From private practice; the Department for Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich; Division of Plastic and Reconstructive Surgery, Mayo Clinic; CH Dermatologia; Department of Radiology and Medical School, University of Belgrade; and Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science.
Plast Reconstr Surg. 2022 Mar 1;149(3):587-595. doi: 10.1097/PRS.0000000000008826.
Novel imaging methods have provided new insights into the layered anatomy of the forehead. This study seeks to critically reevaluate the layered anatomy of the forehead by using ultrasound imaging and cadaveric dissection to provide an accurate anatomical description that can be used to guide safer surgical and minimally invasive frontal procedures.
This study used ultrasound imaging in a sample of 20 volunteers (12 female and eight male volunteers; aged 35.25 ± 4.2 years; body mass index, 24.28 ± 3.5 kg/m2) and cadaveric dissections of 16 body donors (12 female and four male body donors; aged 72.76 ± 9.5 years) to reevaluate the layered anatomy of the forehead. Layer-by-layer dissections and ultrasound-based measurements of the frontal structures guided conclusions.
The following layered arrangement was identified: layer 1, skin; layer 2, superficial fatty layer; layer 3, suprafrontalis fascia; layer 4, orbicularis oculi and frontalis muscle (same plane); layer 5, a homogenous layer of fat [preseptal fat (in the upper eyelid), retro-orbicularis fat (deep to the orbicularis oculi muscle), and retro-frontalis fat (deep to the frontalis muscle); layer 6, subfrontalis fascia; layer 7, preperiosteal fat within the prefrontal space in the lower forehead and deep compartments in the upper forehead; and layer 8, periosteum.
The results of this study add to the current understanding of the layered arrangement of the forehead. The combination of ultrasound imaging and cadaveric dissections provided evidence for a continuous fatty layer deep to the frontalis muscle.
新的成像方法为额部的分层解剖结构提供了新的认识。本研究旨在通过超声成像和尸体解剖来重新评估额部的分层解剖结构，提供准确的解剖描述，以指导更安全的手术和微创额部手术。
本研究使用超声成像对 20 名志愿者（12 名女性，8 名男性志愿者；年龄 35.25±4.2 岁；体重指数 24.28±3.5kg/m2）和 16 具尸体捐献者（12 名女性，4 名男性尸体捐献者；年龄 72.76±9.5 岁）进行尸体解剖，以重新评估额部的分层解剖结构。分层解剖和基于超声的额部结构测量指导了结论的得出。
确定了以下分层排列：第 1 层，皮肤；第 2 层，浅脂肪层；第 3 层，额肌筋膜；第 4 层，眼轮匝肌和额肌（同一平面）；第 5 层，一层均匀的脂肪[上睑的眶隔前脂肪（preseptal fat）、眼轮匝肌深面的眶周脂肪（retro-orbicularis fat）和额肌深面的额前脂肪（retro-frontalis fat）]；第 6 层，额下筋膜；第 7 层，前额下部和额上部深间隙的额前骨膜下脂肪；第 8 层，骨膜。
本研究结果增加了对额部分层排列的理解。超声成像和尸体解剖的结合为额肌深面连续的脂肪层提供了证据。
