Ebook Surgical approaches to the facial skeleton (3/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Surgical approaches to the facial skeleton (3/E): Part 2
Ebook Surgical approaches to the facial skeleton (3/E): Part 2
SECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2incisions and anatomy vary depending on the region of the mandible that is approached. Because (here are almost no anatomic hazards in the transfacial exposure of (he mandibular symphysis, this approach is not presented. The focus of this section is on the submandibular, retromandibular, and rhytide Ebook Surgical approaches to the facial skeleton (3/E): Part 2ctomy approaches. All these are used to expose (he posterior regions of the mandible and all must negotiate important anatomic structures. ApproachesEbook Surgical approaches to the facial skeleton (3/E): Part 2
to (he temporomandibular joint are presented in Section 6.261SubmandibularApproachThe submandibular approach is one of the most useful approaches to tSECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2to a myriad of mandibular osteotomies, angle/body fractures, and even condylar fractures and temporomandibular joint (TMJ) ankylosis. Descriptions of the approach differ on some points, but in all the incision is made below the inferior border of the mandible (Video 9.1).Surgical AnatomyMarginal Man Ebook Surgical approaches to the facial skeleton (3/E): Part 2dibular Branch of the Facial NerveAfter the facial nerve divides into temporofacial and cervicofacial branches, the marginal mandibular branch originaEbook Surgical approaches to the facial skeleton (3/E): Part 2
tes and extends anteriorly and inferiorly within the substance of the parotid gland. The marginal mandibular branch or branches, which supply motor fiSECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2mandible. Studies have shown that the nerve passes below the inferior border of the mandible only in very few individuals (see Fig. 9.1). In the Dingman and Grabb classic dissection of 100 facial halves, the marginal mandibular branch was almost 1 cm below the inferior border in 19% of the specimens Ebook Surgical approaches to the facial skeleton (3/E): Part 2 (1). Anterior to the point where the nerve crossed the facial262artery, all dissections in the above study displayed the nerve above the inferior borEbook Surgical approaches to the facial skeleton (3/E): Part 2
der of the mandible.Ziarah and Atkinson (2) found more individuals in whom the marginal mandibular branch passed below the inferior border. In 53% of SECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2 continued for a further distance of almost 1.5 cm before turning upward and crossing the mandible. The farthest distance between a marginal mandibular branch and the inferior border of the mandible was 1.2 cm. In view of these findings, most surgeons recommend that the incision and deeper dissectio Ebook Surgical approaches to the facial skeleton (3/E): Part 2n be at least 1.5 cm below the inferior border of the mandible.Another important finding of the study by Dingman and Grabb (1) was that only 21% of thEbook Surgical approaches to the facial skeleton (3/E): Part 2
e individuals had a single marginal mandibular branch between the angle of the mandible and the facial vessels (see Fig. 9.2); 67% had two branches (FSECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2ibular gland, facial artery (FA) and vein (FV), and marginal mandibular branches of the facial263nerve (V//). Two marginal mandibular branches are present in this specimen, one below the inferior border of the mandible.FIGURE 9.2 Anatomic dissection of the lateral face showing the relation of the su Ebook Surgical approaches to the facial skeleton (3/E): Part 2bmandibular gland, facial artery (FA) and vein (FV), retromandibular vein (/?V), and marginal mandibular branch of the facial nerve (WI) (parotid glanEbook Surgical approaches to the facial skeleton (3/E): Part 2
d has been removed). Only one marginal mandibular branch is present in this specimen and it is superior to the inferior border of the mandible.Facial SECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2e mandible and in fairly close contact with the pharynx. It runs superiorly, deep to the posterior belly of the digastric and stylohyoid muscles, and then crosses above them to descend on the medial surface of the mandible, grooving or passing through the submandibular salivary gland as it rounds th Ebook Surgical approaches to the facial skeleton (3/E): Part 2e lower border of the mandible. It is visible on the external surface of the mandible264around the anterior border of the masseter muscle (Figs. 9.1 aEbook Surgical approaches to the facial skeleton (3/E): Part 2
nd 9.2). Above the inferior border of the mandible, it lies anterior to the facial vein and is tortuous.Facial VeinThe facial (anterior facial) vein iSECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2ial artery above the level of the inferior mandibular border, but it is posterior to the artery (Figs. 9.1 and 9.2). Unlike the facial artery, the facial vein runs across the surface of the submandibular gland to end in the internal jugular vein.Technique> STEP 1. Preparation and DrapingPertinent la Ebook Surgical approaches to the facial skeleton (3/E): Part 2ndmarks on the face, useful during dissection, should be left exposed throughout the procedure. For surgeries involving the mandibular ramus/angle, thEbook Surgical approaches to the facial skeleton (3/E): Part 2
e corner of the mouth and lower lip should be exposed within the surgical field anteriorly and the ear, or at least the ear lobe, posteriorly. These lSECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2sion and VasoconstrictionThe skin is marked prior to the injection of a vasoconstrictor. The incision is placed 1.5 to 2 cm inferior to the mandible. Some surgeons place the incision parallel to the inferior border of the mandible; others place the incision in or parallel to a neck crease (see Fig. Ebook Surgical approaches to the facial skeleton (3/E): Part 29.3). Incisions made parallel to the inferior border of the mandible may be unobtrusive in some patients; however, extensions of this incision anterioEbook Surgical approaches to the facial skeleton (3/E): Part 2
rly may be noticeable unless hidden in the submandibular shadow. A less conspicuous scar results when the incision is made in or parallel to a skin crSECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he i Ebook Surgical approaches to the facial skeleton (3/E): Part 2 to anteroinferiorly. Therefore, the further anterior the incision in or parallel to a skin crease, the more the distance to dissect to reach the inferior border of the mandible. Both incisions can be extended posteriorly to the mastoid region if necessary.265 Ebook Surgical approaches to the facial skeleton (3/E): Part 2SECTION 5Transfacial Approaches to the Mandible260can be exposed by surgical approaches using incisions on (he skin of the face. The position of (he iGọi ngay
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