Surgical anatomy of the midcheek and malar mounds

The anatomy of the midcheek has not been satisfactorily described to adequately explain midcheek aging and malar mounds, nor has it suggested a logical approach to their correction or provided sufficient detail for safe surgery in this area. This cadaver study, which was complemented by many operative dissections, located a missing link: a glide plane space overlying the body of the zygoma. The space functions to allow mobility of the orbicularis oculi, where it overlies the zygoma and the origins of the elevator muscles to the upper lip. The space is a cleft between the sub-orbicularis oculi fat and the preperiosteal fat and is lined by a fine membrane. The anatomic boundaries are clearly defined by retaining ligaments, which correlate with the triangularity of the space. Several anatomic features provide the functional characteristics of the prezygomatic space, including the (1) absence of direct attachments between the orbicularis in the roof to the floor, (2) more rigid inferior boundary formed by the zygomatic ligaments, and (3) more mobile upper ligamentous boundary formed by the orbicularis retaining ligament (separating from the preseptal space of the lower lid). These components determine the characteristic aging changes that occur in this region and explain much about malar mounds. An appreciation of this anatomy has several surgical implications. The prezygomatic space is a junction area that can be approached from the temple, lower lid, and cheek. The zygomatic branches of the facial nerve to the orbicularis do not cross the space; rather, they course in the walls and in the sub-orbicularis fat within the roof of the space.     

Thermal imaging of the periorbital regions during the presentation of an auditory startle stimulus

Infrared thermal imaging of the inner canthi of the periorbital regions of the face can potentially serve as an input signal modality for an alternative access system for individuals with conditions that preclude speech or voluntary movement, such as total locked-in syndrome. However, it is unknown if the temperature of these regions is affected by the human startle response, as changes in the facial temperature of the periorbital regions manifested during the startle response could generate false positives in a thermography-based access system. This study presents an examination of the temperature characteristics of the periorbital regions of 11 able-bodied adult participants before and after a 102 dB auditory startle stimulus. The results indicate that the startle response has no substantial effect on the mean temperature of the periorbital regions. This indicates that thermography-based access solutions would be insensitive to startle reactions in their user, an important advantage over other modalities being considered in the context of access solutions for individuals with a severe motor disability.     

Surgical anatomy of the internal carotid artery

Starting from the carotid trigone, a surgical approach to the parapharyngeal part of the internal carotid artery is described. The retrostyloidal part of the lateropharyngeal space is opened up from laterocaudal after resecting the posterior belly of the digastric muscle and the styloidal muscles. Vulneration of the cranial nerves (VII, IX, X) has to be prevented.     

Surgical anatomy of the gracilis muscle of the thigh

As demonstrates the investigation of 100 preparations, the main vascular-nervous "hilus" of the muscle is situated on the superior third of its lateral part. They contain the transversal branch of the medial artery, circumflexing the femoral bone with the accompanying vein, having the same name, and the anterior branch of the obturative nerve (92 preparations), or muscle branch of the femoral nerve (8 preparations). The muscle has a well developed network of intrasystemic and intersystemic anastomoses. Beginning from the first period of childhood, for sphincter plasticity either the whole muscle, or a graft, cut out from its lateral part, can be used.     

The vascular anatomy of the galeal flap in the interparietal and midline regions.

The potential extension of the galeal flap in the interparietal area was studied on 17 fresh human cadaver heads by intravascular dye injection technique. It was demonstrated that an ipsilateral superficial temporal artery that supplies the galeal flap does not cross the midline or anastomose with the contralateral superficial temporal artery but ensures the survival of a flap extended up to 1 cm proximal to the sagittal suture line. The width of the temporoparietal flap can be extended up to 15 cm, depending on the vascular pattern of the superficial temporal artery. When required, the lateral extension may provide the required soft-tissue bulk despite the reduced flap length.     

Surgical anatomy of the abdominal part of the thoracic duct

With the aim to determine local orienting points, that facilitate in searching the abdominal part of the thoracic duct, 43 corpses of mature persons have been investigated by means of a complex of anatomical techniques. The distance between the levels, where the superior mesenteric artery and renal arteries get off, can be used for preventing possible complications at certain surgical manipulations. In particular, when the distance from the beginning of the superior mesenteric artery is 37-64 mm, the thoracic duct is mainly situated behind the inferior vena cava; when this distance is 16-34 mm, the duct is situated between the inferior vena cava and the aorta, and when the distance between the superior mesenteric and renal arteries is 6-15 mm, the abdominal part of the thoracic duct should be searched for behind the inferior vena cava.     

New aspects of the topographical anatomy of the mammary gland regarding its neurovascular supply along a regular ligamentous suspension

The exact location of the main nerves and vessels to the breast and the nipple-areola complex has always been obscure. We found that the course of the rich neurovascular supply to the nipple runs along a regularly-located, suspensory apparatus and can therefore be predicted exactly. It consists of a horizontal fibrous septum originating at the pectoral fascia along the 5th rib, merging into vertical ligaments along the sternum medially and along the lateral border of pectoralis minor laterally. Cranially, and in an anterior direction, the vertical ligaments are connected by the superficial fascia. In the current anatomical study, we seek to demonstrate the vascular supply provided by these structures more impressively. For this purpose we dissected the ligamentous suspension after intraarterial injection with colored latex in both breasts of 10 female cadavers. The large vessels, guided by this circle of fibrous attachments could then be seen clearly. In a further 4 female cadavers, a similar procedure was performed after intraarterial injection of surgical ink. This stained the vascular layers even more intensely. This topographical knowledge has clinical relevance. The rich and constant neurovascular supply to the nipple areola complex may be maintained in a new breast-reduction technique, which allows safe postoperative viability and sensibility of the nipple. The clinical results act as a striking evidence of our anatomical findings. Further procedures taking advantage of the easy determination and access to the neurovascular supply may be seen in future.     

Surgical anatomy of the anastomotic branch between the occipital and vertebral arteries

Using anatomical material of mature persons and, for the first time, that of newborns, the discovered well developed anastomotic branch between the occipital and vertebral arteries can be considered as an anatomical variant of the vascular system, important for the collateral blood circulation. Similar branch in mature persons can also serve as an intermediate link for transmitting irritation at the neck osteochondrosis along the periarterial plexuses from the vertebral artery to the occipital one, that results in reflectory pains in the posterior area of the neck.     

Surgical anatomy of subaortic conus of the normal heart]

One hundred and fourty-three normal hearts have been studied. The conoid septum, supraventricular crest, bulboventricular fold, area of the fibrous tissue between the aortal and mitral valves and the anterior interventricular septum make the walls (frontal view, in the direction of the hour hand) of the left ventricular cone. In the normal heart there is no real contact between the fibrous rings of the aortal and mitral valves. They are connected by means of a strip of the fibrous tissue, its size varies. The subaortal cone and deferent part of the left ventricular axes make an obtuse angle; the axes of the subpulmonary and subaortal cones have a cross direction. The geometrically definitive left ventricular cone is seen as obliquely-sectioned overturned isosceles cone, with its big base directed upward, right and back, and the small one forward and left.