Anatomic Study On The Small Incison And Endoscopic Rhytidectomy

1. ObjectiveTo study the distribution of the ligaments, the nerves and the anatomic plane correspond to the dissection in rhytidectomy; To investigate the design of the incision, the anatomic structures of each approach in the small incision and endoscopic rhytidectomy; To determine the methods and techniques in the operative procedures; To provide the anatomic basis and alternative for the small incision and endoscopic rhytidectomy.2. Materials and methods30 sides of 15 antiseptic adult head specimens and 20 sides of 10 fresh adult head specimens were studied, the endoscopic instrumentation includes a 4.0-mm-diameter, 17-cm-length, rigid scope with 30-degree angle, a standard endoscopic light source with a monitor provideing viewing, the incisions were designed in the head specimens and the anatomic structures in each approach were studied with or without endoscopic.3. Results(1)The anatomic plane correspond to the rhytidectomy(1) The scalp was hard to detach with the dense connective tissue between skin and aponeurosis; The loose connective tissue deep to the epicranial aponeurosis allows the scalp to be easily removed; the thickness ofperiosteum is not identical in different specimens and the average thicknesswas (0.9±0. 2) mm.(1) In the temporal region, the loose areolar tissue consisted of multiple layers. Areolar planes existed between the temporoparietal and deep temporal fascias within the temporal region. The superficial temporal fascia was continuous with galea aponeurotica in the most cephalic border and extended as the SMAS below the zygomatic arch. The deep temporal fascia split into two separate fascia, a thick outer layer and a thinner deep layer, continuing inferiorly to the zygomatic arch. The two layers of deep temporal fascia remain separated from each other by a fat pad (the superficial temporal fat pad).(3) The superficial facial fascia invested the superficially situated mimetic muscles(platysma, orbicularis oculi, and zygomaticus major and minor). The thickness of the superficial varied greatly from one region of the face to another. Continuing the sub-SMAS dissection plane into the malar region and a thin fascia fat tissue flap was developed; there existed a thick fat layer between the skin and the mimic muscle in the nasolabial fold area, resembling the structure of a sandwich.(2) The distribution of ligaments of the face(1) The ligaments located in the certain anatomic region of the face. In the frontal and temple region, it appeared as a fibrous wall passing between the deep fascia and the undersurface of the superficial temporal fascia. In the medial midface and lower face, the true ligaments were a series of dense fibrous bands.(2) Three types of ligaments existed: The first type, the ligaments ran from periosteum to dermis. Second type, the ligament occured between the superficial and deep facial fascias. The third type, the ligaments ran between the superficial fascia and the overlying skin. The superior temporal septum, the inferior temporal septum, the temporal ligaments, the orbital ligaments, the orbitalmalar ligament located in the temple and periorbital region; the anterior-auricular ligament, the inferior-auricular cutaneous muscle ligament,the zygomatic ligament, the masseteric ligament, the parotid ligament located in the middle or the low face.(3) The neurovascular structures passed through or located nearby the ligaments.(3) The anatomic study of the nerves of the face(1) The supraorbital nerve, the auriculotemporal nerve, the temporal branch of the facial nerve formed the frontal-temporal nerve triangle in the upper third of the face. The temporal branch and its terminal branches ran inferior to the frontal branch of the superficial temporal artery in the deep surface of superficial fascia in 59.4% of the specimens; The 1~2 terminal branches of the temporal branch may ran across the frontal branch of the superficial temporal artery in its deep surface of superficial fascia in 38.2% of the specimens.(2) The z...