the left side showed the structures observed when the skin and superficial fat layer are removed, and the right side revealed the deeper layer structures that can be seen when some muscles are cut. Fifteen superficial and deep muscles important in esthetic procedures were meticulously painted on the face. The face painting took a total of 6 h, and the video was edited to 5 min. This study merged the advantages of 2D and 3D by painting directly on the skin surface of a living model. Thus, it can provide more dynamic surface anatomy data. These contents inform clinicians about 3D anatomic location, which can help avoid complications when performing clinical procedures on the face.

Does the fixture thread depth affect the accuracy of implant placement during fully guided immediate implant placement?: A human cadaver study

BACKGROUND

The fixture thread depth reportedly influences the primary stability of dental implant, but its effect on the positional accuracy in immediate implant placement has not been reported previously.

MATERIALS AND METHODS

Fifty-six single-rooted, anterior and premolar teeth were extracted from six human cadavers, followed by installing either regular-threaded implants (RT group, N = 30) or deep-threaded implants (DT group, N = 26) completely relying on the surgical guide. Optical impressions taken after osteotomy and fixture installation were superimposed with the preoperative virtual planning data to measure the vertical, angular, platform and apex deviations that occurred during osteotomy and installation.

RESULTS

While the osteotomy deviations were similar between the two groups, the angular and apex deviation of the DT group (2.67 ± 2.56°; 1.04 ± 0.49 mm, respectively) were significantly larger than those of the RT group (1.61 ± 1.04°; 0.67 ± 0.41 mm, respectively) during installation (p < .05). When the installation deviations were analysed in the anterior and premolar areas separately, the angular, platform and apex deviations of the DT group (3.05 ± 3.26°; 0.75 ± 0.32 mm; 1.08 ± 0.56 mm, respectively) were significantly larger than those of the RT group (1.56 ± 0.73°, 0.59 ± 0.28 mm; 0.62 ± 0.38 mm, respectively) in the anterior site (p < .05), whereas there was no significant intergroup difference in the premolar site.

CONCLUSION

In immediate-implant surgery, using an implant with a deeper thread might increase the deviations during installation, especially in the anterior area.

Ultrasonographic Analyses of Crow's Feet and Novel Guideline for Botulinum Toxin Injection

BACKGROUND

Crow's feet are bilateral orbital wrinkles formed by the orbital portion of the orbicularis oculi muscle, which is the target muscle for botulinum neurotoxin (BoNT) injection.

OBJECTIVES

This study's aim was to demonstrate a novel BoNT injection guideline by assessing muscle width, thickness, and dynamic features using ultrasonography.

METHODS

Twenty healthy Korean volunteers (10 men, 10 women; mean age, 25.6) participated. The width, thickness, and dynamic movement of the orbicularis oculi muscle were measured using ultrasonography. Two volunteers were selected to receive BoNT injections. Injections were administered using a novel method with two curved reference lines passing a point 15 mm lateral to the lateral canthus (conventional injection) and a point 5 mm lateral to the lateral margin of the frontal process of zygomatic bone (additional injection).

RESULT

At the lateral canthus level, the distance between the lateral margin of the frontal process and the most lateral margin of the orbicularis oculi muscle was 12.5±1.3 mm. The thickness of the orbicularis oculi muscle at the midpoint of the frontal process, the lateral marginal of the frontal process, and 5 mm lateral to the lateral marginal of the frontal process was 0.7±0.3 mm, 1.1±0.3 mm, and 1.2±0.3 mm, respectively. The crow's feet of the two volunteers began to disappear from day 3 and completely disappeared on day 7 after the injection.

CONCLUSION

The novel injection technique based on the ultrasonographic anatomy resulted in improvements in the appearance of crow's feet.

Ultrasonography Analysis of Vessels Around the Forehead Midline

BACKGROUND

Filler injection into the glabella is well known to be a highly dangerous procedure due to the high risk of embolism and intravascular injection. Although it is conventional practice to insert the cannula into the middle of the forehead to perform injections into the glabella or radix, vascular structures can be observed in this region during anatomic dissection procedures.

OBJECTIVES

The aim of this study was to characterize the blood vessels around the forehead midline in order to provide crucial anatomic information for ensuring the safety of noninvasive procedures involving the forehead and glabella.

METHODS

Ultrasonography image scanning was performed at the following 4 points on the forehead midline: trichion (P1), metopion (P2), halfway point between metopion and glabella (P3), and glabella (P4). The courses and locations of vessels were identified and classified according to their proximity to the forehead midline.

RESULTS

Vessels coursing within 0.75 cm either side of the forehead midline were found in 34% to 50% of individuals. Arteries running near the forehead midline tended to be dominant on the right side of the forehead except in the P4 area. About half of the individuals had vessels in the P4 area, of which 96.7% were veins.

CONCLUSIONS

The present results indicate that there are superficial vessels running close to the midline of the forehead. This anatomic information can explain the higher incidence of vascular complications during conventional aesthetic procedures. To ensure safety, the cannula entry point or needle puncture point for glabella augmentation should be reconsidered.

Three-Dimensional Evaluation of the Depressor Anguli Oris and Depressor Labii Inferioris for Botulinum Toxin Injections

BACKGROUND

Botulinum toxin type A (BoNT-A) injection administered at an inappropriate site or depth can produce an unwanted change in facial animation because the depressor anguli oris (DAO) and depressor labii inferioris (DLI) muscles are partially overlapped. Therefore, simple BoNT-A injection guidelines, based on 3-dimensional (3D) facial anatomic references and landmarks, would be very useful.

OBJECTIVES

The aim of this study was to establish novel BoNT-A injection guidelines that include the soft tissue thickness at the lower perioral region. Data were acquired with a 3D scanning system combined with dissections in order to obtain accurate injection sites and depths for the DAO and DLI.

METHODS

3D scans of the facial skin, superficial fat, and facial muscle surface were performed in 45 embalmed cadavers. The thicknesses of the skin and subcutaneous layer were calculated automatically from superimposed images at each of 5 reference points (P) in the perioral region.

RESULTS

In every case (100%), P3 and P5 were located in the DLI and DAO areas, respectively (45/45). Therefore, we defined P3 as the "DLI point" and P5 as the "DAO point." The soft tissue thicknesses at the DLI and DAO points were 6.4 [1.7] mm and 6.7 [1.8] mm, respectively.

CONCLUSIONS

The P3 and P5 described in this study are effective guidelines that only target the DLI and DAO. Clinicians, specifically, can easily use facial landmarks, such as the cheilion and pupil, to assign the DLI and DAO points without any measurement or palpation of the modiolus.

Clinical anatomy considerations on the muscular and vascular components of the midface by ultrasonographic imaging

The first signs of face aging appear in the midface, so procedures such as botulinum toxin and filler injections are performed there. However, no guidelines based on clinical anatomy describing the muscular and vascular components in vivo have been published. The aim of this research was to describe the depths of the midface muscles and the locations of vessels using ultrasonographic (US) imaging. US was applied at 12 landmarks on the midface in 88 volunteers (49 males and 39 females; 19-36 years) to detect sex differences in the depths of muscles and the locations of the vessels. The depths of the orbicularis oculi (OOc), levator labii superioris alaeque nasi (LLSAN), and zygomaticus minor (Zmi) differed significantly with sex at P7 (p = 0.001) and P8 (p = 0.017), P1 (p = 0.028), and P4 (p = 0.035), respectively. The facial artery, facial vein, angular artery, angular vein, and perforator vessels were found at P9, P2 and P10, P1, P1 and P5, and P8, P11 and P12, respectively. The findings indicate that the depths of the OOc, LLSAN, and Zmi muscles differ between the sexes and that the vessels appear at specific landmarks. This information could help in developing anatomical guidelines for several procedures.

Body donation trends in Yonsei University: a statistical analysis of donor records

Body donation trends in Korea have changed significantly over the last 3 decades. Establishing a body donation system will promote donations to universities for academic purposes. Yonsei University College of Medicine started its own body donation system in 1992, including documenting donors’ records. However, there has been no reported attempt to analyze the trend of these records, which could provide noteworthy information that can be interpreted for medical advances. This study performed a statistical analysis of the donors’ records between 1992 and 2019 to analyze the sociological and anthropological changes. Donor personal information such as sex, age, religion, and place and cause of death were extracted from the Yonsei University College of Medicine database. Our statistical analysis revealed significant correlations between donors’ records and the changes in the number of geriatric hospitals, religious beliefs, number of donations, and donor age.

Three-dimensional topography of facial soft tissues for the safer and effective threading procedures

INTRODUCTION

To reduce complications caused by the procedure, the target layer for thread lifting should be the superficial fat or superficial musculoaponeurotic system of the face. The aim of this study was to establish the thicknesses of the facial skin and superficial fat using a 3D scanning system to provide basic clinical data for thread lifting.

MATERIAL AND METHODS

Thirty fixed Korean and Thai cadavers (male: 17, female: 13) were used. The depths of the skin and superficial fat were measured using a three dimensional (3D) structured-light scanner. Facial images of both undissected and removed skin and superficial fat were taken with the 3D scanner. The paths from the temple and the front of the tragus to the infraorbital, perioral, cheek, and mental areas were displayed on the 3D image. The thickness along the path was measured by calculating the difference between the undissected and dissected 3D images.

RESULTS

The means and standard deviations of thicknesses of the skin and superficial fat were 2.1 ± 0.4 mm and 5.2 ± 1.9 mm in the 11 pathways. The facial skin became thicker going toward the lower aspect of the face from temple to infraorbtial and perioral regions. The thickness of the superficial fat around the marionette line showed the biggest change.

CONCLUSIONS

The present findings indicate that a 3D scanning system can yield crucial anatomical information about the thickness of the facial skin and superficial fat for use in various minimally invasive clinical procedures including thread lifting.

Anatomical variations of the stylopharyngeus and superior constrictors in relation to their function

The aims of this study were to clarify the topography and variations stylopharyngeus (STP) and superior constrictor (SC) muscles, and to examine what role they play in the pharyngeal movement. Forty-four specimens (22 right and 22 left sides) from embalmed Korean adult cadavers (13 males, 9 females; age range, 46–89 years; mean age, 69.2 years) were used in this study. The accessory bundle of STP and petropharyngeus was found in 18.2% (8/44) and 25.0% (11/44) of cases, respectively. A variation of the STP, in which it ran transversely and merged with the SC muscle, was found in 2.3% (1/44) of cases while a variation of the SC muscle, in which it ran longitudinally and merged with the contralateral constrictors, was found in 11.4% (5/44). The variant muscle bundles play their own role in pharyngeal movement according to their morphology. These results provide information that will help a comprehensive understanding of the effects of pharyngeal muscles on movement.

Sonographic Analysis of the Upper Labial Orbicularis Oris and Its Clinical Implications

BACKGROUND

Purse string lips, which include the vertical wrinkles over the lips, are frequently observed in aged individuals. Botulinum toxin and fillers are routinely injected into these areas to remove the wrinkles; however, the anatomy of the orbicularis oris muscle (OOr) near the vermilion border area has not been well defined.

OBJECTIVES

The aim of this study was therefore to identify any morphological differences of the upper OOr via sonographic imaging.

METHODS

The upper lip muscles as observed utilizing an ultrasound device were divided into 2 muscles (pars peripheralis and pars marginalis) that were subsequently divided into a further 2 types (Type I and Type II) associated with the development of the pars marginalis. Type II was further divided into Type IIa and Type IIb depending on whether the muscle fibers were well developed and connected.

RESULTS

On the midline of the lip, Type I, in which the pars marginalis was rarely observed and only appeared in traces, was observed in 20.0% of the volunteers. Type IIa, in which the pars marginalis was well-developed and appeared continuous, was observed in 42.9% of the volunteers. Type IIb, in which the pars marginalis was observed but appeared discontinuous, was observed in 37.1% of the volunteers.

CONCLUSIONS

The shapes of the upper pars marginalis of the OOr varied markedly between volunteers. Type classification of the OOr based on its shape and the lip appearance serves as a reliable source of reference information to be utilized when injecting botulinum toxin into the upper lip.

Intramuscular Neural Distribution of Rhomboid Muscles: Evaluation for Botulinum Toxin Injection Using Modified Sihler's Method

This study describes the nerve entry point and intramuscular nerve branching of the rhomboid major and minor, providing essential information for improved performance of botulinum toxin injections and electromyography. A modified Sihler method was performed on the rhomboid major and minor muscles (10 specimens each). The nerve entry point and intramuscular arborization areas were identified in terms of the spinous processes and medial and lateral angles of the scapula. The nerve entry point for both the rhomboid major and minor was found in the middle muscular area between levels C7 and T1. The intramuscular neural distribution for the rhomboid minor had the largest arborization patterns in the medial and lateral sections between levels C7 and T1. The rhomboid major muscle had the largest arborization area in the middle section between levels T1 and T5. In conclusion, botulinum neurotoxin injection and electromyography should be administered in the medial and lateral sections of C7-T1 for the rhomboid minor and the middle section of T1-T7 for the rhomboid major. Injections in the middle section of C7-T1 should also be avoided to prevent mechanical injury to the nerve trunk. Clinicians can administer safe and effective treatments with botulinum toxin injections and other types of injections by following the methods in our study.

A novel anatomical consideration on the exposed segment of the facial artery

An understanding of the location and depth of the facial artery (FA) is essential in aesthetic surgery and various cosmetic procedures. The purpose of this study was to clarify the three-dimensional (3D) topography of the exposed segment (ES) of the FA and to provide information to help minimize complications during clinical procedures. From 50 embalmed adult cadavers, the undissected and dissected hemifaces were scanned and reconstructed using the 3D scanner. Then the topographic location of the ES was identified and measured from the superimposed the 3D images. The ES was observed in 82% of the whole specimens. The exposure patterns of the ES were examined, and classified into three types: Type I, one site exposed pattern (74%); Type II, two sites exposed pattern (8%); and Type III, nonexposed pattern (18%). The extent of the ES was located at 2.2 mm above and 4.2 mm below the cheilion (Ch)-otobasion inferius line, and 20.0 to 25.2 mm from the Ch on the lateral aspect. In the frontal view, the average distance from the mid-pupillary line to the ES was 7.1 mm, and from the lateral canthal line to the ES was 6.1 mm. The ES was 7.6 mm below the skin surface. The results of this study will help to provide safe guidelines for filler injections as well as selecting the safe regions in various clinical procedures. Clin. Anat. 33:257-264, 2020. © 2019 Wiley Periodicals, Inc.

Ultrasonographic Analyses of the Forehead Region for Injectable Treatments

Botulinum toxin type A (BoNT-A) injections in the forehead region should only target the frontalis. This study applied ultrasonography with the aim of providing guidelines for predicting the layered structure and soft-tissue thickness of the forehead. We performed ultrasound scanning at 7 facial landmarks in 40 Korean adults. Allowing for the error range, the minimum depth from the skin to exclude the muscle layer was 2.3 mm, and the maximum depth from the skin to include the muscle layer was 2.8 mm. Of the total 7 points from the skin to muscle surface, significant differences between the males and females were found in 6 points (p < 0.05). Clinicians can use ultrasonography to identify the structural layers of the scalp. Even if ultrasound-guided injections are not performed, it is possible to target only muscle layers in BoNT-A injections by maintaining a needle depth of around 2.5 mm.

Eight-week healing of grafted calvarial bone defects with hyperbaric oxygen therapy in rats

Purpose

The purpose of this study was to evaluate the synergistic effect of adjunctive hyperbaric oxygen (HBO) therapy on new bone formation and angiogenesis after 8 weeks of healing.

Methods

Sprague-Dawley rats (n=28) were split into 2 groups according to the application of adjunctive HBO therapy: a group that received HBO therapy (HBO group [n=14]) and another group that did not receive HBO therapy (NHBO group [n=14]). Each group was divided into 2 subgroups according to the type of bone graft material: a biphasic calcium phosphate (BCP) subgroup and an Escherichia coli-derived recombinant human bone morphogenetic protein-2-/epigallocatechin-3-gallate-coated BCP (mBCP) subgroup. Two identical circular defects with a 6-mm diameter were made in the right and left parietal bones of each rat. One defect was grafted with bone graft material (BCP or mBCP). The other defect was not grafted. The HBO group received 2 weeks of adjunctive HBO therapy (1 hour, 5 times a week). The rats were euthanized 8 weeks after surgery. The specimens were prepared for histologic analysis.

Results

New bone (%) was higher in the NHBO-mBCP group than in the NHBO-BCP and control groups (P<0.05). Blood vessel count (%) and vascular endothelial growth factor staining (%) were higher in the HBO-mBCP group than in the NHBO-mBCP group (P<0.05).

Conclusions

HBO therapy did not have a positive influence on bone formation irrespective of the type of bone graft material applied after 8 weeks of healing. HBO therapy had a positive effect on angiogenic activity.