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Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The maxillae are the bones which form the medial aspect of the cheek (Figure 3.4), positioned between the nasal bone and zygoma. They have three primary functions: Allowing a point of anchor for the upper teeth in the alveolar processForming the floor and lateral wall of the nasal cavityForming part of the medial wall of the orbit The point of fusion of the maxillae is at the midline immediately inferior to the nose at the intermaxillary suture. Aside from structural support, the maxillae contain sinuses which are important in both altering the depth of voice as well as keeping decreasing the weight of the facial bones. The maxilla is also the site of the infra-orbital foramen, which is located just below the infraorbital margin of the orbit, at an average distance of 6–10 mm inferiorly in the midline. The infraorbital foramen is important in the transmission of the infraorbital artery, vein and nerve, and therefore, this region must be respected, especially in the context of dermal filler administration as it is at risk of avascular necrosis, filler embolisation and neuronal damage.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
(See also Scalp Blocks)Infratrochlear (eyelids, nose and conjunctivae) Blocked along medial orbit wall, 1 cm above inner canthusSupraorbital and supratrochlear (forehead) Blocked a few millimetres above supraorbital ridgeInfraorbital (lower eyelid and upper lip) Blocked at infraorbital foramen, 1.5 cm below infraorbital margin in line with the pupilMental (chin, lower lip) Midpoint between upper and lower border of mandible, in line with pupil
Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The appearance of the infraorbital margin is carefully assessed. Almost any patient seeking a lower eyelid blepharoplasty with lower eyelid ‘bags’ and/or a skeletonization of the inferior orbital margin is a candidate for an arcus marginalis release. In contrast, however, younger patients with a congenital excess of orbital fat are less likely to benefit from this technique. These patients are better managed using a traditional resection of the excess fat via a transconjunctival approach, with the use of CO2 skin resurfacing or a chemical peel to manage any associated lower eyelid skin wrinkling and photodamage.
Different prognoses in patients with profound sudden sensorineural hearing loss
Published in Acta Oto-Laryngologica, 2019
Fan-Qin Wei, Lanying Wen, Kaitian Chen, Min Liu, Xuan Wu
Otolith function was evaluated by recording cervical vestibular evoked myogenic potentials (c-VEMP) and ocular vestibular evoked myogenic potentials (o-VEMP). c-VEMP resembled the vestibulo-collic reflex and were recorded from the ipsilateral sternocleidomastoid muscle. o-VEMP resembled the vestibulo-ocular reflex and were recorded from extra-ocular muscles by a surface electrode beneath the contralateral infraorbital margin. VEMPs were evoked by 500 Hz tone bursts at 100 dBnHL using a SmartEP evoked potential acquisition system (Intelligent Hearing Systems, Inc., Miami, FL). Disappearance of typical wave and an interaural amplitude ratio increase (≥1.61) were abnormal in c-VEMP and o-VEMP. Abnormal VEMP was defined by lack of typical wave and an interaural amplitude ratio increase (≥1.61).
A new treatment protocol of microfocused ultrasound for lower eyelid fat bulging
Published in Journal of Dermatological Treatment, 2021
Hye Chan Jeon, Do-Yeop Kim, Seon-Pil Jin, Dong Hun Lee
In the first step, MFU was performed on the patients in the supine position using the L7-1.5 transducer (7 MHz, 1.5-mm focal depth) and either the L7-3.0 (7 MHz, 3.0-mm focal depth) or the L4-4.5 transducer (4 MHz, 4.5-mm focal depth) to tighten the lower eyelid dermis and orbital septum. Either the L7-3.0 or the L4-4.5 transducer was used depending on the depth of the orbital septum, which was measured before treatment using a handheld ultrasound device (UProbe-L5NC, Sonostar Technology Co., Guangzhou, China). To ensure that the orbital septum could be targeted by each shot, we applied proper pressure toward the infraorbital margin with the transducer during the procedure.
Manuscript title: the maxillary swing approach – the first Scandinavian experience
Published in Acta Oto-Laryngologica, 2021
Hani Ibrahim Channir, Magnus Balslev Avnstorp, Irene Wessel, Jørgen Rostgaard, Niclas Rubek, Katalin Kiss, Christian von Buchwald, Jimmy Yu Wai Chan, Birgitte Wittenborg Charabi
A tracheostomy was performed in the initial cases to ensure upper airway safety and to ensure adequate surgical access in the oral-facial region. The maxillary swing approach was initiated with a facial Weber-Ferguson incision dividing the upper lip, curving around the nasal alae, following the infra-orbital margin over the zygomatic bone, where it was directed caudally to the inferior border of the zygomatic arch (Figure 2(a,b)). The incision in the lip was extended intraorally in the hard palate following the palatal alveolar rim creating a medially based mucosal flap. The pterygoid process was separated from the maxilla using a curved osteotome. The orbicularis oculi muscle was dissected and kept anatomically intact on the maxilla, and the infraorbital nerve was identified, marked and divided. Titanium plates were placed and fixed on the planned osteotomies on the premaxilla, the zygomatic arch and the medial part of the maxilla (Figure 2(c)). The plates were removed, and osteotomies were performed on the anterior wall of the maxillary antrum and at the lower portion of the zygomatic arch. The medial and lateral wall of the maxillary sinus was divided horizontally using an oscillating saw. The premaxilla and the hard palate were divided in the midline just lateral to the nasal septum by saw and osteotome leaving the soft palate intact, and the maxilla was swung laterally while maintaining blood supply from the external carotid artery branches (Figures 2(d) and 3). For better access to the nasopharynx, the pterygoid process and the posterior part of the nasal septum was resected. The tumor was excised in toto if possible, guided by perioperative frozen sections or until no further resection was possible, preferably using monopolar cautery. A wide margin of minimum 5 mm was preferred if possible.