Midcheek endoscopic anatomy

Facial Soft Tissue Ptosis: A Quantitative Analysis using 3d Facial Scan App For iPhone

Although the modifications of the aging face have been widely described, to our knowledge, there are no studies that quantitatively analyze the degree of soft tissues facial ptosis. Using a specific iPhone application, the faces of a heterogeneous group of volunteers were scanned and studied with the aim to virtually measure the entity of facial ptosis.Two facial scans, upright and supine, were performed by using the Bellus3D Face app for iPhone in a sample of 60 volunteers. We virtually superimposed the two scans, and then, we calculated the discrepancy between them through the Geomagic Design X 3D software. A multivariate regression statistical model was used to analyze the correlation between the mean discrepancy values compared to three main variables: age, BMI and gender. Mean ptosis increases with age (coeff. = 0.02; 95% CI = 0.01-0.02, p < 0.001), BMI (coeff. = 0.03; 95% CI = 0.01-0.05; p < 0.001) and has been found higher in females (female versus male: coeff. = 0.22; 95% CI = 0.13-0.31; p < 0.001). The method we used allowed us to measure the degree of ptosis, and to make a complete morphological study of the effect of gravity on the facial surface in a very accurate, low cost and easily reproducible way.

A Minimally Invasive Endoscopic Approach to Midcheek Mass: Showcase for Technical Description

BACKGROUND

Surgical approaches to the midcheek area are challenging. This area is included between the lower eyelid above, and the upper lip below. The peculiar anatomical location makes it really important for attractiveness, thus the need to obtain a correct balance between the operation's safety and minimally invasive aspect. To the authors' knowledge, this is the first showcase and technical description of a novel minimally invasive endoscopic approach for midcheek mass removal.

METHODS

Making 3 incisions in concealed area an endoscopically aided facial dissection was performed to remove a solitary venus malformation of the left midcheek region.

RESULTS

After the surgical procedure was performed, no hematoma, no edema, or facial nerve paralysis were observed. To date, during the follow-up period, no recurrence of the lesion has been observed, and the quality of life of the patient was good with a minimally scar outcome. Magnetic resonance imaging, performed 2 weeks postoperatively, demonstrated a complete removal of the mass CONCLUSION:: The authors' finding experience suggests that the minimally invasive approach provides an excellent surgical window that achieves greater exposure for the dissection of the midcheek area. Further clinical applications are required to assess advantages and/or limitations of this procedure.

Tumor model for surgical simulation to assess a minimally invasive endoscopic approach for midcheek mass removal

INTRODUCTION

The midcheek is considered one of the most important facial area due to its involvement in mimic expression and communication. Pathology of this district is complex due to the variety of soft tissue belonging to the face. We propose a surgical simulation, to assess the feasibility of a new minimally invasive endoscopic approach for midcheek mass removal.

TECHNICAL REPORT

This study was performed on four cadavers, at the Anatomy Laboratory of the University of Tubingen. In all the cadavers 3 cm³ of Acquasil Dent Sply Ultra were injected via trans-cutaneous along the nasolabial fold to simulate a midcheek mass. Three incisions in concealed areas were performed to create an access to reach the anterior compartment of the face. By using the Optical Dissector with distal spatula and a 30° endoscope we provided a wide surgical window and a greater exposure to isolate, dissect and remove the midcheek tumor model safely.

CONCLUSION

The proposed endoscopic technique allowed us to visualize and preserve all the key anatomic structures of the midcheek region. Due to its nature, the suggested material may provide a valid tumor model for surgical training also in other districts.