The lateral inframalleolar fat pad: a poorly recognized anatomical structure.

The authors carried out an anatomical histological study of the lateral inframalleolar region in order to improve knowledge of a fat pad of the lateral aspect of the ankle which is not mentioned in most anatomical texts. Twenty-four ankles, from 12 cadavers, free of any local pathology or malformation, were studied. Twenty ankles were dissected, of which, five had samples taken for histological examination. Colored latex was injected into the joint cavities of the last four ankles before anatomical cuts were made in three planes. This study allowed the description of the fat pad which we have called the lateral inframalleolar fat pad (LIMFP). It is oval and made up of a classical unilocular fatty tissue which is clearly distinct from the subcutaneous plane. We have defined its relationships and in particular, the neurovascular ones. The sural nerve which supplies cutaneous sensation to part of the 5th toe runs over the surface of the fat pad. It is accompanied on this part of its course by the short saphenous vein which gives off a medial perforator which traverses the LIMFP. Because of these neurovascular relationships, the LIMFP may play a role in the pathophysiology of neuralgias of the lateral aspect of the 5th toe or of the 4th digital interspace. It should be recognized before any operations on the lower limbs, in particular, before any plastic surgical liposuction, in order to optimize the resection volume to prevent inaesthetic over correction or under corrections which are often confused with residual edema.

["CAB" (Corpus Adiposum Buccae). Anatomical description and surgical reflexions apropos of buccal fat pads]. / Le "CAB". Description anatomique et réflexions chirurgicales a propos des boules graisseuses de Bichat.

Thirty hemi-faces of fresh cadavers and two centuries of bibliographies have been studied. Both packed fat and organ fat linked to the mastication, the Corpus Adiposum Buccae (CAB-Bichat's fat ball) is an anatomic structure which involves the entire hemi-face. The CAB stretches from the temporal region to the cheek, passing through the zygomatico-malar tunnel and the pterygomandibular fossa. It is completely enclosed within a partitioned capsule of varying thickness which allows to recognise it. From its main part, the Body, the CAB has ten extensions. Size, volume and aspect are different from one subject to another and one side to another. Its cheek extensions are inconsistent or disappear with age. However, its outline remains characteristic. This is not a ball one except in the case of the foetus and new born and for the most sloping extension, buccal, which gives its name to CAB. The CAB is always found under the SMAS plane which keeps it apart from superficial fat. Where fronto-facial liftings are more extensive and deeper, the CAB becomes an important surgical reference. It is possible to use the CAB as a local flap for filling in the cheek area. Local partial amputations have been put forward as an aesthetic goal. In the light of the present study, the author suggests a discussion with regards to the validity of these surgical manipulations.

[Adipose pad of the external sub-malleolar fossa. Anatomy and value in liposuction of the lower limbs]. / Le "C.A.S.M.E.": coussinet adipeux sous-malléolaire externe--anatomie et intérêt dans les lipo-aspirations des membres inférieurs.

The existence of an adipose formation under the skin of the lateral part of the ankle is constant in both sexes. It is more important in the female ankle. No anatomical study has been made before, except for an illustration in Sarrafian's Treatise of Anatomy, where it is described as a "fat pad of the prelateral malleolar fossa", whereas no actual description is provided in the text. Therefore, there exists no international anatomical definition (PNA) of this constant superficial formation, and we propose to adopt Sarrafian's definition (in French: C.A.S.M.E.). This fat pad is located directly under the lateral malleola, just before the projection of the extensor digitorum brevis muscle. The prelateral malleolar fat pad is spontaneously visible, as a redundant tissue, on the side of all adult female ankles. The present study includes anatomical dissections of seven ankles of fresh cadavers. Its surgical interest resides in the fact that it may affect the results of liposuction of the lower extremities, because it could be mistaken for a chronic oedema resulting from surgery. In ankle liposuction, it will be advisable to perform an additional liposuction of this fat pad, with a syringe, to improve results. Therefore it is important to perform a systematic examination of this fat pad and to note its clinical characteristics before and after surgery in all cases of liposuctions of all parts of the lower extremities.

[Postoperative xeroradiography in esthetic rhinoplasty. Comparison of tissue reactions]. / La télé-xérographie post-opératoire dans les rhinoplasties esthétiques. Comparaisons des réactions tissulaires.

The cephaloxerogram has been a very useful exam before rhinoplasty since 1975. The comparison with post-operative cephaloxerograms performed on 72 rhinoplasties between. 10 and 23 months, was performed to investigate the soft-tissue response following rhinoplasty. The soft-tissue response was studied in seven different zones. This study shows how the soft tissue alteration is very different from one zone to one another. It is possible to conclude that the study of the importance of the soft tissue response is difficult; but necessary to obtain the most exact super imposed profile before and after operation. The soft tissue alteration is particularly hypertrophic in relation to the upper cartilage zone and supratic area, where the musculo-aponeurotic system (nasal SMAS) is very important. Preservation of this system, during undermining of the nasal soft tissue, may be an important step to reduce the hypertrophic response at this level.