Andretto Amodeo Chiara, Casasco Andrea, Icaro Cornaglia Antonia, Kang Robert, Keller Gregory S
Department of Plastic and Reconstructive Surgery, University of Pavia, Pavia, Italy.
Histology and Embryology Unit, Department of Experimental Medicine, University of Pavia, Pavia, Italy.
JAMA Facial Plast Surg. 2014 Jan-Feb;16(1):36-41. doi: 10.1001/jamafacial.2013.53.
During anatomic and surgical dissections, a connection was seen between the superficial layer of the deep temporal fascia and the prezygomatic area. These findings were in contrast to previous evaluations. This study defines this connection, which is important to understand from both surgical and anatomic standpoints.
To define the connection between the superficial layer of the deep temporal fascia and the prezygomatic area and demonstrate the presence of a deep fascial layer in the midface.
Anatomical study performed at the Laboratoire d'Anatomie de la Faculté de Médecine de Nice, Sophia Antipolis, France; at the Centre du Don des Corps de l'Université Paris Descartes, Paris, France; and at the Department of Experimental Medicine, Histology, and Embryology Unit of the University of Pavia, Pavia, Italy. Twenty-four hemifaces of 14 white cadavers were dissected to define the relationship between deep temporal fascia and the midface. Four biopsy samples were harvested for histologic analysis.
Dissection of 24 hemifaces from the fresh cadavers revealed the following findings. There is a connection of the deep fascia of the temple (superficial layer of deep temporal fascia) to the midface that divides the fat deep to the orbicularis muscle into 2 layers. One layer of fat is the so-called suborbicularis oculi fat (SOOF), which is superficial to the deep fascia, and the other layer of fat (preperiosteal) is deep to the deep fascia and adherent to malar bone. These findings are in contrast to previous anatomical findings. RESULTS In 12 hemifaces, the superficial layer of the deep temporal fascia directly reached the prezygomatic area as a continuous fascial layer. In 16 hemifaces, the superficial sheet of the deep temporal fascia inserted at the level of the zygomatic and lateral orbital rim and continued as a deep fascial layer over the prezygomatic area. In all specimens, a deep fascial layer was present in the prezygomatic-infraorbital area. This deep fascial layer is adherent to the muscles of the infraorbital area, and it divided the fat located deep to the orbicularis oculi muscle into 2 layers: the SOOF and a deeper layer. Histologic examination of the biopsy samples confirmed these findings.
This study demonstrates the existence of a deep fascial layer in the midface. This fascia is connected to the superficial layer of the deep temporal fascia, and it divides the fat deep to the orbicularis oculi muscle into 2 layers. This new finding carries interesting implications related to the classic concept of the superficial musculoaponeurotic system.
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在解剖和手术解剖过程中，发现颞深筋膜浅层与颧前区域之间存在连接。这些发现与先前的评估结果相反。本研究明确了这种连接，从手术和解剖学角度理解这一点都很重要。
明确颞深筋膜浅层与颧前区域之间的连接，并证明面中部存在深筋膜层。
在法国索菲亚安提波利斯尼斯医学院解剖实验室、法国巴黎笛卡尔大学人体捐赠中心以及意大利帕维亚大学实验医学、组织学和胚胎学系进行的解剖学研究。解剖了14具白色尸体的24个半侧面部，以确定颞深筋膜与面中部的关系。采集了4份活检样本进行组织学分析。
对新鲜尸体的24个半侧面部进行解剖，发现如下情况。颞部深筋膜（颞深筋膜浅层）与面中部存在连接，该连接将眼轮匝肌深层的脂肪分为两层。一层脂肪是所谓的眼轮匝肌下脂肪（SOOF），位于深筋膜浅层，另一层脂肪（骨膜前脂肪）位于深筋膜深层并附着于颧骨。这些发现与先前的解剖学发现不同。结果：在12个半侧面部中，颞深筋膜浅层作为连续的筋膜层直接延伸至颧前区域。在16个半侧面部中，颞深筋膜浅层附着于颧骨和眶外侧缘水平，并作为深筋膜层在颧前区域延续。在所有标本中，颧前 - 眶下区域均存在深筋膜层。该深筋膜层附着于眶下区域的肌肉，并将眼轮匝肌深层的脂肪分为两层：SOOF和更深层。活检样本的组织学检查证实了这些发现。
本研究证明了面中部存在深筋膜层。该筋膜与颞深筋膜浅层相连，并将眼轮匝肌深层脂肪分为两层。这一新发现对浅表肌肉腱膜系统的经典概念具有有趣的启示。
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