Orthodromic temporalis tendon transfer: anatomical considerations.

OBJECTIVES: To define (1) at-risk structures during the orthodromic temporalis tendon transfer and (2) achievable tendon length without temporal releasing incisions or perioral lengthening materials. METHODS: Ten fresh cadavers provided 20 hemifaces for dissection. Measurements and photographic documentation were used to examine the parotid duct, masseteric artery, inferior alveolar nerve, internal maxillary artery, and mobilized tendon relative to adjacent landmarks. RESULTS: The parotid duct was found in a reproducible region posterior to the melolabial crease and inferior to a parotid duct reference line. The masseteric artery was found posterior to the posterior-most attachment of the tendon at its exit from the sigmoid notch (mean, 14.5 mm). The inferior alveolar nerve was found posterior to the anterior edge of the ascending ramus (mean, 18.3 mm). The internal maxillary artery coursed superiorly from posterior to anterior along the medial mandible near the coronoidectomy site. The tendon reached beyond the melolabial crease in 17 of 20 hemifaces (85%). CONCLUSIONS: The parotid duct reference line and the melolabial crease allow estimation of the parotid duct location. Anatomical relationships between the tendon, parotid duct, neurovasculature, and anatomical landmarks underscore the importance of deliberate soft-tissue retraction and subperiostial elevation to minimize injury. The tendon alone usually provides adequate length for orthodromic suspension.

Histotopographic study of the fibroadipose connective cheek system.

The purpose of this study was to investigate the morphology of the superficial musculoaponeurotic system (SMAS). Eight embalmed cadavers were analyzed: one side of the face was macroscopically dissected; on the other side, full-thickness samples of the parotid, zygomatic, nasolabial fold and buccal regions were taken. In all specimens, a laminar connective tissue layer (SMAS) bounding two different fibroadipose connective layers was identified. The superficial fibroadipose layer presented vertically oriented fibrous septa, connecting the dermis with the superficial aspect of the SMAS. In the deep fibroadipose connective layer, the fibrous septa were obliquely oriented, connecting the deep aspect of the SMAS to the parotid-masseteric fascia. This basic arrangement shows progressive thinning of the SMAS from the preauricular district to the nasolabial fold (p < 0.05). In the parotid region, the mean thicknesses of the superficial and deep fibroadipose connective tissues were 1.63 and 0.8 mm, respectively, whereas in the region of the nasolabial fold the superficial layer is not recognizable and the mean thickness of the deep fibroadipose connective layer was 2.9 mm. The connective subcutaneous tissue of the face forms a three-dimensional network connecting the SMAS to the dermis and deep muscles. These connective laminae connect adipose lobules of various sizes within the superficial and deep fibroadipose tissues, creating a three-dimensional network which modulates transmission of muscle contractions to the skin. Changes in the quantitative and qualitative characteristics of the fibroadipose connective system, reducing its viscoelastic properties, may contribute to ptosis of facial soft tissues during aging.

Parotid gland with double duct: an anatomic variation description / Glándula parótida con doble conducto: descripción de una variación anatómica

The parotid is the largest salivary gland in humans producing an essentially serous secretion, which normally reaches the oral cavity through a sole duct (the parotid duct) after the latter making its way through the buccinator muscle to reach the mucosa lining the mouth at the level of the cheek. The present study reports on a rare case of double parotid duct found during the dissection the right side of the face of a cadaver of a 46-year-old male individual. The superior (Dl) and inferior (D2) ducts were 26.49 mm and 37.25 mm long, respectively. Based on the diameter of both ducts (Dl and D2) taken in the posterior (3.05 mm and 2.84 mm, respectively) and mid (2.84 mm and 2.68 mm, respectively) thirds, as well as on the histological findings, both ducts were considered to be main parotid ducts. These two ducts merged at the level of the anterior third forming one sole opening into the oral cavity. The data hereby reported are relevant to the various clinical and surgical procedures involving the parotid gland.

La parótida es la glándula salival más grande presente en el hombre y su producto de secreción, básicamente seroso, es normalmente dirigido hasta la cavidad oral, a través de un único canal parotídeo que, luego de perforar el músculo buccinador, desemboca en la mucosa de la mejilla. Este trabajo muestra un caso raro de doble canal parotídeo hallado durante la diseccción de un cadáver de sexo masculino, de 46 años de edad, en el lado derecho del rostro. Los canales superior (DI) e inferior (D2), presentaron una longitud de 26,49 mm y 37,25 mm, respectivamente. En base a los diámetros presentados por los canales en los tercios posterior (DI 3,05mm; D2 2,84 mm) y medio (DI 2,84mm; D2 2,68 mm) y de acuerdo con los hallazgos histológicos, ambos fueron considerados principales. En el tercio más anterior los canales se fusionaron, presentando una única apertura en la cavidad oral. Las informaciones presentadas en este documento son relevantes para diferentes procedimientos clínicos y quirúrgicos que tengan relación con la glándula parótida.

Anatomy of tympanoparotid fascia relating to neck lift.

The aim of this study is to elucidate anatomical detail of the tympanoparotid fascia (TPF), deployed anteroinferiorly to the tragus, in relation to neck lift and platysmaplasty. Forty-one hemifaces of 25 Korean adult cadavers (age range: 43-101 years, 19 males and 6 females) were used for the study. Thirty-seven were dissected. Twenty-one were used for tension measurement and 4 for the histologic study. Tympanoparotid fascia was found in almost 36 hemifaces (100%). It was white-colored dense connective layer anteroinferior to tragus. The whitish fascia was a dense connective tissue layer deployed anteroinferiorly to the tragus. Two thirds of TRF originated from the tympanomastoid fissure and one third from the auricular cartilage and interfused with the parotid fascia, covering the parotid gland in front of the tragus. Tympanoparotid fascia was tetragonal in shape. The anterior side (15.1+/-5.4 mm) was longer than the posterior side (10.4+/-4.4 mm). It was 11.3+/-3.9 cm in upper width and 9.5+/-3.8 cm in lower, respectively. It was located 43.0+/-7.7 mm inferior to the otobasion superioris (obs) and 6.0+/-5.5 mm superior to the otobasion inferioris (obi). The anterior side was at 9.5 to 11.3 mm anterior to the auricle (obs-obi) and the posterior side at obs-obi line of the auricle. The tensile strength of the 5 mm width of TPF was 38.4+/-18.2 N. It is significantly stronger (P=0.00) than the central portion of the parotid fascia (22.7+/-12.2 N). Tympanoparotid fascia strength (38.4 N) is enough to pull and hold the platysma as much as sternocleidomastoid muscle fascia (44.5 N) does. Such an anatomical component of TPF is useful in performing platysmaplasty or platysma suspension.