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Anatomical Considerations to Improve Aesthetic Treatments Using Neuromodulators
Published in Yates Yen-Yu Chao, Optimizing Aesthetic Toxin Results, 2022
Nicholas Moellhoff, Sebastian Cotofana
The platysma muscle majorly determines the tone and positioning of the jawline. It is the main facial depressor muscle, as it ascends over the anterolateral aspect of the neck in a superomedial trajectory, connecting to the superior aspect of the depressor labii inferioris, to the modiolus and extending past the mandibular angle (Figure 11.4). It is continuous with the SMAS and the orbicularis oculi muscle in the midface and the superficial temporal fascia in the upper face (Cotofana et al. 2016) (Figure 11.5). The platysma muscle is highly mobile, as it has no direct connection to the underlying mandible. The inferior displacement of the midfacial fat compartments as well as gravitational effects during aging contribute to a caudal displacement of the platysma muscle and the overlying jowl fat compartment, thereby leading to jowl deformity (Suwanchinda et al. 2018).
Maxillofacial Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The head, face and scalp should be inspected for swelling, bruising and lacerations. Swelling may mask the deformity associated with underlying fractures of the facial bones. The bruising and swelling of a ‘black eye’ may mask fractures of the orbito-zygomatic complex or damage to the globe of the eye. Scalp lacerations should be gently probed with a gloved finger to detect underlying depressed skull fractures, but it is dangerous to probe penetrating neck injuries which have pierced the platysma muscle as this may precipitate severe bleeding, particularly below the angle of the mandible.
Thyroidectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The thyroid is then dissected from the anterior aspect of the trachea. This dissection is most difficult at Berry's ligament, where the recurrent laryngeal nerve usually is entering the larynx (Figure 63.5). There are often small vessels close to the nerve in this area that, if they are not initially controlled, should be handled with pressure and hemostatic agents to avoid nerve injury. With a lobectomy, the isthmus is dissected over to the opposite lobe and removed entirely; a total thyroidectomy entails the same maneuvers on the opposite side. Prior to leaving the initial operative side, the vagus nerve should again be stimulated to ensure an intact recurrent laryngeal nerve if the nerve monitoring system is being used. Following completion of the thyroid resection, hemostasis is ensured. The strap muscles are brought together in the midline with interrupted sutures, leaving a generous opening inferiorly for blood to escape if a postoperative hematoma were to develop. The platysma muscle is brought together, followed by the subcuticular layer and the skin.
Preliminary outcomes of combined surgical approach for lower extremity lymphedema: supraclavicular lymph node transfer and lymphaticovenular anastomosis
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Jae-Ho Chung, Yong-Jae Hwang, Seung-Ha Park, Eul-Sik Yoon
In all patients, we used right side to avoid a potential injury to the thoracic duct on the left side. The entire supraclavicular lymph node transfer process was performed as previously described by Chang [6]. Before surgery, the anatomical landmarks of the posterior triangle, consisting of the clavicle, external jugular vein (EJV), and the lateral border of sternocleidomastoid(SCM) muscle, were marked up. Initially, a transverse incision 1 cm above the clavicle was made and the platysma muscle was divided. Then, meticulous dissection was performed at the space between the SCM muscle and the EJV. In this process, we tried to include as much superficial lymphoid tissue for lymph node flap as possible. Following the division of the omohyoid muscle, dissection proceeded lateral to the internal jugular vein (IJV). After the identification of the transcervical artery and vein, the adipose flap including supraclavicular lymph nodes was elevated based on the transcervical vessels above the plane of the scalene muscle.
Efficacy and safety of injectable deoxycholic acid for submental fat reduction: a systematic review and meta-analysis of randomized controlled trials
Published in Expert Review of Clinical Pharmacology, 2021
Karin Soares Cunha, Flávia Lima, Roberta Marques Cardoso
One important AE associated with DOC injections is the marginal mandibular nerve injury typically presented as an asymmetrical smile. It occurred in 24 cases (1,3%) of DOC-treated participants in this systematic review and meta-analysis. Its occurrence possibly resulted from injections administered too deeply into the platysma muscle or too close to the marginal mandibular nerve [20]. Although most cases were classified by the authors as mild or moderate, and all of them resolved without sequelae, its occurrence highlights the importance of the clinician training and understanding of the submental anatomy [10,20]. Moreover, some cases of skin ulceration occurred in two studies [3,10]. It is usually caused by improper injection of DOC superficially into the skin, and reinforces the need for a correct technique, with the injection of DOC midway into the SMF to avoid the dermis [10]. The use of cannulas would also probably reduce the risk of skin ulceration.
Neck rejuvenation using a multimodal approach in Asians
Published in Journal of Dermatological Treatment, 2018
Eun Jin Doh, Jiwon Kim, Dong Hun Lee, Je-Young Park
Neck rejuvenation is one of the most challenging cosmetic subjects for clinicians. The anatomical structure of the anterior neck is composed of several layers, including relatively thin skin and superficial fat, platysma muscle, and deep fat (1). A multimodal approach is required to rejuvenate the neck, because as the aging progresses, it deteriorates these multiple layers (2). The various clinical aspects and anatomical characteristics of aging necks are why it is difficult to achieve satisfactory cosmetic benefits after rejuvenation procedures. Specifically, there may be varying degrees of loosening of the skin, protrusion of the submental fat pads, prominent platysmal bands, and horizontal neck lines. These clinical features appear together rather than alone in aging of the neck (3–5).