1
|
Yi KH, Lee S, Lee JH, Lee HJ. Observation of Anatomical Structures in the Human Larynx Using Micro-Computed Tomography with Lugol's Solution Enhancement. Diagnostics (Basel) 2023; 13:3005. [PMID: 37761372 PMCID: PMC10530111 DOI: 10.3390/diagnostics13183005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Histological and naked-eye dissections are frequently used to investigate human anatomy. However, limitations of conventional methods include tissue damage and difficulty in observing structures, rendering findings limited. Micro-computed tomography (micro-CT) allows for a three-dimensional observation with whole-mount staining for contrast enhancement. A precise anatomical understanding of the larynx is essential for both the medical and surgical fields; however, the larynx is difficult to dissect because of its minuscule and complex structures. Therefore, we aimed to clarify the detailed anatomy of the larynx using micro-CT. The study was conducted on twelve specimens of cadavers using Lugol-based-contrast micro-CT. Using Lugol-micro-CT, relevant information on human structures was obtained. Consequently, we successfully employed the Lugol-micro-CT technique in the analysis of specific human soft tissue structures that are challenging to analyze using conventional methods.
Collapse
Affiliation(s)
- Kyu-Ho Yi
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOURProject, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea;
- Maylin Clinic (Apgujeong), Seoul 07335, Republic of Korea
| | - Siyun Lee
- Department of Cancer Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA;
| | - Ji-Hyun Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam 13120, Republic of Korea
| | - Hyung-Jin Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| |
Collapse
|
2
|
Minelli L, Brown CP, Warren RJ, van der Lei B, Mendelson BC, Little JW. Lifting the Anterior Midcheek and Nasolabial Fold: Introduction to the Melo Fat Pad Anatomy and Its Role in Longevity and Recurrence. Aesthet Surg J 2023; 43:941-954. [PMID: 37130080 PMCID: PMC10481114 DOI: 10.1093/asj/sjad126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND A limitation of current facelift techniques is the early postoperative reappearance of anterior midcheek laxity associated with recurrence of the nasolabial fold (NLF). OBJECTIVES This study was undertaken to examine the regional anatomy of the anterior midcheek and NLF with a focus on explaining the early recurrence phenomenon and to explore the possibility of alternative surgical methods that prolong NLF correction. METHODS Fifty cadaver heads were studied (16 embalmed, 34 fresh; mean age, 75 years). Following preliminary dissections and macrosectioning, a series of standardized layered dissections were performed, complemented by histology, sheet plastination, and microcomputed tomography. Mechanical testing of the melo fat pad (MFP) and skin was performed to gain insight on which structure is responsible for transmission of the lifting tension in a composite facelift procedure. RESULTS Anatomic dissections, sheet plastination, and microcomputed tomography demonstrated the 3-dimensional architecture and borders of the MFP. Histology of a lifted midcheek demonstrated that a composite MFP lift causes a change in connective tissue organization from a hanging-down pattern into a pulled-upward pattern, suggesting traction on the skin. Mechanical testing confirmed that, in a composite lift, despite the sutures being placed directly into the deep aspect of the MFP, the lifting tension distal to the suture is transmitted through the skin and not through the MFP. CONCLUSIONS The usual method of performing a composite midcheek lift results in the skin, and not the MFP itself, bearing the load of the nondissected tissues distal to the lifting suture. For this reason, early recurrence of the NLF occurs following skin relaxation in the postoperative period. Accordingly, specific surgical procedures for remodeling the MFP should be explored, possibly in combination with volume restoration of the fat and bone, for more lasting improvement of the NLF.
Collapse
Affiliation(s)
- Lennert Minelli
- Corresponding Author: Dr Lennert Minelli, Mendelson Advanced Facial Anatomy Course, Australasian Society of Aesthetic Plastic Surgeons, PO Box 592, Toorak 3142, Victoria, Australia. E-mail: ; Instagram: @dr.lennert.minelli
| | | | | | | | | | | |
Collapse
|
3
|
Minelli L, Yang HM, van der Lei B, Mendelson B. The Surgical Anatomy of the Jowl and the Mandibular Ligament Reassessed. Aesthetic Plast Surg 2023; 47:170-180. [PMID: 36050569 PMCID: PMC9944027 DOI: 10.1007/s00266-022-02996-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A visible jowl is a reason patients consider lower facial rejuvenation surgery. The anatomical changes that lead to formation of the jowl remain unclear. The aim of this study was to elucidate the anatomy of the jowl, the mandibular ligament and the labiomandibular crease, and their relationship with the marginal mandibular branch of the facial nerve. MATERIALS AND METHODS Forty-nine cadaver heads were studied (16 embalmed, 33 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology, sheet plastination and micro-CT. RESULTS The jowl forms in the subcutaneous layer where it overlies the posterior part of the mandibular ligament. The mandibular ligament proper exists only in the deep, sub-platysma plane, formed by the combined muscular attachment to the mandible of the specific lower lip depressor muscles and the platysma. The mandibular ligament does not have a definitive subcutaneous component. The labiomandibular crease inferior to the oral commissure marks the posterior extent of the fixed dermal attachment of depressor anguli oris. CONCLUSION Jowls develop as a consequence of aging changes on the functional adaptions of the mouth in humans. To accommodate wide jaw opening with a narrowed commissure requires hypermobility of the tissues overlying the mandible immediately lateral to the level of the oral commissure. This hypermobility over the mandibular attachment of the lower lip depressor muscles occurs entirely in the subcutaneous layer to allow the mandible to move largely independent from the skin. The short, elastic subcutaneous connective tissue, which allows this exceptional mobility without laxity in youth, lengthens with aging, resulting in laxity. The development of subcutaneous and dermal redundancy constitutes the jowl in this location. LEVEL OF EVIDENCE IV "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."
Collapse
Affiliation(s)
- Lennert Minelli
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons (ASAPS), PO Box 592, Toorak, VIC, 3142, Australia. .,Medical Engineering Research Facility (MERF), Queensland University of Technology (QUT), Brisbane, QLD, Australia. .,Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Melbourne, VIC, Australia. .,Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea
| | - Berend van der Lei
- Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Bryan Mendelson
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons (ASAPS), PO Box 592, Toorak, VIC 3142 Australia
| |
Collapse
|
4
|
Minelli L, Bown RGC, Mu EWH, Whitehead DL, Henderson TH, Lawrence F, Mellor I, Wissemann MI, Brown CP, van der Lei B, Mendelson BC. Enhanced study of facial soft tissues using a novel large scale histology technique. Clin Anat 2023; 36:110-117. [PMID: 35951617 PMCID: PMC10086818 DOI: 10.1002/ca.23943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Abstract
The safety and effectiveness of facial cosmetic surgery procedures are dependent on detailed 3D understanding of the complex surgical anatomy of the face. Traditional, small sample size anatomical dissection studies have limitations in providing definitive clarification of the fascial layers of the face, and especially in their relationship with the facial nerve, and their reaction to surgical manipulation. The objective study of large tissue areas is required to effectively demonstrate the broader architecture. Conventional histology techniques were modified to handle extraordinarily large tissue samples to fulfill this requirement. Full-thickness soft tissue samples (skin to bone) of maximum length 18 cm, width 4 cm, and tissue thickness 1 cm, were harvested from 20 hemifaces of 15 fresh human cadavers (mean age at death = 81 years). After fixation, the samples were processed with an automated processor using paraffin wax for 156 h, sectioned at 30 μm, collected on gelatin-chromium-coated glass slides, stained with a Masson's Trichrome technique and photographed. Using this technique, excellent visualization was obtained of the fascial connective tissue and its relationship with the facial mimetic muscles, muscles of mastication and salivary glands in 73 large histological slides. The resulting slides improved the study of the platysma and superficial musculo-aponeurotic system (SMAS), the spaces and ligaments, the malar fat pad, and the facial nerve in relations to the deep fascia. Additionally, surgically induced changes in the soft-tissue organization were successfully visualized. This technique enables improved insight into the broad structural architecture and histomorphology of large-scale facial tissues.
Collapse
Affiliation(s)
- Lennert Minelli
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia.,Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rory George Charles Bown
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia
| | - Erica Wung Hwa Mu
- School of Biomedical Sciences, The University of Queensland, Saint Lucia, Australia
| | | | - Tania Helen Henderson
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Felicity Lawrence
- Central Analytical Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Ian Mellor
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Matthew Ian Wissemann
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Cameron Peter Brown
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia
| | - Berend van der Lei
- Department of Plastic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Bryan Christopher Mendelson
- Melbourne Advanced Facial Anatomy Course (MAFAC), Australasian Society of Aesthetic Plastic Surgeons, Toorak, Australia
| |
Collapse
|
5
|
Guillen K, Comby PO, Salsac AV, Falvo N, Lenfant M, Oudot A, Sikner H, Dencausse A, Laveissiere E, Aho-Glele SL, Loffroy R. X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran ®2 Polymerization: A Rabbit-Model Study. Biomedicines 2022; 10:2625. [PMID: 36289887 PMCID: PMC9599502 DOI: 10.3390/biomedicines10102625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 08/30/2023] Open
Abstract
Although introduced decades ago, few cyanoacrylate glues have been approved for endovascular use, despite evidence of their usefulness, notably for complex procedures suchas hemostatic embolization. Indications include massive bleeding requiring emergent hemostasis and prevention of severe bleeding during scheduled surgery to remove a hypervascular tumor. Adding radiopaque Lipiodol Ultra Fluid® (LUF) modulates glue polymerization and allows fluoroscopic guidance, but few comparative in vivo studies have assessed the impact of the resulting change in glue concentration or of other factors such as target-vessel blood flow. In a rabbit model, we used ex vivo X-ray microtomography to assess the results of in vivo renal-artery embolization by various mixtures of N-butyl cyanoacrylate (NBCA), metacryloxysulfolane, and LUF. Overall, penetration to the superficial interlobular arteries was achieved in about two-thirds of cases and into the capillaries in nearly half the cases, while cast fragmentation was seen in slightly more than half the cases. Greater NBCA dilution and the blocked-blood-flow technique were independently associated with greater distality of penetration. Blocked-blood-flow injection was independently associated with absence of fragmentation, capillary penetration, a shorter cast-to-capsule distance, and higher cast attenuation. A larger mixture volume was independently associated with higher indexed cast ratio and deeper penetration. Finally, microtomography is an adapted tool to assess ex vivo distribution of glue cast.
Collapse
Affiliation(s)
- Kévin Guillen
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
| | - Pierre-Olivier Comby
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Anne-Virginie Salsac
- Biomechanics and Bioengineering Laboratory, UMR CNRS 7338, Université de Technologie de Compiègne, 60203 Compiègne, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
| | - Marc Lenfant
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Alexandra Oudot
- Department of Nuclear Medicine, Plateforme d’Imagerie et de Radiothérapie Préclinique, Georges-François Leclerc Center, 1 Rue Professeur Marion, BP 77980, CEDEX, 21079 Dijon, France
| | - Hugo Sikner
- Department of Nuclear Medicine, Plateforme d’Imagerie et de Radiothérapie Préclinique, Georges-François Leclerc Center, 1 Rue Professeur Marion, BP 77980, CEDEX, 21079 Dijon, France
| | - Anne Dencausse
- R&D, Guerbet Research, CEDEX, 95943 Roissy Charles-de-Gaulle, France
| | | | - Serge Ludwig Aho-Glele
- Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, Bourgogne/Franche-Comté University, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France
| |
Collapse
|
6
|
Three-dimensional anatomy of the Denonvilliers' fascia after micro-CT reconstruction. Sci Rep 2021; 11:21759. [PMID: 34741081 PMCID: PMC8571354 DOI: 10.1038/s41598-021-01106-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/15/2021] [Indexed: 12/29/2022] Open
Abstract
An understanding of the anatomy of the Denonvilliers’ fascia is essential for successful surgical outcomes for patients with rectal cancer in the mid- to lower regions, especially near the seminal vesicles and prostate in males. Whether the correct surgical plane during a total mesorectal excision should be anterior or posterior to the Denonvilliers’ fascia is currently under debate. This study aimed to investigate the Denonvilliers’ fascia using micro-computed tomography (micro-CT) to acquire three-dimensional images nondestructively for assessments of the relationship between the Denonvilliers’ fascia, the mesorectal fascia, and neurovascular bundles to elucidate the correct anterior total mesorectal excision plane. Eight specimens were obtained bilaterally from four fresh human cadavers. Four specimens were stained with phosphotungstic acid to visualize the soft tissue, and micro-CT images were obtained; the other four specimens were stained with Masson’s trichrome to visualize connective tissue. Micro-CT images corroborate that the Denonvilliers’ fascia consists of a multilayered structure that separates the rectum from the seminal vesicles and the prostate. Specimens stained with Masson’s trichrome showed that the urogenital neurovascular bundle located at the posterolateral corner of the prostate is separated from the mesorectum by the Denonvilliers’ fascia. For the preservation of autonomic nerves necessary for urogenital function and optimal oncologic outcomes in patients with rectal cancer, a successful mesorectal excision requires a dissection plane posterior to the Denonvilliers’ fascia.
Collapse
|