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Adapting Injection Techniques to Different Regions
Published in Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh, Adapting Dermal Fillers in Clinical Practice, 2022
Yates Yen-Yu Chao, Sebastian Cotofana, Nicholas Moellhoff
PLLA can be injected along the margin of the mandible by the techniques of point depot and linear threading (Figure 6.89). CaHA and PCL can be delivered as a focal depot or in a tower pattern to give better support or in a linear pattern overlying the defining margin to form shape and angles. Parallel threading could be placed more efficiently by a cannula and the depot injection by needles. The layer of choice is the subdermal plane as this plane is mainly free of crucial neurovascular structures. The facial artery and vein and the marginal mandibular branch of the facial nerve are located deep to the platysma. Whereas most injection techniques can be administered with a cannula, the angle of the mandible can be additionally treated with a perpendicular injection in contact with the bone. Here, the product is administered into the masseter muscle and can result in similar surface projection compared to a subdermal cannula injection.
Physiology of the Neonate
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Anatomical differences in the airway include a longer U-shaped epiglottis, and a larynx situated at a cephalic level opposite to the third and fourth cervical vertebrae, descending to the fifth cervical vertebra during the first 3 years and then at puberty to the final position at the sixth vertebra. The narrowest part of the larynx is the cricoid ring. After puberty, the cricoid enlarges and the narrowest part of the larynx is the vocal cords. The length of the trachea varies from 3.2 to 7 cm depending on the size of the baby. The angle at which the bronchi branch is similar to that of adults, 30° on the right bronchus and 47° on the left bronchus. The tongue is relatively large, and the angle of the mandible is 140° compared with 120° in an adult. The shape of the chest wall in neonates influences the mechanics of breathing. The anteroposterior expansion is limited because the ribs are more horizontal, whereas the transverse expansion is reduced due to the lack of the buckle handle mechanism of ribs. There are also fewer type I muscle fibres (slowly contracting and highly oxidative fibres used for sustained contractions) in the diaphragm and intercostal muscles, and hence these respiratory muscles fatigue easily. The intercostal muscles comprise 20%, 45% and 65% type I muscle fibres in the premature, neonate at term and at full maturity, respectively. The diaphragm comprises 10%, 25% and 55% type I muscle fibres in the premature, neonate and at 9 months of age, respectively.
Temporomandibular Joint Disorders
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Collapse of the joint may cause retrusion of the chin if bilateral, or rotation of the chin centreline towards the side of collapse. In addition there will be loss of definition of the angle of the mandible due to loss of ramus height (Figure 57.2). The opposite features occur where there is joint overgrowth with centreline deviation towards the opposite side and lengthening of the ramus with possible open bite on the affected side.
A novel treatment of pediatric bilateral condylar fractures with lateral dislocation of the temporomandibular joint (TMJ) using transfacial pinning
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Kerry A. Morrison, Roberto L. Flores
After right nasal endotracheal tube insertion with general anesthesia was achieved, attention was drawn to closed reduction of the fracture, as significant widening of the bigonial width and lateral dislocation of the left TMJ was a consequence of this tripartite fracture. Firm medial pressure at the mandibular angle was required to relocate the condyle on the left side and reduce the lower facial width. Appropriate reduction was confirmed by resolution of the anterior crossbite when the patient was brought into occlusion. Furthermore, temporomandibular joint was externally palpated with the jaw both open and closed, confirming reduction of the laterally dislocated left condyle. 1% lidocaine with 1:100,000 epinephrine was then injected into the skin overlying the left angle of the mandible. After 10 min elapsed, a 15-blade scalpel was used to make a puncture in the lower aspect of the cheek, and blunt dissection was used to reach the left angle of the mandible. A 2.8 mm threaded Steinman pin was engaged into left mandibular angle and carefully advanced to the right mandibular angle in a transfacial trajectory. Care was taken to avoid the tongue and endotracheal tube. This pin was advanced until the right angle of the mandible was penetrated however the tip of the pin remained within the soft tissue of the right cheek. This Steinman pin was cut, and a red rubber catheter with a xeroform dressing was placed over the external portion of the pin for protection (Figure 2).
Design and application of submental island flap to reconstruct non-circumferential defect after hypopharyngeal carcinoma resection: a prospective study of 27 cases
Published in Acta Oto-Laryngologica, 2020
Wenting Pang, Aobo Zhang, Cheng Lu, Jun Tian, Wan-xin Li, Zhenxiao Wang, Yanbo Dong, Shuoqing Yuan, Zihao Niu, Yiyuan Zhu, M. Shahed Quraishi, Liangfa Liu
The surgical procedure used was based on the technique originally described by Martin et al. [14] and modified by Patel et al. [17] In brief, the size of the flap was designed to be as large as possible by the skin pinch test to ensure that the donor site could be closed primarily [13,15]. The patient was positioned supine with the head extended and an elliptical skin paddle was marked according to the size of the defect, in a manner that it could be extended from one angle of the mandible to the other. An upper incision was made 1.5 cm below the mandible in the midline so as to put the upper border of the flap was just under the mandibular arch, and the lower limit was marked by a pinch test for primary closure. Neck dissection was first started, with extreme caution to preserve the facial vessels. The strategy regarding neck treatment was individualized for every patient.
Improving mandibular contour: A pilot study for indication of PPLA traction thread use
Published in Journal of Cosmetic and Laser Therapy, 2018
Stefania Guida, Flavia Persechino, Giuseppe Rubino, Giovanni Pellacani, Francesca Farnetani, Giacomo Giovanni Urtis
A schematic representation of threads and the appearance of the skin immediately after the procedure are reported in Figure 1. PLLA threads (Silhouette Lift S.L., Barcelona, Spain. Silhouette Lift Inc Irvine, CA) show bidirectional cones. We used threads with four cones, each composed of lactide glicolide per direction (eight in total), separated by knots. After local anesthesia in entry and exit points, a hole is performed in the skin 1 cm above and below the mandibular angle with an 18G needle. The thread is introduced in a depth of about 5 mm (5 cm from the exit point in two different directions) through the hole. In particular, the superior entry point should be located along the line linking the angle of the mandible and ala nasi, whereas for the inferior one a skin fold should be performed in order to avoid any damage to underlying structures when creating the entry point. Furthermore, establishing the exit point is essential to exert the maximum traction effect. In detail, the upper exit point of both threads should anchor the thread to the temporal (for the upper thread) and mastoid (for the lower thread) fascia. When each branch of the thread has been introduced, the skin is tightened between the two ends and the thread is cut at the level of the skin (Figure 1).