Anatomy for Plastic Surgery of the Face, Head, and Neck Koich i Wat an ab e, MD, Ph D Assist an t Professor Depar t m en t of An atom y Ku ru m e Un iversit y Sch ool of Medicin e Fukuoka-Prefect u re, Jap an Moh am m ad ali M Sh oja, MD Research Scien t ist Sect ion of Pediat ric Neu rosurger y Ch ildren’s Hospit al Birm ingh am , Alabam a, USA Mar ios Lou kas, MD, Ph D Dean of Basic Scien ces Professor an d Ch air Depar t m en t of An atom ical Scien ces St George’s Un iversit y Gren ada, West In dies R Sh an e Tu b bs, MS, PA-C, Ph D Professor an d Ch ief Scien t i c O cer Seat tle Scien ce Fou n dat ion Seat tle, Wash ington , USA 269 illu st rat ion s Th iem e New York • St ut tgar t • Delh i • Rio de Jan eiro Execu t ive Editor: Tim othy Hiscock Man aging Editor: Elizabeth Palum bo Director, Ed itorial Ser vices: Mar y Jo Casey Editorial Assist an t: Haley Paskalides Product ion Editor: Barbara A Ch ern ow In tern at ion al Produ ct ion Director: An dreas Sch abert Vice Presiden t , Editorial an d E-Produ ct Developm en t: Vera Spilln er In tern at ion al Market ing Director: Fion a Hen derson In tern at ion al Sales Director: Lou isa Tu rrell Director of Sales, North Am erica: Mike Rosem an Sen ior Vice President an d Ch ief Operat ing O cer: Sarah Van derbilt Presid en t: Brian D Scan lan Typeset t ing by Carol Pierson , Ch ern ow Editorial Ser vices, In c Librar y of Congress Cat aloging-in -Publicat ion Dat a Nam es: Wat an abe, Kåoich i, 1968– au th or | Sh oja, Moh am m adali M., au th or | Lou kas, Marios, au th or | Tu bbs, R Sh an e, au th or Title: An atom y for plast ic su rger y of th e face, h ead, an d n eck / Kåoichi Watan abe, Moh am m adali M Sh oja, Marios Lou kas, R Sh an e Tu bbs Descript ion : New York : Th iem e, [2016] | In clud es bibliograph ical referen ces an d in dex Iden t i ers: LCCN 2015031107| ISBN 9781626230910 (alk pap er) | ISBN 9781626230927 (eISBN) Subject s: | MESH: Head—an atom y & h istology—Atlases | Neck—an atom y & h istology—Atlases | Recon st ruct ive Su rgical Procedu res—Atlases Classi cat ion : LCC RD119 | NLM W E 17 | DDC 617.9/52—dc23 LC record available at ht t p://lccn loc.gov/2015031107 Im po rtant note: Medicin e is an ever-ch anging scien ce u n dergoing t in u al develop m en t Research an d clin ical exp erien ce are t in ually expan ding our kn ow ledge, in part icular our kn ow ledge of p rop er t reat m en t an d drug th erapy In sofar as th is book m en t ion s any d osage or app licat ion , readers m ay rest assured th at th e au th ors, editors, an d p ublish ers h ave m ade ever y e ort to en su re th at su ch referen ces are in accordan ce w ith the state of know ledge at the tim e o f pro ductio n o f the bo o k Neverth eless, th is does n ot involve, im ply, or exp ress any gu aran tee or respon sibilit y on the part of th e publish ers in respect to any dosage in st ruct ion s an d form s of applicat ion s st ated in the book Every user is requested to exam ine carefully th e m an u fact u rers’ lea et s accom p anyin g each d r ug an d to ch eck, if n ecessar y in su lt at ion w it h a p hysician or sp ecialist , w h et h er t h e d osage sch edu les m en t ion ed th erein or th e t rain dicat ion s st ated by th e m an u fact u rers di er from th e statem en t s m ad e in t h e p resen t book Su ch exam in at ion is p ar t icu larly im p or t an t w it h drugs th at are eith er rarely used or h ave been n ew ly released on t h e m arket Ever y d osage sch ed u le or ever y form of ap p licat ion u sed is en t irely at t h e u ser’s ow n r isk an d resp on sibilit y Th e au t h ors an d p u blish ers requ est ever y u ser to rep or t to t h e p u blish ers any d iscrep an cies or in accu racies n ot iced If er rors in t h is w ork are fou n d after p u blicat ion , errat a w ill be p osted at w w w th iem e.com on th e p rodu ct descript ion p age Som e of th e produ ct n am es, p aten t s, an d registered design s referred to in th is book are in fact registered t radem arks or prop rietar y n am es even th ough sp eci c referen ce to th is fact is n ot alw ays m ade in th e text Th erefore, the appearan ce of a n am e w ith out design at ion as propriet ar y is n ot to be st rued as a rep resen tat ion by th e pu blish er th at it is in th e p u blic dom ain ©2016 Thiem e Medical Publish ers, In c Th iem e Pu blish ers New York 333 Seven th Aven u e, New York, NY 10001 USA +1 800 782 3488, custom erservice@thiem e.com Th iem e Pu blish ers St u t tgart Rü digerst rasse 14, 70469 St ut tgart , Germ any +49 [0]711 8931 421, custom erser vice@th iem e.d e Th iem e Pu blish ers Delh i A-12, Secon d Floor, Sector-2, Noida-201301 Ut t ar Pradesh, Ind ia +91 120 45 566 00, cu stom erser vice@thiem e.in Th iem e Pu blish ers Rio d e Jan eiro, Th iem e Pu blicaỗừes Ltda Edifớcio Rodolph o de Paoli, 25 o an dar Av Nilo Peỗan h a, 50 – Sala 2508 Rio de Jan eiro 20020-906, Brasil +55 21 3172 2297 Prin ted in In d ia by Man ipal Tech n ologies Ltd., Man ip al ISBN 978-1-62623-091-0 Also available as an e-book: eISBN 978-1-62623-092-7 Th is book, in cluding all part s th ereof, is legally p rotected by copyrigh t Any use, exploit at ion , or com m ercializat ion ou t side th e n arrow lim it s set by copyrigh t legislat ion w ith ou t th e publish er’s sen t is illegal an d liable to p rosecu t ion Th is ap p lies in p art icu lar to p h otost at rep rod u ct ion , copying, m im eograp h ing or d u p licat ion of any kin d , t ran slat in g, p rep arat ion of m icro lm s, an d elect ron ic dat a processing an d storage Contents List of Videos vii Preface ix Con t ribu tors xi Neuro cranium and Facial Skeleto n David Kahn, Toom as Arusoo, and Eric J W right Anterio r Skull Base 13 Surjith Vat toth and Philip R Chapm an Middle Skull Base 20 Philip R Chapm an and Surjith Vat toth So ft Tissue of the Scalp and Tem po ral Regio ns 33 Noriyuk i Koga Arterial Supply o f the Facial Skin 40 Nobuak i Im anishi Arteries o f the Face and Neck 47 Yelda Atam az Pinar, Figen Govsa, and Servet Celik Veins o f the Face and Neck 63 Yusuke Shim izu Facial Nerve and Tem po ral Bo ne 72 Orlando Gunt inas-Lichius Pe ripheral Branches o f the Facial Nerve 79 Andrew P Trussler 10 Se nso ry Ne rves o f the Head and Neck 86 Ibrahim Khansa, Jenny C Barker, and Jef rey E Janis 11 Super cial Musculo apo ne uro tic Syste m and the Facial So ft Tissues 101 Yoko Tabira, Joe Iw anaga, Tsuyoshi Saga, and Koichi W atanabe 12 Mim etic Muscles 111 Hee-Jin Kim 13 Orbital Anato m y 120 Sw apna Vem uri and Jerem iah P Tao 14 Orbital So ft Tissues 126 Sw apna Vem uri and Jerem iah P Tao 15 Eyelid Anato m y 134 Catherine Y Liu, Sw apna Vem uri, and Jerem iah P Tao 16 Nasal Cavity and Paranasal Sinuses 142 Joe Iw anaga, Tsuyoshi Saga, and Koichi W atanabe 17 External No se 155 Hideak i Rikim aru 18 Auricle and External Aco ustic Meatus 161 Noritaka Kom une, Junichi Fuk ushim a, and Albert L Rhoton, Jr 19 Mandible and Masticato ry Muscles 172 Kyung-Seok Hu and Yang Hun Mu Content s 20 Oral Cavity and Pharynx 183 Joe Iw anaga, Shinya Mik ushi, and Haruk a Tohara 21 Ne ck 200 Sherine S Raveendran and Lucian Ion In dex 221 vi List of Videos Video Facial m uscles and facial nerve o n the anterio r face Low er face Middle face Video Dissectio n o f the external no se Mu scles on th e extern al n ose Bony an d car t ilagin ou s st r uct u re Video Main trunk o f the facial ne rve and its branches Lan dm arks of th e facial n er ve t r u n k Tem poral bran ch Zygom at ic bran ch Buccal bran ch Margin al m an d ibu lar bran ch Cer vical bran ch Video Se nso ry ne rves o f the face Supraorbital n er ve In fraorbital n er ve Zygom at icofacial n er ve Men t al n er ve Video Layers o f the tem po ral regio n Super cial tem poral fascia Deep tem p oral fascia Tem poralis m u scle vii Preface Th is book w as plan n ed as a h ead an d n eck surgical an atom y book for plast ic surgeon s, h ead an d n eck surgeon s, an d surgeon s w h o pract ice in related elds Un fort u n ately, few su rgical textbooks em ph asize an atom y, especially textbooks in th e eld of plast ic surger y In m ost su rgical textbooks, th e procedures are d escr ibed on ly in m in u te d et ail Conversely, t rad it ion al an atom ical text books d o n ot p rovid e ad equ ate in for m at ion on t h e region al an atom y, preven t ing surgeon s from obtain ing th e kn ow ledge n ecessar y to exper tly perform various surgical procedures On e reason for th is is th at alth ough th e basic an atom y of th e h um an body w as alm ost com pletely described m ore th an 100 years ago, th e an atom y in th e h ead an d n eck region , especially th at applicable to plast ic surger y, is st ill developing Addit ion ally, an atom ical textbooks often n ot provide th e m ost u p -to-date in form at ion Th erefore, w e h ave at tem pted to in clude th e latest an atom ical un derstan ding of th e h ead an d n eck an atom y from a p last ic su rgeon’s p ersp ect ive In w rit ing th is p reface, I (KW) discu ssed h ead an d n eck an atom y w ith m y m en tors in t w o specialt ies: gross an atom y an d plast ic surger y Th is allow ed m e to sider an atom y from t w o di eren t view poin t s First , m y m en tor in gross an atom y m ade th e follow ing ob ser vat ion s: Th e an atom y of t h e h ead an d n eck is ext rem ely com plicated an d th e det ails di er am ong in dividuals an d during di eren t st ages of life Th ese di eren ces in clude th e th ickn ess of th e t issues, th eir ch anges in respon se to aging, an d even an atom ical variat ion s in vessels, n er ves, an d m uscles Each organ in th e h ead an d n eck region h as a ver y dist in ct fun ct ion Con sequen tly, path ologies involving th e h ead th at require surger y w ill be operated on by surgeon s specializing in n eurosurger y, otorhinopharyngolaryngology, ophthalm ology, den tal m edicin e, an d p last ic su rger y W h ile in -depth kn ow ledge in th e an atom ical area of specializat ion is ext rem ely im por tan t in t reat ing pat ien t s, th e su rgeon as w ell as th e m edical st a m ust also be h igh ly fam iliar w ith n ot ju st related region s of th e body bu t also w ith unrelated regions In m edical education, unfort unately, the im portance of anatom ical education has been dow nplayed glob ally in recen t years Th is m ay be becau se n ow adays m edical st u - dents have less tim e to study anatom y, given the m any new elds of m edicin e th at th ey are expected to be fam iliar w ith Apparen tly, som e m edical sch ools n o longer o er an atom ical dissect ion Th us, n ot surprisingly, th e n um ber of an atom ist s, especially gross an atom ist s, is decreasing Th is ten d en cy h as crit ical, n egat ive im p licat ion s for su rger y Gross an atom y is t h e basis of know ledge for ever y surgeon Surgeons m ust be experts in gross an atom y if th ey h op e to acqu ire th e su rgical skills to becom e exp ert s in su rger y My secon d m en tor, a specialist in p last ic su rger y, o ered th e follow ing: Th e m ost im p or tan t asp ect of p erform ing p last ic su rger y is kn ow ledge of th ree-dim en sion al region al an atom y For exam ple, each n er ve an d blood vessel takes u p space th ree dim en sion ally It is im port an t to recogn ize h ow th ese st ru ct u res t ravel on t h e su r face p lan e, bu t it is m ore im p or t an t for t h e su ccess of t h e act u al su rger y to kn ow w h ich t issu e layers t h ese st r u ct u res r u n t h rough An atom ical at lases an d text books p ro vid e det ailed im ages of t h ese st r u ct u res, bu t t h e kn ow ledge gain ed from th em is t w o-dim en sion al Novice su rgeon s t yp ically m em orize th e t w o-dim en sion al im age of th eir surgical eld Becau se of th is, su rgical resu lt s are som et im es u n sat isfactor y, or un expected surgical com plicat ion s m ay occu r To perform su rgeries w ith a h igh degree of di cu lt y, a su rgeon h as to be able to vividly visu alize th e th ree-dim en sion al region al an atom y of th e surgical eld Plast ic surger y residen ts h ave to st udy t h e region al an atom y in an atom ical at lases an d text books, an d r m t h eir an atom ical kn ow ledge in p ract ical op erat ion s By repeat ing th is p at tern m any t im es, a residen t is able to est ablish an d pract ice th ree-dim en sion al an atom ical kn ow ledge By having surgical training based on accurate anatom ical know ledge, a su rgeon w ill be bet ter equ ip p ed to p erform h igh -degree operat ion s We h ope th at our textbook w ill n ot on ly h elp to im prove th e su rgical skill of in dividu al su rgeon s, bu t w ill also prom ote th e d evelop m en t of h ead an d n eck su rger y I w ou ld like to t h an k Dr Koh -ich i Yam aki, Professor of An atom y, an d Dr Ken su ke Kiyokaw a, Professor of Plast ic Su rger y, for kin dly t ribu t ing th e above com m en t s to th e preface ix ... Plastic Surgery of the Face, Head, and Neck a Fig 1.3 (a) Superior view of the ethmoid bone This view of the ethmoid bone provides a bet ter appreciation for the ethmoidal labyrinth and air cells, the. .. Anatomy for Plastic Surgery of the Face, Head, and Neck Koich i Wat an ab e, MD, Ph D Assist an t Professor Depar t m en t of An atom y Ku ru m e Un iversit y Sch ool of Medicin e Fukuoka-Prefect... y of the orbital part surface features, including the fossa for the lacrimal gland, the sphenoidal articulating surface, and the zygomatic process, is obtained from this view Anatom y for Plastic