The Superficial Temporal Artery and Zygomatico-Orbital Artery: Superficial Arterial Distribution of the Anterior Temple Area.

A hollow temple may give rise to a false impression of early facial aging. This is corrected with dermal fillers that are injected into the hollow temple area to produce a smoother facial contour. However, various complications of this procedure have been reported, with the most common being the inadvertent injection of the filler material into the superficial temporal artery (STA). The aim of this study was to investigate the topographic anatomy of the STA and zygomatico-orbital artery (ZOA) to provide essential anatomical information to aid in various clinical procedures involving the temporal region. The superficial arterial distribution of the temple area was studied in 43 hemisectioned Korean cadavers. The courses of the STA and ZOA were identified and classified based on the line connecting the tragus and the superciliary arch (TR-SA line). The ZOA was present in 85.2% of cases and bifurcated from the frontal branch of the STA, after which it ran along the TR-SA line. In this study, the STA pattern was classified into a typical pattern where the ZOA coexists with the STA and a lower pattern where the ZOA was absent. The current findings suggested that the ZOA ran close to the TR-SA line. Therefore, to minimize vascular complications during invasive procedures, injection into this area should be avoided. In addition, clinicians should verify the existence of ZOA and the course of STA before performing various clinical procedures.

Changes in the neck tissue layers during pinch manipulation: Implications for lipolytic deoxycholate injections for double chin.

BACKGROUND: The skin of the neck is often pinched during minimally invasive esthetic procedures for the double chin using a lipolytic agent in order to facilitate injecting into the subcutaneous fat layer rather than under the platysma muscle. However, how the neck tissue layers move during the pinch manipulation is not well understood. AIMS: To determine which layer of the neck is lifted during pinching and to evaluate the usefulness of the pinch manipulation during injection therapy. METHODS: The pinched submentum of a living person was scanned using MRI, and ultrasonography was also performed in the same area in both resting and pressed states. At four sites on a fresh cadaver, the skin of the neck was pinched and the elevated neck skin was excised. The exposed areas were grossly examined. RESULTS: MRI scanning revealed that the pinch manipulation extended the subcutaneous fat layer and moved the platysma muscle to a deeper location. Ultrasonography revealed that the thickness of each layer of the neck was reduced when pressing the neck. In the cadaver examination, pinching resulted in part of the subcutaneous fat lifting, and this was removed when the lifted skin was cut, leaving the platysma muscle intact. CONCLUSIONS: When performing an esthetic procedure that involves injecting a lipolytic agent into the submental area, the pinch manipulation is a very useful technique for ensuring a safe procedure that avoids injecting into the deep layer under the platysma muscle.

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.

Changes in the Layers of the Temple During Pinch Manipulation: Implications for Thread Lifting.

BACKGROUND: During minimally invasive aesthetic procedures, the skin is often pinched to facilitate filler injection or thread insertion into the desired layer. However, little is known about changes in the facial layers during pinch manipulation. OBJECTIVE: To determine which layer of the temple is lifted during pinching and whether the artery and the nerve are affected by pinching. MATERIALS AND METHODS: At 11 sites on 3 fresh Korean cadavers, the skin of the temple was pinched gently or deeply, and the skin pulled up was cut at the bottom. The exposed areas were grossly and histologically examined. RESULTS: With gentle pinching, the subcutaneous fat and superficial temporal fascia (STF) layer were separated, and the fat was removed with the skin. The superficial temporal artery and temporal branches of the facial nerve were intact. With deep pinching, the STF was separated from the deep temporal fascia and lifted with the skin. CONCLUSION: When thread lifting is performed, deep pinching is helpful for anchoring thread to the temporal fascia, whereas gentle pinching helps to insert thread into the safe subcutaneous fat layer, where no significant blood vessels or nerves are present.

Tissue changes over time after polydioxanone thread insertion: An animal study with pigs.

BACKGROUND: Polydioxanone (PDO) sutures have been widely used to tighten and lift the face. However, why the complexion brightens and skin elasticity is maintained with a smaller facial outline after a PDO monofilament thread treatment remains unclear. AIMS: We aimed to determine what significant changes occur in the tissue over time when a PDO suture is inserted. METHODS: We selected four White Yucatan variety pygmy pigs with skin that most closely resembles the structure of human skin. 4-0 PDO thread was inserted into the subcutaneous fat. Tissue samples were obtained at 4, 12, 24, and 48 weeks. For the histologic analysis, H&E staining, Masson trichrome staining, and anti-smooth muscle actin immunohistochemical staining techniques were used. RESULTS: Nine histological findings appeared over time, and these findings are summarized as five tissue changes. CONCLUSIONS: PDO sutures cause specific changes to the surrounding tissues that result in neo-collagenesis, a fibrous merging effect, fat reduction, tissue contracture, and an improved vascular environment. The results of this study explain the positive changes described in previous clinical research.

Anatomical and radiographic study of the mandibular retromolar canal.

BACKGROUND/PURPOSE: As the demand for surgical procedure in the retromolar area of the mandible has been increasing, the identification of the retromolar foramen (RMF) and canal involving the retromolar triangle (RMT) has become an issue of clinical concern. We examined the shape of the RMT, incidence of the RMF, and intraosseous trajectory of the retromolar canal (RMC). MATERIALS AND METHODS: A total of 118 sides of dry mandibles, 22 sides of mandibles of 13 cadavers, and cone-beam computed tomography (CT) images of 100 patients were examined. Micro-CT data of 13 cadavers were reconstructed using imaging analysis software for the presence of an RMC. RMCs were classified into three types according to the courses. The width and location of the RMCs were evaluated. RESULTS: The shape of the RMT was classified into three categories, with the most common type being the triangular type (81.4%). Forty-seven retromolar foramina (33.6%) were observed in 140 sides of mandibles. The horizontal distances from the RMF to the second and third molars were 12.1 ± 3.3 mm and 5.8 ± 3.6 mm (mean ± standard deviation), respectively, and the distance from the mandibular foramen to the arising point of the RMC and the vertical distance from the RMF to the mandibular canal were 21.5 ± 11.2 mm and 15.3 ± 4.6 mm, respectively. CONCLUSION: This study used various methods to obtain precise anatomical data on the RMT, foramen, and canal in Koreans. The reported findings may be helpful for the clinical management of patients.

Anatomical study of medial zygomaticotemporal vein and its clinical implication regarding the injectable treatments.

BACKGROUND: The medial zygomaticotemporal vein (MZTV), clinically known as sentinel vein, has been observed in the vicinity of the temporal branch of the facial nerve during endoscopic procedures aiming to lift the upper face. The aim of the present study was to describe the topography of the MZTV with reference to the superficial landmarks for providing detailed anatomical information during injectable treatment procedures. METHODS: Eighteen hemifaces were harvested from nine embalmed Korean adult cadavers (5 males and 4 females, mean age 76 years). The piercing location, vascular diameter, drainage pattern of the MZTV, and its relationship with the orbicularis oculi muscle (OOc) were recorded photographically, and using diagrams and written notes. RESULTS: The piercing point of the MZTV was located 26.8 ± 5.9 mm from the lateral epicanthus, 18.8 ± 6.9 mm lateral to the plane (HP) through the tragus and the lateral epicanthus, and 19.0 ± 5.4 mm superior to the plane (VP) through the lateral epicanthus point and perpendicular to the HP. The diameter of the MZTV at the piercing point was 1.9 ± 0.8 mm. All of the MZTV ultimately connected with the middle temporal vein (MTV). In particular, the MZTV was connected the MTV by anastomosing with the periorbital vein. Anastomosis of the MZTV and a well-developed periorbital vein was found in 27.8 % of cases. CONCLUSION: The physician must determine the location of the MZTV and should be able to accurately estimate its connection with significant veins at the temple to reduce the risk of severe complications during injectable treatments.

Resveratrol induces the expression of interleukin-10 and brain-derived neurotrophic factor in BV2 microglia under hypoxia.

Microglia are the resident macrophages of the central nervous system (CNS) and play an important role in neuronal recovery by scavenging damaged neurons. However, overactivation of microglia leads to neuronal death that is associated with CNS disorders. Therefore, regulation of microglial activation has been suggested to be an important target for treatment of CNS diseases. In the present study, we investigated the beneficial effect of resveratrol, a natural phenol with antioxidant effects, in the microglial cell line, BV2, in a model of hypoxia injury. Resveratrol suppressed the mRNA expression of the pro-inflammatory molecule, tumor necrosis factor-α, and promoted the mRNA expression of the anti-inflammatory molecule, interleukin-10, in BV2 microglia under hypoxic conditions. In addition, resveratrol inhibited the activation of the transcription factor, nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB), which is upstream in the control of inflammatory reactions in hypoxia-injured BV2 microglia. Moreover, resveratrol promoted the expression of brain-derived neurotrophic factor (BDNF) in BV2 microglia under hypoxic stress. Overall, resveratrol may promote the beneficial function of microglia in ischemic brain injury.

Clinical implications of the middle temporal vein with regard to temporal fossa augmentation.

BACKGROUND: The middle temporal vein (MTV) traverses the temporal fossa between the superficial and deep layers of the deep temporal fascia. During filler injection into a deficient temporal fossa, filling agents may be inadvertently injected into the MTV, which results in vascular complications. OBJECTIVE: To investigate the course of the MTV to enable safe filler injection in the temple area. MATERIALS AND MATERIALS: The course and diameter of the MTV were measured in 18 hemifaces from 9 Korean cadavers. RESULTS: The MTV was located 23.5 and 18.5 mm above the zygomatic arch at the jugale and the zygion, respectively. The diameter of the MTV at its thickest point was 5.1 mm. A splitting and reuniting pattern, such that the MTV occupied more space than a single trunk, was observed in 28% of cases. CONCLUSION: We propose that the safest area for filler injection in temporal fossa augmentation is one finger width above the zygomatic arch.

Three-dimensional surface models of detailed lumbosacral structures reconstructed from the Visible Korean.

Unlike volume models, surface models representing hollow, three-dimensional images have a small file size; allowing them to be displayed, rotated, and modified in real time. Therefore, surface models of lumbosacral structures can be effectively used for interactive simulation of, e.g., virtual lumbar puncture, virtual surgery of herniated lumbar discs, and virtual epidural anesthesia. In this paper, we present surface models of extensive lumbosacral structures which can be used in medical simulation systems. One-hundred and thirty-eight chosen structures included the spinal cord, lumbar and sacral nerves, vertebrae, intervertebral discs, ligaments, muscles, arteries, and skin. The structures were outlined in the sectioned images from the Visible Korean. From these outlined images, serial outlines of each structure were stacked. Adopting commercial software (3D-DOCTOR, Maya), an advanced surface reconstruction technique was applied to create a surface model of the structure. In the surface models, we observed the anatomical relationships of the lumbosacral structures (e.g., cauda equina and ligaments) in detail. Additionally, the portions of some spinal nerves that could not be outlined were drawn and added to the surface models. These constructed models will hopefully facilitate development of high quality medical simulation of the lumbosacral region.

Improved analysis of palm creases.

Palm creases are helpful in revealing anthropologic characteristics and diagnosing chromosomal aberrations, and have been analyzed qualitatively and quantitatively. However, previous methods of analyzing palm creases were not objective so that reproducibility could not be guaranteed. In this study, a more objective morphologic analysis of palm creases was developed. The features of the improved methods include the strict definition of major and minor palm creases and the systematic classification of major palm creases based on their relationships, branches, and variants. Furthermore, based on the analysis of 3,216 Koreans, palm creases were anthropologically interpreted. There was a tendency for palm creases to be evenly distributed on the palm, which was acknowledged by the relationship between major and minor creases as well as by the incidences of major creases types. This tendency was consistent with the role of palm creases to facilitate folding of palm skin. The union of major palm creases was frequent in males and right palms to have powerful hand grip. The new method of analyzing palm creases is expected to be widely used for anthropologic investigation and chromosomal diagnosis.

Variations of the superficial brachial artery in Korean cadavers.

The superficial brachial artery (SBA), a branch of the axillary artery, is one of the most common arterial variations in this area. While it is more vulnerable to accidental arterial injection or injury, it could be useful for the nourishment of a medial arm skin free flap. To analyze the relationship between the SBA of axillary origin and segmental variation of the axillary artery, we dissected 304 arms of Korean cadavers. We found an SBA of axillary origin in 12.2% of cadaveric arms. Unilateral occurrence was detected in 16 cadavers and bilateral in 10. SBAs gave rise to radial and ulnar arteries in the cubital fossa (8.9%), continued in the forearm as the radial artery (2.3%), or ended in the upper arm (1.0%). The SBA ended as ulnar artery was not found in any of the cadavers. The bifurcation of the SBA into the radial and ulnar arteries, presence of an SBA that ends in the upper arm, and the lack of continuation as the ulnar artery are characteristics of SBAs in Korean cadavers.

Unilateral arteria peronea magna associated with bilateral replaced dorsalis pedis arteries.

During anatomic dissection, a 59-year-old man presented with an arteria peronea magna that replaced all the branches of the posterior tibial artery as well as the dorsalis pedis artery. Thus, the right popliteal artery terminated into the anterior tibial artery and the enlarged peroneal artery. The right anterior tibial artery ended before it reached the ankle. The right dorsalis pedis artery arose from the peroneal artery through its perforating branch. The left popliteal artery gave rise to a common stem that subdivided into two individual branches replacing the proximal part of the anterior tibial artery, and then divided into the posterior tibial artery and the peroneal artery. As on the right side, the left dorsalis pedis artery also arose from the peroneal artery through its perforating branch. A possible embryologic explanation of these variations is proposed.