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The Superficial Musculo-Aponeurotic System (SMAS) in the Parotid and Cheek Area
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
While the SMAS and platysma are interconnected with the skin and subcutaneous tissue, the under surface of this anatomic flap is not intimately fixed to the deeper structures. A potentially avascular space is present between the superficial flap and the external layer of the deep cervical fascia of the neck, which continues into the cheek as the true parotid fascia. Due to this anatomic configuration, the SMAS-platysma layer is easily separated from the deep cervical fascia. Almost no vessels cross this plane. This deeper fascial dissection respects the function of the SMAS and it allows a stronger pullback of the fascia and skin together. When the excess part of the SMAS is resected and sutured to the pre-tragal area, the anterior muscles and the skin may be pulled back (or “lifted”). This approach also lessens the area which has to be undermined, as only the parotid area has to be freed to obtain this pullback.
Anatomy of the Lower Face and Neck
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Evan Ransom, Stephen A. Goldstein
The superficial musculoaponeurotic system (SMAS) is the tissue layer continuous with the platysma, which invests the mimetic muscles in the lower face. Laterally, the platysma muscle fibers reach the parotid tail before dissipating and becoming the parotid fascia. In the middle of the platysma, muscle fibers cross over the mandibular body loosely, accounting for the relative mobility of the facial skin in this area. More anteriorly, overlying the parasymphysis, the platysma is attached to the mandible at a band of tissue called the mandibular septum or mandibular retaining ligament (19,20).
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The deep cervical fascia has four components: Investing fascia. This is the layer of deep fascia that lies beneath the subcutaneous fat and splits into superficial and deep layers as the parotid fascia surrounds the gland. A local thickening forms the stylomandibular ligament.Prevertebral fascia. This covers the muscles (splenius capitis, levator scapulae, scalenus posterior, medius and anterior) that form the floor of the posterior triangle, and forms a layer over which the pharynx and oesophagus can freely slide. It covers the brachial plexus trunks and subclavian artery but not the subclavian vein and is pierced by the four nerves of the cervical plexus.Pretracheal fascia. This separates the trachea from the overlying strap muscles to allow trachea gliding. It encloses the thyroid gland (pierced by the thyroid vessels) and blends laterally with the carotid sheath.Carotid sheath. This envelopes the carotid arteries (common and internal), the IJV (where it is thin) and vagus nerve. It is adherent to the deep surface of SM.
Auricular reconstruction after Mohs excision utilizing combination of pre-auricular transposition and chondrocutaneous advancement flaps
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Annet S. Kuruvilla, Jared M. Gopman, Peter W. Henderson
A unique combination procedure was designed that consisted of a unilateral chondrocutaneous advancement (Antia-Buch) flap (to improve the shape of the ear) and a pre-auricular fasciocutaneous transposition flap (to provide skin coverage) (Figure 2). The Antia-Buch flap was designed along the lateral helical rim, the posterior skin was kept intact as the vascular support to the helical rim cartilage, the cartilage was advanced, and a small amount of cartilage was debrided and removed as a wedge extending into the scapha to allow for appropriate closure without disruption of normal contour. Separately, a superiorly-based pre-auricular fasciocutaneous transposition flap was raised superficially to the superficial musculoaponeurotic system (SMAS)/parotid fascia. The flap was rotated approximately 90° and draped over the helical root, and inset with 5-0 nylon sutures to the leading edge of the helical rim chondrocutaneous advancement flap.
Refinement of the surgical indication and increasing expertise are associated with a better quality of pathology specimen in pleomorphic adenomas
Published in Acta Oto-Laryngologica, 2021
Konstantinos Mantsopoulos, Ann-Kristin Iro, Matti Sievert, Sarina Katrin Müller, Abbas Agaimy, Michael Koch, Heinrich Iro
In our department, surgical modalities in the parotid gland are defined as follows: extracapsular dissection (ED) is the removal of the tumour with a cuff of parotid tissue without intending to expose the main trunk or branches of the facial nerve. The procedure is called a partial superficial parotidectomy (PSP) if the main nerve trunk is deliberately exposed before dissection and only parts of the superficial lobe are removed together with the tumour. Removal of the entire parotid gland lateral to the facial nerve (superficial lobe) is defined as a lateral parotidectomy (LP), while excision of all the glandular parenchyma (superficial and deep parotid lobe) with preservation of the facial nerve trunk and its branches is referred to as complete parotidectomy (CP) [12,13]. PSP, LP and CP are classified as ‘facial nerve dissecting’ surgical techniques. In pathology specimens, complete coverage of PA by healthy tissue was defined as coverage of PA through healthy tissue (salivary gland parenchyma, parotid fascia, connective or fat tissue, muscle fibres of the superficial musculoaponeurotic system, sternocleidomastoid or digastric muscle) all around its periphery (irrespective of width of clear margins), so that its capsule was not exposed at all (Figure 1). That means that a limited focal exposure of an anatomically intact capsule, which equals to a locally marginal ‘in sano’ excision of a PA, precludes 100% coverage of the lesion through healthy tissue.