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auricular ligaments
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The paper reports our experience in rhytidectomy. The report contains a description of various operative technique, including the forehead-brow lift, the deep temporal facelift, and the SMAS-platysma cervicofacialplasty. These technique have been used in 115 lifting operations with satisfactory results. The anatomic data discussed are of major importance during the surgical procedures, which are the SMAS, SMAP flap, and the skin retaining ligaments. The creation of two distinct flaps by utilizing both sub-SMAS...

The paper reports our experience in rhytidectomy. The report contains a description of various operative technique, including the forehead-brow lift, the deep temporal facelift, and the SMAS-platysma cervicofacialplasty. These technique have been used in 115 lifting operations with satisfactory results. The anatomic data discussed are of major importance during the surgical procedures, which are the SMAS, SMAP flap, and the skin retaining ligaments. The creation of two distinct flaps by utilizing both sub-SMAS and subcutanecous undermining offers a distinct advantage in face lifting, because it allows upward lifting of the sagging SMAS-platysma flap followed by a laterally directed advancement of the cheek skin flap. The zygomatic ligaments, mandibular ligaments, and platysma-auricular ligaments were routinely cut off in our technique of lifting operations. And we fixed the platsma-auricular ligaments to the mastoid fascial-periosteum, with good results, particularly for the correction of turkey gobbler deformities. Details to be presented are the relationship of facial nerve to the safe plane of dissection and how to deal with most frequent complications after rhytidectomy.

本文报告我院115例除皱手术的经验。重点讨论了除皱术式选择,皮肤支持韧带和SMAS和SMAP瓣在下面除皱术中的重要意义,解剖分离平面及与面神经的解剖关系和相关并发症的预防等问题。

Twenty-two hemifaces of fresh human cadaver were studied, through an operating microscope, and histologic examination to identify the facial ligaments. Data revealed: there were six ligaments demonstrated: zygomatic ligament(ZL), mandibular ligament(ML), suspensory platysma ligament(SPL), platysma-auricular ligament(P-AL), SMAS-malar ligament(SMAS-ML)and anterior platysma-cutaneous ligament(AP-CL). Except the ML and the AP-CL, they are all in the neighbourhood...

Twenty-two hemifaces of fresh human cadaver were studied, through an operating microscope, and histologic examination to identify the facial ligaments. Data revealed: there were six ligaments demonstrated: zygomatic ligament(ZL), mandibular ligament(ML), suspensory platysma ligament(SPL), platysma-auricular ligament(P-AL), SMAS-malar ligament(SMAS-ML)and anterior platysma-cutaneous ligament(AP-CL). Except the ML and the AP-CL, they are all in the neighbourhood of vessels and nerves, and hence important for dissecting and protecting vessels and nerves as well as their retaining the skin or the ptalysma-SMAS. On the other hand, this adds the difficulty in treating the ligaments.The findings under microscope were:: ①The SPL consists of fibrous fascia, and the others are bands of dense connective tissue; ②they are not perpendicular at all from the originating part to the attaching one. The SMAS-ML has been described qualitatively and quantitatively for the first time. The SPL is the new structure of the retaining platysma discovered.

采用手术显微镜下解剖、光镜组织切片观察结合外科手术方法研究表浅肌肉腱膜系统(SMAS)。SMAS是上至颅顶额枕部、下至颈部的连续解剖学结构。主要与国外报道不同的是:它连接于浅层表情肌周边部而不跨越肌浅面;SMAS有肌性区域、腱膜性区域和混合性区域之分,提出腱膜性区域是SMAS的“中间腱”假说;第一次定义了SMAS这一解剖结构。

Objective To study the techniques of rhytidectomy by tighting superficial muscular aponeurotic system (SMAS) and platysma. Methods The temporal and faciocervical subcutaneous tissues were seperated in a small region, and the superficial tissue above the deep temporal fascia was sufficiently seperated from the faciocervical tissues under SMAS and platysma with splitting SMAS zygomatic ligament. SMAS faciocervical muscle flap was divided into two parts, front and back. The front part was closely raised:...

Objective To study the techniques of rhytidectomy by tighting superficial muscular aponeurotic system (SMAS) and platysma. Methods The temporal and faciocervical subcutaneous tissues were seperated in a small region, and the superficial tissue above the deep temporal fascia was sufficiently seperated from the faciocervical tissues under SMAS and platysma with splitting SMAS zygomatic ligament. SMAS faciocervical muscle flap was divided into two parts, front and back. The front part was closely raised: the flap at the distal end of its anterior part was sutured with trans-mattress method with 3-0 terylene thread in order to fix it into the posterior and superior sharp end of SMAS; at the same time the posterior and superior parts were sutured in trans-mattress method to fix it on the periosteum at the root of the zygoma, and then the posterior part was closely lift, and the distal end of its anterior and inferior parts was also sutured in trans-mattress method with 3-0 terylene thread in order to fix it into the posterior and superior sharp end of SMAS. Meanwhile, the posterior part was sutured in the aponeurosis of sternoclavicular mastoid muscle. Temporal branch pedicle flap was closely fixed in the same two-step advanced method, and platysma auricular ligament was reconstructed. The most important operational skill of frontal rhytidectomy was to cut corrugator, procerus and frontal muscle accurately.Results From June 2002, we had performed this operation in 284 cases using the above procedures, in which the majority was satisfied by both patients and surgeons. Only 9 cases had minor or intermediate hematoma, and mastoid flap had bad blood supply at the early stage in 8 cases. With proper treatment, no poor complication occurred in those cases.Conclusions This two-step advanced procedure that raises closely and fix SMAS- faciocervical muscle flap and temporal branch pedicle flap has relative obvious advantages for fixing the droopping of the soft tissue near the nasolabial groove and the anterior part of maxillary edge. But, to the indiridual who has a static face and/or dynamic one, this method is not very effective.

目的探讨两级递进式提紧面部浅表肌腱膜系统(superficial muscular aponeurotic sys-tem,SMAS)-颈阔肌除皱术效果。方法颞面颈部皮下小范围分离,颞区颞深筋膜浅面大范围分离,面颈部SMAS-颈阔肌下大范围分离,离断SMAS-颧颊部韧带。分SMAS-颈阔肌瓣为前、后两叶。先提紧前叶:在其前下方最远处以3-0涤纶线横褥式缝1针向后上提紧固定在SMAS的后上切缘处;再在其后上方以褥式缝合固定在颧弓根部骨膜上。后提紧后叶:在其前下方最远处以3-0涤纶线横褥式缝合,向后提紧固定在SMAS瓣的后切缘处;再在其后方横褥式缝合固定在胸锁乳突肌腱膜上。颞支蒂瓣也以两级递进式提紧固定,重建颈阔肌-耳韧带。额部除皱术的操作要点是确切地切除皱眉肌、降眉肌和额肌。结果共施术284例,绝大部分结果令医者与受术者双方满意。仅有9例发生中度(15~20ml)血肿,8例耳后乳突区皮瓣早期血运不良,经及时处理无不良后果产生。结论两级递进式提紧固定SMAS-颈阔肌瓣和颞支蒂瓣,对于提紧表情区,特别是鼻唇沟附近、颌缘前段的软组织松垂,具有比较明显的效果,但是对于静态脸型或(和)动态脸型比较宽大者,上述方法的效果不...

目的探讨两级递进式提紧面部浅表肌腱膜系统(superficial muscular aponeurotic sys-tem,SMAS)-颈阔肌除皱术效果。方法颞面颈部皮下小范围分离,颞区颞深筋膜浅面大范围分离,面颈部SMAS-颈阔肌下大范围分离,离断SMAS-颧颊部韧带。分SMAS-颈阔肌瓣为前、后两叶。先提紧前叶:在其前下方最远处以3-0涤纶线横褥式缝1针向后上提紧固定在SMAS的后上切缘处;再在其后上方以褥式缝合固定在颧弓根部骨膜上。后提紧后叶:在其前下方最远处以3-0涤纶线横褥式缝合,向后提紧固定在SMAS瓣的后切缘处;再在其后方横褥式缝合固定在胸锁乳突肌腱膜上。颞支蒂瓣也以两级递进式提紧固定,重建颈阔肌-耳韧带。额部除皱术的操作要点是确切地切除皱眉肌、降眉肌和额肌。结果共施术284例,绝大部分结果令医者与受术者双方满意。仅有9例发生中度(15~20ml)血肿,8例耳后乳突区皮瓣早期血运不良,经及时处理无不良后果产生。结论两级递进式提紧固定SMAS-颈阔肌瓣和颞支蒂瓣,对于提紧表情区,特别是鼻唇沟附近、颌缘前段的软组织松垂,具有比较明显的效果,但是对于静态脸型或(和)动态脸型比较宽大者,上述方法的效果不明显。

 
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