Platysma and the cervical superficial musculoaponeurotic system - Comparative analysis of facial crease and platysmal band development.

OBJECTIVE: The superficial musculoaponeurotic system connects the mimic muscles to the skin, allowing mimic expressions with regional morphological architectural differences. The aim of this study was to perform an architectural analysis of the cervical platysma-skin interaction, determine the morphological implications in platysmal band development and compare the findings to the facial SMAS architectural types. METHOD: Full-thickness blocks of skin, SMAS and platysma from seven hemifaces (three male and two female) and full-thickness blocks of skin, SMAS and mimic muscles of the periorbital, perioral, forehead and midfacial regions from six hemifaces (three male and three female) of donor bodies were collected postmortem. Serial histological sections were cut and stained with Azan. After the morphological analysis, three-dimensional reconstruction of the tissue block was performed with AutoCAD. The morphological and mechanical properties of the different facial SMAS types were compared with those of the cervical SMAS. RESULTS: The architecture of the cervical SMAS (type V) consists of parallel, aligned septum fibrosus profundus and septum fibrosus superficialis tissue connected by vertical, aligned septa fibrotica commisurales tissue delimiting fatty tissue compartments transferring platysmal contractions to the skin. The facial morphological dynamic mimic pattern (SMAS types I, II and III) describes the point-by-point transfer of mimic muscle bundle contractions to the skin, explaining facial crease formation. The cervical morphological dynamic mimic pattern (SMAS type V) can be explained by dual traction force collimation over the septum fibrosus superficialis and profundus in platysmal band development. CONCLUSIONS: The cervical SMAS (type V) description supports the hypothesis that the SMAS and platysma have different morphological origins. The two different facial and cervical morphological dynamic mimic patterns support the phenotypical difference between facial fold and platysmal band development.

Histological, SEM and three-dimensional analysis of the midfacial SMAS - New morphological insights.

INTRODUCTION: The superficial musculoaponeurotic system (SMAS) of the midface has a complex morphological architecture, and a multitude of controversial opinions exist regarding its in vitro appearance and clinical relevance. The aim of this study was to investigate the three-dimensional architecture of the midfacial SMAS. METHOD: Histological and SEM analyses were performed on tissue blocks of the skin, subcutaneous tissue and mimic musculature of the midfacial region between the anterior parotid gland pole and lateral to the nasolabial fold and tissue blocks of the skin, subcutaneous tissue and parotid fascia. Blocks were collected postmortem from six formalin-fixed donor bodies. Serial histological sections were made, stained with Azan and digitized. Three-dimensional reconstructions and visualization of the tissue blocks were performed using AutoCAD. RESULTS: Two different SMAS architectures were found in the midfacial region: parotideal (type IV) and preparotideal (type I) SMAS. Type I SMAS showed three-dimensional interconnecting fibrous chambers embracing fat tissue lobules that cushioned the space between the skin and mimic musculature. Fibrous septa divided the mimic musculature surrounding the muscular bundles. Beneath the mimic muscular level, SMAS septa were oriented parallel to the muscular plane. Above the mimic muscular plane, SMAS septa were oriented perpendicularly, inserted into the skin. Type IV SMAS showed a parallel alignment of the fibrous septa to the skin level, anchoring the skin to the parotid fascia, presenting lymphatic nodes in the fat tissue compartments. The fat cells of the SMAS were enveloped in a fibrotic membrane at the border of the fibro-muscular septa. The SMAS blood supply comprised two subcutaneously epimuscularly spreading anastomosing vascular systems. CONCLUSIONS: Midfacial SMAS represents a functional unit with physical and immunological tasks appearing in two different morphological architecture types. A well-defined nomenclature is needed to prevent controversy.

Morphological analysis and three-dimensional reconstruction of the SMAS surrounding the nasolabial fold.

BACKGROUND: The superficial musculoaponeurotic system (SMAS), a structure that has been discussed with some controversy, has a complex morphological architecture. MATERIAL AND METHODS: Histological analysis was performed on tissue blocks of the nasolabial fold (NLF) collected postmortem from formalin-fixed bodies of one male and one female donor. Serial histological sections were made, stained and digitized. Three-dimensional reconstructions of the histological structures were performed. Specimen- and location-specific differences were determined. SEM analysis of the NLF tissue block was performed. RESULTS: The NLF SMAS is a fibro-muscular, three-dimensional meshwork bolstered with fat cells. Two SMAS structure types were identified adjacent to the NLF. The cheek SMAS structure showed a regular, vertical and parallel alignment of the fibrous septa, building a three-dimensional meshwork of intercommunicating compartments. It changed its morphology, condensing while transiting the NLF and passing over to form an irregular structure in the upper lip region. SEM analysis demonstrated the connection between the fibrous meshwork and the fat cells. SMAS blood circulation expanded subcutaneously without perforating the fibro-muscular septa. CONCLUSIONS: The NLF has a recognizable condensed cheek SMAS structure and represents the transition zone between the two SMAS types. Specimen-specific morphological differences necessitate individual planning and area-specific surgical procedures.

Three-dimensional reconstruction of the suborbicularis oculi fat and the infraorbital soft tissue.

The aim of this study was to reveal the histomorphological connections among the suborbicularis oculi fat (SOOF), the orbicularis oculi muscle (OOM), the superficial musculoaponeurotic system (SMAS), the infraorbital fat and the skin. Full graft tissue blocks of the infraorbital region with the skin, SMAS, OOM and SOOF were collected post mortem from one female and two male formalin-fixed body donors. Serial histological sections were made, stained and digitized. Digitalization and three-dimensional (3D) reconstruction of the histological meshwork were performed. SOOF was revealed as a fibro-adipose tissue underlying the OOM, which was strictly separated from the intraorbital fat pad by the orbital septum. SOOF, OOM and SMAS were connected by fibrous septa derived from the SOOF, traversing the OOM with division into multiple muscular bundles, continuing above the muscular plane by forming the SMAS and ending with skin insertion. In the infraorbital region, two different types of SMAS bordering the infraorbital fold have been recognized. Muscle cells have been demonstrated in the SMAS fibrous septa of both SMAS types. Together with the OOM, the SMAS and the skin, SOOF forms an anatomical functional unit. Muscular contraction of the OOM could be transferred by the SMAS to the skin level, producing periorbital mimic expression. The 3D reconstruction facilitates the comprehension of the morphological structure, its connections and space correlations in the infraorbital area. The morphological and topographical peculiarities of the infraorbital structures make it possible to conclude that surgical interventions in this area need to be elaborated and individualized.

Parallel study about the effects of psychotherapy on patients with dental phobia determined by anxiety scores and saliva secretion and composition.

BACKGROUND: The aim of this study was to determine the success of psychotherapeutic treatment for dental phobia by measurement of anxiety using the dental anxiety score (DAS), the state trait anxiety score (STAI state), salivary cortisol and protein concentrations and the salivary secretion rate. Primary endpoint of the study was the comparison of the data before and after psychotherapeutic treatment. METHODS: Forty patients were included into the study. Twenty-four were allocated to the phobic group, 16 to the control group. Saliva was collected upon entering the dental clinic and again after three weeks of psychotherapy. The results were compared with those of a control group. The DAS and STAI questionnaires were completed at each visit. RESULTS: A reduction in DAS values was found after psychotherapy. However, the values remained significantly higher in the phobic group than in the controls. Similar results were found for STAI scores. A slightly higher salivary cortisol level was found in the phobic group. No changes occurred in cortisol or protein concentrations. The salivary secretion rate increased in the phobic patients after psychotherapy. CONCLUSIONS: It could be concluded that psychotherapy is effective in the treatment of dental phobic patients. TRIAL REGISTRATION: This study has been retrospectively registered in the German Clinical Trials Register (# DRKS00009552 ) on 10/19/15.

Kinetics of fluoride bioavailability in supernatant saliva and salivary sediment.

UNLABELLED: The assessment of the fluoride kinetics in whole saliva as well as in the different salivary phases (supernatant saliva and sediment) is essential for the understanding of fluoride bioavailability. OBJECTIVES: To assess the fluoride content, provided by sodium fluoride and amine fluoride, in the supernatant saliva and in salivary sediment. METHODS: Seven trained volunteers were randomly attributed to 2 groups in a cross-over design and brushed their teeth in the morning for 3 min with a product containing either sodium fluoride or amine fluoride. Saliva was collected before, immediately after tooth brushing and 30, 120, and 360 min later and measured. The samples were centrifuged 10 min at 3024 × g. Fluoride content of the supernatant saliva and of the sediment was analysed using a fluoride sensitive electrode. All subjects repeated the study cycles 2 times, and statistical analyses were made using the nonparametric sign test for related samples, the Wilcoxon-Mann-Whitney-test for independent samples. RESULTS: There was a significant increase in fluoride immediately after tooth brushing in both groups in saliva and sediment. The distribution of fluoride between salivary sediment and supernatant saliva (ratio) varied considerably at the different collection times: decreased from 17.87 in baseline samples of saliva to 0.07 immediately and to 0.86 half an hour after tooth brushing in the sodium fluoride group and from 14.33 to 2.85 and to 3.09 in the amine fluoride group. Furthermore after 120 min and after 360 min after tooth brushing the ratio increased from 17.6 to 31.6 in the sodium fluoride group and from 20.5 to 25.76 in the amine fluoride group. No difference was found in the sediment-supernatant saliva ratio between the sodium fluoride and the amine fluoride groups 360 min after tooth brushing. CONCLUSION: For the assessment of fluoride kinetics in whole saliva it is necessary to pay attention to at least four factors: fluoride formulation, time after fluoride application, fluoride concentration in supernatant saliva and fluoride concentration in salivary sediment. This study was approved by the Ethical Committee of the University of Witten/Herdecke permission 21/2008.

Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris.

Bisphosphonates (BPs) are widely used as bone-stabilizers, but side effects of BP therapy include bisphosphonate-related osteonecrosis of the jaw (BRONJ), which is resistant to therapy. The aim of this study was to evaluate the outcome of maxillary BRONJ involving sinusitis maxillaris. 21 patients presenting with maxillary BRONJ, from 2005 to 2008, were included in the study. In 18 cases BP had been administered for carcinoma and in 3 cases for osteoporosis, with an average exposure time of 47.4 months. 12 patients spontaneously developed BRONJ. The 10 patients diagnosed with stage III BRONJ presented with concomitant sinusitis maxillaris. Despite treatment, there were six recurrences of BRONJ, four of them with additional sinusitis maxillaris. Whether BRONJ occurred spontaneously or after extraction there was no difference in the outcome. Patients with advanced maxillary BRONJ often suffer from sinusitis maxillaris, both of which are frequently resistant to therapy.

[Ontogeny of the immune response in mice. II. Direct hemolytic plaque forming cells and indirect hemolytic plaque forming cells in the spleen of mice antigenically stimulated at various ages]. / Ontogenia raspunsului imun la soarece. II. Celule formatoare de PHD si PHI în splina soarecilor stimulai antigenic la diferite virste.

Investigations were carried out by the direct and indirect haemolytic plaque (DHP and IHP) forming technique in order to determine the capacity of the lymphoid cells of A2G mice fetuses grafted on irradited adults and of mice of different ages, to react after antigenic stimulation with sheep red blood cells, by the synthesis of antibody belonging to the IgM and IgG class. Fetal lymphocytes build up again the lymphoid system of the animals irradiated with lethal doses and develop humoral mediated immune reactions. The sucklings coming in contact with the antigen within the first 20 hours after birth do not synthetize antibodies, and the sucklings stimulated up to the age of 5 days only synthetize antibodies in low amounts. In the spleen of the sucklings stimulated antigenically on day 0 and again on day 10, IgM and not IgG antibody forming cells are predominant. The secondary immune response in the sucklings up to the age of 5 days develops later necessitating a longer period than in the adults or older sucklings. The significance of these results is discussed with reference to the possible biological implications of alpha-proteins.