PURPOSE: There are marked differences in facial skeletal characteristics between Asian and Caucasian. However, ethnic differences in age-related facial skeletal changes have not yet been fully established. The aims of this study were to evaluate age-related changes in Asian midfacial skeletons and to explore ethnic differences in facial skeletal structures with aging between Caucasian and Asian. MATERIALS AND METHODS: The study included 108 men (aged 20-79 years) and 115 women (aged 20-81 years). Axial CT images with a gantry tilt angle of 0 were analyzed. We measured three-dimensional (3D) coordinates at each point with a pixel lens cursor in a picture archiving and communication system (PACS), and angles and widths between the points were calculated using 3D vector mathematics. We analyzed angular changes in 4 bony regions, including the glabellar, orbital, maxillary, and pyriform aperture regions, and changes in the orbital aperture width (distance from the posterior lacrimal crest to the frontozygomatic suture) and the pyriform width (between both upper margins of the pyriform aperture). RESULTS: All 4 midfacial angles in females and glabellar and maxillary angles in males showed statistically significant decreases with aging. On the other hand, the orbital and pyriform widths did not show statistically significant changes with aging. CONCLUSION: The results of this study suggest that Asian midfacial skeletons may change continuously throughout life, and that there may be significant differences in the midfacial skeleton between both sexes and between ethnic groups.
Adult ; Aged ; Aging/ethnology/*physiology ; Asian Continental Ancestry Group ; Facial Bones/*anatomy & histology/*radiography ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Mathematics ; Maxilla/anatomy & histology/radiography ; Middle Aged ; Orbit/anatomy & histology/radiography ; Radiology Information Systems ; Republic of Korea ; Tomography, X-Ray Computed/*methods ; Young Adult ; Zygoma/anatomy & histology/radiography

The aim of this review is to familiarize the reader with the critical lower eyelid anatomy as is related to lower blepharoplasty or a midface lift. The contents include 1) the lacrimal canaliculus in the lower eyelid: the depth and width (diameter) of the vertical portion were 2.58+/-0.24 mm and 0.44+/-0.07 mm, respectively. A vertical portion of the canaliculus was about 1 mm (1.11+/-0.16 mm) deep, and the horizontal portion was about 2~3 mm (2.08+/-2.74 mm) long 2 mm below the mucocutaneous junction, which is where an incision may be made when performing epicanthoplasty. 2) Motor innervation to the lower orbiculis oculi muscle: the pretarsal and preseptal OOMs were innervated by five to seven terminal twigs of the zygomatic branches of the facial nerve that approached the muscle at a right angle. The mean horizontal distance between the lateral canthus and the zygomatic branch was 2.31+/-0.29 cm (range: 1.7~2.7 cm) and the vertical distance was 1.20+/-0.20 cm (range: 0.8~1.5 cm). 3) Sensory innervation of the lower eyelid skin: the majority of the terminal branches (93.8%) of the ION were distributed to the medial to the lateral canthus. Most (99.4%) of the terminal branches of the ZFN were distributed to lateral to the lateral canthus. 4) Retractor of the lower eyelid; capsulopalpebral fascia (CPF): the orbital septum blended with the CPF most closely at 3.7~5.4 mm beneath the lower tarsal border and differently at 3.7+/-0.7 mm on the medial limbus line, 4.3+/-0.8 mm on the midpupillary line and 5.4+/-1.0 mm on the lateral limbus line. 5) Arcuate expansion (AE): The AE was a fibrous band expanding from the inferolateral orbital rim to the medial canthal ligament. A sector (fan-shaped) of the AE originated in the angle of 5 to 80 degrees at the circumference of the inferolateral orbital rim circle, falling within the range of 3 to 5.5 o'clock, and then it tapered and attached to the inferior border of the medial canthal ligament. 6) Suborbicularis oculi fat (SOOF) in the lower eyelid: the SOOF was located in the inferolateral side of the orbit within a range between medial +15 and lateral -89 degrees to a vertical midpupillary line. Histologically, the SOOF was situated deep to the Orbicularis oculi muscle and superficial to the orbital septum and periosteum. The SOOF consisted more of fibrofatty tissue rather than being the pure fatty nature like orbital fat. I hope surgeons can achieve desirable outcomes with the knowledge reviewed in this article.
Anatomy, Regional ; Blepharoplasty ; Eyelids ; Facial Nerve ; Fascia ; Ligaments ; Muscles ; Orbit ; Periosteum

To better understand the anatomic location of scalp nerves involved in various neurosurgical procedures, including awake surgery and neuropathic pain control, a total of 30 anterolateral scalp cutaneous nerves were examined in Korean adult cadavers. The dissection was performed from the distal to the proximal aspects of the nerve. Considering the external bony landmarks, each reference point was defined for all measurements. The supraorbital nerve arose from the supraorbital notch or supraorbital foramen 29 mm lateral to the midline (range, 25-33 mm) and 5 mm below the supraorbital upper margin (range, 4-6 mm). The supratrochlear nerve exited from the orbital rim 16 mm lateral to the midline (range, 12-21 mm) and 7 mm below the supraorbital upper margin (range, 6-9 mm). The zygomaticotemporal nerve pierced the deep temporalis fascia 10 mm posterior to the frontozygomatic suture (range, 7-13 mm) and 22 mm above the upper margin of the zygomatic arch (range, 15-27 mm). In addition, three types of zygomaticotemporal nerve branches were found. Considering the superficial temporal artery, the auriculotemporal nerve was mostly located superficial or posterior to the artery (80%). There were no significant differences between the right and left sides or based on gender (P>0.05). These data can be applied to many neurosurgical diagnostic or therapeutic procedures related to anterolateral scalp cutaneous nerve.
Adult ; Aged ; Aged, 80 and over ; *Cadaver ; Female ; Frontal Bone/anatomy & histology ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; Orbit/anatomy & histology ; Peripheral Nerves/*anatomy & histology ; Scalp/*innervation ; Zygoma/anatomy & histology

OBJECTIVETo evaluate the orbital bone quantity by spiral computer tomography (CT) for orbital implant operation.

METHODSFifty-two normal skull specimens with marks received spiral CT scan and their multiplanar images were obtained. The quantity (length x width) were measured on multiplanar images.

RESULTSThe right orbital bone quantity at 7:00 was the highest, average 11.91 mm x 8.38 mm, and at 3:00 was the lowest, average 2.31 mm x 1.34 mm. The left orbital bone quantity at 5:00 was the highest, average 12.03 mm x 8.56 mm, and at 9:00 was the lowest, average 2.44 mm x 1.29 mm. There had no significance correlation with gender at the same position in both sides.

CONCLUSIONUseful data had been obtained for the selection of the placement sites, direction, length, and diameter of orbital implants.

Dental Implants ; Humans ; Orbit ; anatomy & histology ; Tomography, X-Ray Computed

OBJECTIVETo study the anatomic mechanism of tear trough deformity and palabromalar groove deformity.

METHODSSix cadavers (12 sides, 3 male, 3 female, an average age of 67.2 years) with tear trough deformity and palpbromalar groove deformity underwent lower eyelid and periorbital area dissection.

RESULTSTear trough deformity and palabromalar groove deformity locate at the junction of thin eyelid skin and thick cheek skin. Skin is closely attached to the orbicularis oculi muscle. The superior horder of the malar fat pad covers the junction of the palpebral and orbital portions of the orbicularis muscle, and does not descend with malar fat pad, which is also corresponded to the location of tear trough and palphromalar groove. The gap between the orbicularis oculi muscle and the levator labii superioris alaeque nasi muscle is not correspond to tear trough. The orbicularis retaining ligament arises from the orbital rim and ends at the junction of the palpebral and orbital portions of the orbicularis muscle, and the ligament connects with the deep part of the orbicularis muscle which directly attaches to the infraorbital rim. Suborbicular oculi fat pads locate at the inferolateral of the orbital region, thin and flabby. Orbital septal arises from the infraorbital rim, and the orbital fat extrudes anteriorly and inferiorly.

CONCLUSIONSTear trough deformity and palabromalar groove deformity are resulted from combination of age-related relaxation, atrophy and ptosis of layers of tissues. The orbital septal and the orbicularis retaining ligament prevent tissues from descending, which makes tear trough deformity and palabromalar groove deformity more visible.

Aged ; Cadaver ; Eyelids ; anatomy & histology ; Female ; Humans ; Male ; Orbit ; anatomy & histology ; Skin Aging

OBJECTIVE: To provide transnasal endoscopic optic canal decompression with the anatomic reference. METHOD: 15 samples of the adult corpse wet specimen (30 sides for the optic canal) were examined under the endoscope to scrutinize the regional anatomy of the optic canal. RESULT: distance between the spina nasalis anterior and the midpoint of optic canal medial wall is (61.02 +/- 5.83) mm, and the angle between spina nasalis anterior and the midpoint of optic canal medial wall is (45.1 +/- 4.81) degrees. The medial wall of optic canal is longest, with an average length of (11.61 +/- 1.58) mm; the lateral wall of optic canal is thickest, and the medial wall thinnest. 10 traumatic blind patient underwent endoscopic optic canal decompression with satisfactory outcome. CONCLUSION The regional anatomy of the optic canal under endoscope is of importance to endoscopic optic canal decompression. Which is microinvasive with direct approach and clear view thus is widely used in clinical practice.
Adolescent ; Adult ; Blindness ; surgery ; Child ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Nose ; anatomy & histology ; surgery ; Optic Nerve ; anatomy & histology ; surgery ; Orbit ; anatomy & histology ; surgery ; Young Adult

OBJECTIVE: To investigate the anatomical relationship among optic nerve, posterior ethmoid sinus and ophthalmic artery to further provide surgical instruction for endoscopic transsphenoidal optic nerve decompression. METHOD: Messerklinger technique was adopted in eight cases of adult cadaveric head to expose the posterior ethmoid sinus and sphenoid sinus. The optic-carotid recess and optic canal were identified. The adjacent structure of optic canal was observed. After removal of the bony wall of optic canal, the relationship between the optic nerve and the ophthalmic artery was disrupted. RESULT: the optic-carotid recess was observed in all specimens. The occurrence of optic nerve prominence was 62%. Three patterns of the syntropy of optic nerve were observed. Optic nerve was border by posterior ethmoid sinus anteriorly and sphenoid sinus posteriorly in 8 cases (50%), by sphenoid sinus in 5 (31%), and by posterior ethmoid sinus in 3 (19%). At the cranial end, The ophthalmic artery was observed, 9 (56%) inferior-medially, 4 (25%) inferiorly and 3 (19%) inferior-laterally relative to optic nerve. At the ophthalmic end, the artery was observed 3 (19%) inferiorly and 13 (81%) inferior-laterally relative to optic nerve. CONCLUSION The optic-carotid recess can be regarded as the first landmark. The ophthalmic artery injury should be avoided with regard to its relationship with optic nerve during endoscopic decompression surgery.
Adult ; Cavernous Sinus ; anatomy & histology ; Decompression, Surgical ; methods ; Endoscopy ; Ethmoid Sinus ; anatomy & histology ; Humans ; Ophthalmic Artery ; anatomy & histology ; Optic Nerve ; anatomy & histology ; surgery ; Orbit ; anatomy & histology ; Sphenoid Sinus ; anatomy & histology ; surgery

OBJECTIVE: To explore the significance of the lacrimal bone at the lateral nasal wall in endoscopic dacryocystorhinostomy. METHOD: The position, dimension and thickness of the exposed lacrimal bone at the lateral nasal wall in 10 cadaveric heads(male 5, female 5) were examined and the anatomy of uncinate process, the maxillary line and M point were studied, too. RESULT: The lacrimal bone at the lateral nasal wall is always situated immediately anterior to the uncinate process. The average length and width of the lacrimal bone was 9.23 mm and 3.63 mm, respectively. The lacrimal bone was very thin with an average thickness of 0.06 mm. CONCLUSION The study indicates that the lacrimal bone is so thin that a bony rongeur is usually sufficient to nibble it away. The medial wall of the sac is then removed without the use of drill or chisel with less operative trauma. The uncinate process, the maxillary line and M point are reliable landmarks in endoscopic dacryocystorhinostomy.
Adult ; Dacryocystorhinostomy ; Female ; Humans ; Male ; Nasal Bone ; anatomy & histology ; surgery ; Orbit ; anatomy & histology ; surgery

OBJECTIVETo understand the anatomy of the supraorbital ethmoid cell and its relationship with the frontal sinus drainage pathway.

METHODSFive patients (5 sides) who had supraorbital ethmoid cell underwent endoscopic frontal sinus surgery. Computed tomographic (CT) scans of the sinuses were obtained in coronal and axial views. The frontal sinus ostium and the supraorbital ethmoid cell were endoscopically identified respectively.

RESULTSOn coronal CT scans, the supraorbital ethmoid cell was a separate cell lateral to the frontal sinus. And on axial CT scans, it was lateral and posterior to the frontal sinus drainage pathway. Under endoscope, its opening was lateral and posterior to the frontal sinus ostium.

CONCLUSIONSThe supraorbital ethmoid cell extended superolateral the boundaries of the lamina papyracea and the roof of the ethmoid to pneumatize the orbital plate of the frontal bone.

Adult ; Endoscopy ; Female ; Frontal Sinus ; anatomy & histology ; diagnostic imaging ; Humans ; Male ; Orbit ; anatomy & histology ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo explore the anatomical structures, and depth and direction of needling at Jingming (BL 1), so as to provide anatomical basis for its clinical application.

METHODSForty-eight adult orbital specimens were observed by dissection.

RESULTSWhen a needle was vertically inserted into Jingming (BL 1), the needle tip will past through the skin, subcutaneous tissue, medial palpebral ligament, medialis rectus and orbital adipose body. Above the body of the needle, there are ophthalmic artery, anterior ethmoidal artery and nasociliary nerve. The average distance between the skin at the punctured point and the anterior ethmoidal artery is (18.25 +/- 4.45) mm, with an angle of (12.5 +/- 5.5) degrees, and the average distance between the skin at the punctured point and the optic nerve tunnel frontal point is (43.37 +/- 7.84) mm.

CONCLUSIONTo avoid bleeding caused by injuring the anterior ethmoidal artery, acupuncture at Jingming (BL 1) should avoid deeply inserting needled back-upwards and upwards, and the needling depth should not exceed 30.36 mm to avoid injury of the optic nerve tunnel frontal point.

Acupuncture Points ; Female ; Humans ; Male ; Orbit ; anatomy & histology