A New Target for Temple Volumization? An Anatomical and Ultrasound Guided Study of the Intermediate Temporal Fat Pad

2021 ◽  
Author(s):  
Christopher C Surek
Keyword(s):  
Ultrasound Guidance ◽  
Temporal Artery ◽  
Fat Pad ◽  
Cross Sectional ◽  
Temporal Fossa ◽  
Clinical Patient ◽  
Filler Injection ◽  
Temporal Fascia ◽  
Deep Layers ◽  
Ultrasound Technology

Abstract Background Current techniques for temple volumization primarily focus on deep or superficial targets. Further anatomical exploration of intermediate injection targets is warranted. Objectives The purpose of this study was to examine the anatomy of the intermediate temporal fat pad (ITFP) as it relates to filler injection procedures and to explore the utilization of ultrasound technology for clinical localization. Methods Ultrasound technology was utilized to identify and inject red dyed hyaluronic acid filler into the ITFP in 20 hemifacial fresh cadavers. Cross-sectional dissection was performed to confirm injection accuracy and document pertinent anatomical relationships. The same technique was performed in a single clinical patient case employing ultrasound guidance and injectable saline. Results The ITFP is a quadrangular structure located in the anterior-inferior bony trough. The ITFP is supplied by a middle temporal artery branch and encased between the superficial and deep layers of deep temporal fascia. In 18 of 20 (90%) injections performed under ultrasound guidance, the injected product was accurately delivered to the substance of the ITFP, and in 2 of 20 (10%), the product was found immediately below the deep layer of deep temporal fascia within the temporalis muscle. In the single clinical case, saline was successfully injected in the ITFP under ultrasound guidance. Conclusions The ITFP is a consistent anatomical structure in the anterior-inferior trough of the temporal fossa. Ultrasound technology can be utilized to identify and inject the fat pad. Further clinical evaluation will determine the role of this fat pad as a potential intermediate injection target for temple volumization procedures.

scholarly journals Subparaneural injection in popliteal sciatic nerve blocks evaluated by MRI

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 346-353
Author(s):  
Benedikt Büttner ◽  
Alexander Schwarz ◽  
Caspar Mewes ◽  
Katalin Kristof ◽  
José Hinz ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Resonance Imaging ◽  
Nerve Blocks ◽  
Cross Sectional ◽  
Neurological Sequelae ◽  
Patient Reported ◽  
Study Population ◽  
Intraneural Injection

AbstractIntraneural injection of a local anesthetic can damage the nerve, yet it occurs frequently during distal sciatic block with no neurological sequelae. This has led to a controversy about the optimal needle tip placement that results from the particular anatomy of the sciatic nerve with its paraneural sheath.The study population included patients undergoing lower extremity surgery under popliteal sciatic nerve block. Ultrasound-guidance was used to position the needle tip subparaneurally and to monitor the injection of the local anesthetic. Sonography and magnetic resonance imaging were used to assess the extent of the subparaneural injection.Twenty-two patients participated. The median sciatic cross-sectional area increased from 57.8 mm2 pre-block to 110.8 mm2 immediately post-block. An intraneural injection according to the current definition was seen in 21 patients. Two patients had sonographic evidence of an intrafascicular injection, which was confirmed by MRI in one patient (the other patient refused further examinations). No patient reported any neurological symptoms.A subparaneural injection in the popliteal segment of the distal sciatic nerve is actually rarely intraneural, i.e. intrafascicular. This may explain the discrepancy between the conventional sonographic evidence of an intraneural injection and the lack of neurological sequelae.

scholarly journals Fillers and Vessels: The Story of Arterial Obstruction after Cosmetic Treatment

2021 ◽  
Vol 6 (2) ◽  
pp. 1-4
Author(s):  
Velthuis PJ
Keyword(s):  
Hyaluronic Acid ◽  
Skin Necrosis ◽  
Ultrasound Guidance ◽  
Arterial Occlusion ◽  
Calcium Hydroxyapatite ◽  
Duplex Sonography ◽  
Low Grade ◽  
Filler Injection ◽  
Retinal Artery ◽  
Cosmetic Medicine

Most popular fillers in cosmetic medicine are hyaluronic acid based. These comprise over 90% of the market and come with the advantage to be soluble in case of complications. Other fillers are contained in the group of bio-stimulatory fillers. They exert a secondary volumizing effect by provoking a low-grade inflammatory response that produces extra collagen. Examples are calcium-hydroxyapatite and L-poly-lactid acid. Finally autologous fat is being used as a filling substance (lipofilling). The gravest complications with fillers are intravascular injections. In particular when injected in arteries fillers can block blood flow and lead to skin necrosis or vison loss in case the material occludes the Central Retinal Artery (CRAO). Two opposing theories about the nature of arterial occlusion exist. One based on Ian Taylor idea of choke anastomoses assume vasoconstriction induced by the filler, both of the primary offended artery and its anastomosing vasosomes. In this case resolving the hyaluronic acid filler with the enzyme hyaluronidase at the primary occluding location would suffice. This is done under ultrasound guidance. The other theory assumes displacement of parts of the filler to end arterioles. Then, the whole affected area has to be flooded with large dosages of hyaluronidase. Obstructions with fillers based on other materials cannot be resolved. It seems logical to prevent intra-arterial filler injection by duplex sonography detection of the course of arteries prior to injection. Ultrasound has additional advantages for cosmetic doctors such as recognizing remains of previously injected filler. It also can give feedback on a physician’s ability to inject filler in the correct subdermal location.

Human Masticatory Muscle Volume and Zygomatico-mandibular Form in Adults with Mandibular Prognathism

2002 ◽  
Vol 81 (11) ◽  
pp. 752-756 ◽  
Author(s):  
N. Kitai ◽  
Y. Fujii ◽  
S. Murakami ◽  
S. Furukawa ◽  
S. Kreiborg ◽  
...  
Keyword(s):  
Masticatory Muscles ◽  
Muscle Volume ◽  
Zygomatic Arch ◽  
Masticatory Muscle ◽  
Mandibular Ramus ◽  
Cross Sectional ◽  
Temporal Fossa ◽  
Mandibular Prognathism ◽  
Masseter Muscles ◽  
Area And Volume

Although several investigators have reported associations between masticatory muscles and skeletal craniofacial form, there is no agreement on the association. We tested the hypothesis that masticatory muscle volume correlates with the size and form of the adjacent local skeletal sites. For this purpose, we investigated the morphological association of the cross-sectional area and volume of temporal and masseter muscles with zygomatico-mandibular skeletal structures using computerized tomography (CT) in 25 male adults with mandibular prognathism. Muscle variables significantly correlated with widths of the bizygomatic arch and temporal fossa but not with the cranium width. Masseter volume significantly correlated with cross-sectional areas of the zygomatic arch and mandibular ramus. Masseter orientation was almost perpendicular to the zygomatic arch and mandibular antegonial region. The zygomatic arch angle significantly correlated with the antegonial angle. The results of the study suggest that the masticatory muscles exert influence on the adjacent local skeletal sites.

The Infrazygomatic Segment of the Superficial Temporal Artery: Anatomy and Technique for Harvesting a Better Interposition Graft

2017 ◽  
Vol 13 (4) ◽  
pp. 517-521 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Michael T. Lawton ◽  
Ivan El-Sayed ◽  
Jason Davies ◽  
Halima Tabani ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Average Length ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Zygomatic Arch ◽  
Fat Pad ◽  
Arterial Segment ◽  
Interposition Graft ◽  
Remote Sites ◽  
Superior Border

Abstract BACKGROUND: The superficial temporal artery (STA) is underutilized as an interposition graft because current techniques expose and harvest STA above the level of the zygoma. This technique yields a diminutive arterial segment in both length and diameter, which limits its use for extracranial−intracranial bypass. OBJECTIVE: To introduce a safe and efficient technique for harvesting of the infrazygomatic segment of the STA. METHODS: Scalp layers, STA, and the facial nerve were studied in 18 specimens. The length of the STA segment harvested below the superior border of the zygomatic arch was measured. Safety of this technique was assessed by measuring the distance between the facial nerve and the STA. RESULTS: The galea and subgaleal fat pad were the only anatomical planes found between the facial nerve and the STA below the zygomatic arch. A dense subcutaneous band of galea contained the STA and allowed proximal dissection of the artery without exposing the facial nerve. The average length of the artery harvested between the zygomatic arch and the parotid gland was 20 mm. CONCLUSION: Subcutaneous dissection within the galea below the level of the zygomatic arch and preservation of the dense subcutaneous band surrounding the STA avoids transecting the facial nerve branches while providing increased STA exposure. This anatomical knowledge may increase the use of STA as an interposition graft in cerebrovascular bypass procedures and reduce the need to harvest grafts through additional incisions at remote sites.

scholarly journals Open surgical approach to management of rhino-orbito-cerebral mucormycosis

2021 ◽  
Vol 8 (1) ◽  
pp. 64
Author(s):  
Sunil K. C. ◽  
Praveen Kumar B. Y. ◽  
Ramesh Bhoomannavar ◽  
Rishabh Jain
Keyword(s):  
Surgical Approach ◽  
Effective Means ◽  
Tertiary Care ◽  
Wound Dehiscence ◽  
Open Approach ◽  
Cross Sectional ◽  
Temporal Fossa ◽  
Co Morbidity ◽  
Facial Swelling ◽  
Open Surgical Approach

<p class="abstract"><strong>Background: </strong>Since December 2019, when novel corona virus (COVID 19) was reported, it has spread widely to cause a pandemic. Rhino-orbito-cerebral Mucormycosis (ROCM), an opportunistic fungal infection caused by the order Mucorales and class Zygomycetes has led to an epidemic in our country.</p><p class="abstract"><strong>Methods: </strong>This prospective cross sectional study was conducted at a 1200 bed tertiary care teaching hospital in Mysore. All patients of ROCM who presented to us for treatment were selected for the study after informed consent. Only those patients who were operated via open approach were included.</p><p class="abstract"><strong>Results:</strong> Median age of the patients was 50 years (SD±10). 49 were male patients (67.1%). Diabetes mellitus was the most common underlying co-morbidity seen in 71 patients (97.3%). Facial pain (100%) and facial swelling (90.4%) were the most common presenting complaint. KOH positivity from nasal swab for Mucormycosis was positive in only 37 patients (50.7%). Traditional inaccessible areas to endoscope like the premaxilla, lateral orbit cavity, infra temporal fossa and hard palate were tackled by the open surgical approach route. Advantages of open surgical approach being the access to areas which are traditionally difficult to approach via the endoscope, aggressive debridement is possible which might be challenging endoscopically. Complications like wound dehiscence, oro-antral fistula, osteomyelitis and abscess were noted in our study.</p><p class="abstract"><strong>Conclusions: </strong>Open surgical approach offers a very viable, affordable and a very effective means for aggressive surgical debridement of infection and reduce mortality associated with ROCM.</p><p> </p>

scholarly journals New peripheral nerve blocks: are they worth the hype?

2020 ◽  
pp. S1-S3
Author(s):  
AT Bösenberg ◽  
E Holland
Keyword(s):  
Peripheral Nerve ◽  
Ultrasound Guidance ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Portable Ultrasound ◽  
Spinal Nerves ◽  
Ultrasound Technology ◽  
Innovative Approaches

The advent of portable ultrasound technology has revolutionised our ability to place peripheral nerve blocks within tissue planes. Ultrasound guidance has facilitated the introduction of new innovative approaches to deeper nerves not previously attempted using landmark-based techniques. The majority of these truncal blocks involve the branches of the spinal nerves.

scholarly journals Clinical Outcome of Cooled Radiofrequency Ablation in Chronic Knee Pain Osteoarthritis: An Initial Experience from Nepal

2021 ◽  
Vol 19 (1) ◽  
pp. 175-178
Author(s):  
Anuj Jung Rayamajhi ◽  
Pawan Kumar Hamal ◽  
Rupesh Kumar Yadav ◽  
Nabin Pokhrel ◽  
Prashanta Paudel ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Pain ◽  
Ultrasound Guidance ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Chronic Knee Pain ◽  
Numerical Rating

Background: Cooled Radiofrequency ablation is a newer technique for management of chronic knee pain in osteoarthritis. The aim of the study is to evaluate the clinical outcomes in patients with chronic osteoarthritis in terms of pain scores for first six months of cooled radiofrequency ablation using ultrasound guidance. Methods: A cross-sectional study with retrospective review of database was evaluated to analyze the change in the Numerical Rating Scale from baseline scores at 1 day, 1 month and 6 months after the Cooled Radiofrequency ablation of genicular nerves around knee in patients with chronic knee osteoarthritis. Results: Median age was 71 years [ 61-73 years (IQR: 25-75)] with more female preponderance. Numerical Rating Scale (Mean ± S.D.) was significantly less at 1 day (1.87 ± 1.22), 1 month (3.03 ± 0.99) and 6 months (3.37 ± 1.098) from baseline values (6.77 ± 1.00). No soreness and numbness were noted.Conclusions: Cooled Radiofrequency using Ultrasound guidance for management of knee pain in chronic osteoarthritis is promising and reduces Numerical Rating Score significantly from baseline at 1 month and 6 months respectively.Keywords: Cooled radiofrequency ablation; genicular nerve; numeric rating scale

Sign in / Sign up

Export Citation Format

Share Document