Defining a Preauricular Safe Zone: A Cadaveric Study of the Frontotemporal Branch of the Facial Nerve

The application of basic SMAS rhytidectomy and comprehensive SMAS rhytidectomy

Rhytidectomy has made great progress in the past 50 years, especially after the proposition of the concept of superficial musculoaponeurotic system (SMAS). Our previous research had classified SMAS rhytidectomy into basic SMAS rhytidectomy (B-SMAS) and comprehensive SMAS rhytidectomy (C-SMAS) according to whether the treatment of SMAS aponeurosis is combined with retaining ligament, fat pad, mimetic muscles, etc. The purpose of this paper is to compare the outcomes of the 2 methods. Through multicenter collaborative research, 21 cases of B-SMAS and 18 cases of C-SMAS were collected. Photographs were taken pre- and post-operation for each patient, and the facial width of the lateral canthus level (upper face), the alar base level (middle face), and the oral commissure level (lower face) were measured. We compared the statistics of upper, middle, and lower face pre- and post-B-SMAS and C-SMAS to assess the ramifications of each operation. We used preoperative measurements minus corresponding postoperative measurements of specific operation to assess which position would acquire superior improvements. We also recruited 3 professional plastic clinicians to rate the ramifications of specific positions and approaches after pre- and post-photo comparing. Through comprehensive analyzing, we compared the improvements between B-SMAS and C-SMAS to assess which method is more beneficial concerning facial rejuvenation. Both B-SMAS and C-SMAS would acquire optimal changing concerning facial width in middle and lower face after operation (P < .05). Two methods all harvested better width changing effects in middle and lower face than upper face (P < .05). However, C-SMAS acquired better effects in middle and lower face than B-SMAS (P < .05). Both B-SMAS and C-SMAS are beneficial to facial rejuvenation. The effects in middle and lower face are better than upper face. In addition, C-SMAS may be more effective than B-SMAS.

Primary Neurorraphy of the Frontotemporal Branch of the Facial Nerve in Pediatric Patients

LEVEL OF EVIDENCE

Level III-case-control study.

The Africa Temporal Scalp Flap: a novel flap for facial reconstruction

Although a number of flaps exist for nasal reconstruction, severe scarring of the forehead after burn injury led to the development of a novel two-stage flap based on the superficial temporal artery (STA). The Africa Temporal Scalp (ATS) flap is composed of an axial ascending part on the STA, and a descending anterior extension for reconstruction of the mid face. This is a retrospective analysis of all patients who underwent ATS Flap surgery on the MV Africa Mercy. During the 7.5-year period, the ATS flap was applied to 45 facial reconstructions, with a median age of 28 years (range 19 months to 51 years). The main indications were previous burn injury (n=27, 60%) and noma (n=15, 33.3%). The majority of the flaps were used to reconstruct the lower third of the nose (n=39, 86.7%), and the remaining 6 were for the lips or cheek. Experience allowed for earlier division than three weeks depending on the length of the flap, and the recipient site. There was one partial flap loss, one infection requiring revision, and two injuries to frontal branch of the facial nerve. The ATS flap is a novel two-stage flap that has proved especially versatile when forehead flaps are unavailable for nasal reconstruction due to extensive forehead scarring. The ATS flap reliably provides ample supple skin, and the donor site is effectively obscured from view, located in the periphery of the face.

A Novel Injection Technique to the Lateral Pterygoid Muscle for Temporomandibular Disorders: A Cadaveric Study

BACKGROUND

Lateral pterygoid muscle activity is associated with the pathological mechanisms of some temporomandibular disorders. The authors aimed to define and demonstrate a novel, practical, and safe technique for botulinum toxin type A injection to the lateral pterygoid muscle based on their findings. Their secondary aims were to standardize the injection pattern according to the variations of the lateral pterygoid muscle and its surrounding anatomical structures, and to establish its advantages over intraoral injection.

METHODS

Twenty cadaver heads were dissected. The lateral pterygoid muscle and its surrounding structures were investigated for anatomical variations. Based on these findings, a standardized extraoral injection protocol was defined and compared with the intraoral technique for accuracy and safety.

RESULTS

The average depth of the lateral pterygoid plate from the skin surface was 49.9 ± 2.2 mm, and the mean width of the lateral pterygoid plate was 10.5 ± 3.9 mm. The extraoral injection approach based on the location of the maxillary tuberosity, tragus, and lateral pterygoid plate was consistent in all dissections for the accuracy of the intramuscular injection. In the intraoral approach, standardization of the entry point of the needle through the oral mucosa is difficult, which makes adjustment of the depth of the injection challenging while increasing the risk of neurovascular injury.

CONCLUSIONS

The clinical significance of the lateral pterygoid muscle makes it worthwhile to implement minimally invasive treatments before considering more invasive options. The authors define a safe, accurate, and reliable approach with ease of administration in patients with temporomandibular disorders.