The premaxillary space: a location for filler injection?

BACKGROUND: A four-layer fat structure is found in the anterior cheek region. The deepest of these fat layers is the premaxillary fat. OBJECTIVE: To determine whether the premaxillary fat is located in a closed compartment and whether injection of substances affects the appearance of the face. METHODS & MATERIALS: Filler or arterial mass (0.5-0.8 mL) after Thiel were injected, and gross dissections, horizontal and sagittal sections, and three-dimensional reconstructions with computed tomography were performed. RESULTS: The premaxillary fat is located in a semiopen space, the premaxillary space, with mainly bony and muscular borders. The injected substances spread in lateral and superficial located tissues. CONCLUSION: Injection of substances into this space leads to discrete improvements in the appearance of the nasolabial groove.

Modified lateral block of the suprascapular nerve: a safe approach and how much to inject? A morphological study.

BACKGROUND AND OBJECTIVES: This paper presents an evaluation of a modified lateral suprascapular nerve block with easy orientation, low risk of displacement of the needle, and with an assessment of 2 different volumes to propose an ideal volume for a successful block. METHODS: Both shoulders of 34 cadavers were investigated. Insertion point of the needle was determined in the angle of the lateral end of the clavicle, acromion, and the spine of the scapula. The needle was directed toward the medial, dorsal, and caudad direction. Ten mL of diluted contrast agent for computerized tomography was injected in the 34 right sides (group A) and 5 mL in the 34 left sides (group B). Immediately after injection, all shoulders were investigated by computerized tomography scans and 3-dimensional reconstruction to document the constrast dissemination. Five sides of each group were injected with colored contrast and dissected after computerized tomography investigation. RESULTS: Group A showed a distribution to the entire supraspinous fossa in all cases and the contrast was pressed out of the suprascapular notch in 4 cases with a maximal extension into the axillary fossa in 3 cases. In group B, the supraspinous fossa was filled in 24 cases, with a maximal extension to the axillary fossa in 2 cases. In 9 cases, the contrast agent stayed in the lateral half of the supraspinous fossa. In 1 case we had a medial spread only which still surrounded the suprascapular notch, in another case a superficial spread with misplacement of the needle. CONCLUSION: Based on this cadaver study, the lateral modified approach appears to be a safe technique for a suprascapular nerve block, which might be preferred as a single shot technique. A 5 mL volume appears sufficient to fill the supraspinous fossa and to reach the suprascapular nerve, which branches in this anatomical compartment.

Comparison of different injectate volumes for stellate ganglion block: an anatomic and radiologic study.

BACKGROUND: Volumes from 5 to 20 mL of local anesthetic are used for stellate ganglion block. The variation of practice gave us the impetus to investigate the distribution of 3 different volumes of solution. We documented the regions reached by each volume to assess the possibility to reduce the injectate to 5 mL. MATERIALS AND METHOD: A total of 42 cadavers (84 halves), fixed by Thiel's method and on which pulse simulation was performed, were investigated. Of these 84 halves, 28 were injected with 5 mL of contrast (group A), 28 halves with 10 mL (group B), and 28 halves with 20 mL (group C), according to the tissue-displacement method. Immediately after injection, the cadavers were investigated by use of CT scans with a possible 3-dimensional reconstruction. In addition, 4 halves of group A and group B were dissected, and the contrast distribution was determined by photography. RESULTS: Group A showed a constant dissemination from C4 to Th2-Th3, without spreading to ventral or lateral regions. In group B, a persistent spread from C4 to Th3 was documented. Ventral and lateral regions were also reached in one third of the specimens. Group C showed a constant dissemination from C3 to Th4-Th5, with additional spread to ventral, lateral, and posterior regions of the neck similar to that in group B. CONCLUSION: The use of 5 mL results in an almost ideal vertical distribution in most of the cadavers, whereas high volumes--20 mL more so than 10 mL--are at risk of spreading extensively in both the vertical direction and also uncontrollably to other regions of the neck.

A model for clubfoot based on micro-CT data.

The pathological anatomy of idiopathic clubfoot has been investigated for more than 180 years using anatomy, computed tomography (CT), histology and microscopy. Seven idiopathic clubfeet and two normal feet of aborted fetuses were dissected in the present study, with special emphasis on the shape of the cartilage and bones. A three-dimensional (3D) micro-CT system, which generates a series of X-ray attenuation measurements, was used to produce computed reconstructed 3D data sets of each of the separated bones. Based on the micro-CT data scans a high-definition 3D colour printing system was used to make a four times enlarged clubfoot model, precisely presenting all the bony malformations. This model reflects the complexity of the anatomy of this disease and is designed to be used in the workshops of orthopaedic surgeons and physiotherapists, for training in new surgical and manipulation techniques.