Anato my fo r Plastic Surg e ry o f the Face, He ad, and Ne ck Koich i Watan abe, MD, Ph D Assistant Professor Departm ent of Anatomy Kurum e University School of Medicine Fukuoka-Prefecture, Japan Moh am m adali M. Sh oja, MD Research Scientist Section of Pediatric Neurosurgery Children’s Hospital Birm ingham , Alabam a, USA Marios Lou kas, MD, Ph D Dean of Basic Sciences Professor and Chair Departm ent of Anatom ical Sciences St. George’s University Grenada, West Indies R. Sh an e Tubbs, MS, PA-C, Ph D Professor and Chief Scienti c O cer Seattle Science Foundation Seattle, Washington, USA 269 illustrations Thiem e New York • Stuttgart • Delhi • Rio de Janeiro Executive Editor: Timothy Hiscock Important note: Medicine is an ever-changing science undergo- Managing Editor: Elizabeth Palumbo ing continual development. Research and clinical experience are Director, Editorial Services: Mary Jo Casey continually expanding our knowledge, in particular our knowl- Editorial Assistant: Haley Paskalides edge of proper treatment and drug therapy. Insofar as this book Production Editor: Barbara A. Chernow mentions any dosage or application, readers may rest assured International Production Director: Andreas Schabert that the authors, editors, and publishers have made every e ort Vice President, Editorial and E-Product Development: to ensure that such references are in accordance with the state of Vera Spillner knowledge at the time of production of the book. 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Such examination is particularly important with drugs that are either rarely used or have been newly released Names: Watanabe, Kåoichi, 1968– author. | Shoja, on the market. Every dosage schedule or every form of applica- Mohammadali M., author. | Loukas, Marios, author. | Tubbs, tion used is entirely at the user’s own risk and responsibility. R. Shane, author. The authors and publishers request every user to report to the Title: Anatomy for plastic surgery of the face, head, and neck / publishers any discrepancies or inaccuracies noticed. If errors in Kåoichi Watanabe, Mohammadali M. Shoja, Marios Loukas, this work are found after publication, errata will be posted at R. Shane Tubbs. www.thieme.com on the product description page. Description: New York : Thieme, [2016] | Includes Some of the product names, patents, and registered designs bibliographical references and index. referred to in this book are in fact registered trademarks or pro- Identi ers: LCCN 2015031107| ISBN 9781626230910 (alk. paper) prietary names even though speci c reference to this fact is not | ISBN 9781626230927 (eISBN) always made in the text. Therefore, the appearance of a name Subjects: | MESH: Head—anatomy & histology—Atlases. | without designation as proprietary is not to be construed as a Neck—anatomy & histology—Atlases. | Reconstructive Surgical representation by the publisher that it is in the public domain. Procedures—Atlases. Classi cation: LCC RD119 | NLM WE 17 | DDC 617.9/52—dc23 LC record available at http://lccn.loc.gov/2015031107 ©2016 Thieme Medical Publishers, Inc. 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Co nte nts List of Videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi 1 Neurocranium and Facial Skeleton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 David Kahn, Toomas Arusoo, and Eric J. Wright 2 Anterior Skull Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Surjith Vattoth and Philip R. Chapman 3 Middle Skull Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Philip R. Chapman and Surjith Vattoth 4 Soft Tissue of the Scalp and Temporal Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Noriyuki Koga 5 Arterial Supply of the Facial Skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Nobuaki Imanishi 6 Arteries of the Face and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Yelda Atamaz Pinar, Figen Govsa, and Servet Celik 7 Veins of the Face and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Yusuke Shimizu 8 Facial Nerve and Temporal Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Orlando Guntinas-Lichius 9 Peripheral Branches of the Facial Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Andrew P. Trussler 10 Sensory Nerves of the Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Ibrahim Khansa, Jenny C. Barker, and Jef rey E. Janis 11 Super cial Musculoaponeurotic System and the Facial Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Yoko Tabira, Joe Iwanaga, Tsuyoshi Saga, and Koichi Watanabe 12 Mimetic Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Hee-Jin Kim 13 Orbital Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Swapna Vemuri and Jeremiah P. Tao 14 Orbital Soft Tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Swapna Vemuri and Jeremiah P. Tao 15 Eyelid Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Catherine Y. Liu, Swapna Vemuri, and Jeremiah P. Tao 16 Nasal Cavity and Paranasal Sinuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Joe Iwanaga, Tsuyoshi Saga, and Koichi Watanabe 17 External Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Hideaki Rikimaru 18 Auricle and External Acoustic Meatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Noritaka Komune, Junichi Fukushima, and Albert L. Rhoton, Jr. 19 Mandible and Masticatory Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Kyung-Seok Hu and Yang Hun Mu Contents 20 Oral Cavity and Pharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Joe Iwanaga, Shinya Mikushi, and Haruka Tohara 21 Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Sherine S. Raveendran and Lucian Ion Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 vi List o f Vide o s Video 1. Facial muscles and facial nerve on the anterior face Lower face Middle face Video 2. Dissection of the external nose Muscles on the external nose Bony and cartilaginous structure Video 3. Main trunk of the facial nerve and its branches Landmarks of the facial nerve trunk Temporal branch Zygomatic branch Buccal branch Marginal mandibular branch Cervical branch Video 4. Sensory nerves of the face Supraorbital nerve Infraorbital nerve Zygomaticofacial nerve Mental nerve Video 5. Layers of the temporal region Super cial temporal fascia Deep temporal fascia Temporalis muscle vii Pre face This book was planned as a head and neck surgical anatomy dents have less time to study anatomy, given the many new elds book for plastic surgeons, head and neck surgeons, and sur- of medicine that they are expected to be familiar with. Appar- geons who practice in related elds. Unfortunately, few surgical ently, some medical schools no longer o er anatomical dissec- textbooks emphasize anatomy, especially textbooks in the eld tion. Thus, not surprisingly, the number of anatomists, especially of plastic surgery. In most surgical textbooks, the procedures gross anatomists, is decreasing. This tendency has critical, neg- are described only in minute detail. Conversely, traditional an- ative implications for surgery. Gross anatomy is the basis of atomical textbooks do not provide adequate information on knowledge for every surgeon. Surgeons must be experts in gross the regional anatomy, preventing surgeons from obtaining the anatomy if they hope to acquire the surgical skills to become knowledge necessary to expertly perform various surgical pro- experts in surgery. cedures. One reason for this is that although the basic anatomy My second mentor, a specialist in plastic surgery, o ered the of the human body was almost completely described more than following: The most important aspect of performing plastic sur- 100 years ago, the anatomy in the head and neck region, espe- gery is knowledge of three-dimensional regional anatomy. For cially that applicable to plastic surgery, is still developing. Addi- example, each nerve and blood vessel takes up space three di- tionally, anatomical textbooks often do not provide the most mensionally. It is important to recognize how these structures up-to-date information. Therefore, we have attempted to in- travel on the surface plane, but it is more important for the clude the latest anatomical understanding of the head and neck success of the actual surgery to know which tissue layers these anatomy from a plastic surgeon’s perspective. structures run through. Anatomical atlases and textbooks pro- In writing this preface, I (KW) discussed head and neck anat- vide detailed images of these structures, but the knowledge omy with my mentors in two specialties: gross anatomy and gained from them is two-dimensional. Novice surgeons typi- plastic surgery. This allowed me to consider anatomy from two cally memorize the two-dimensional image of their surgical di erent viewpoints. eld. Because of this, surgical results are sometimes unsatisfac- First, my mentor in gross anatomy made the following ob- tory, or unexpected surgical complications may occur. To per- servations: The anatomy of the head and neck is extremely form surgeries with a high degree of di culty, a surgeon has to complicated and the details di er among individuals and during be able to vividly visualize the three-dimensional regional anat- di erent stages of life. These di erences include the thickness omy of the surgical eld. Plastic surgery residents have to study of the tissues, their changes in response to aging, and even ana- the regional anatomy in anatomical atlases and textbooks, and tomical variations in vessels, nerves, and muscles. Each organ in con rm their anatomical knowledge in practical operations. the head and neck region has a very distinct function. Conse- By repeating this pattern many times, a resident is able to es- quently, pathologies involving the head that require surgery tablish and practice three-dimensional anatomical knowledge. will be operated on by surgeons specializing in neurosurgery, By having surgical training based on accurate anatomical knowl- otorhinopharyngolaryngology, ophthalmology, dental medicine, edge, a surgeon will be better equipped to perform high-degree and plastic surgery. While in-depth knowledge in the anatomi- operations. cal area of specialization is extremely important in treating pa- We hope that our textbook will not only help to improve the tients, the surgeon as well as the medical sta must also be surgical skill of individual surgeons, but will also promote the highly familiar with not just related regions of the body but also development of head and neck surgery. I would like to thank with unrelated regions. In medical education, unfortunately, the Dr. Koh-ichi Yamaki, Professor of Anatomy, and Dr. Kensuke importance of anatomical education has been downplayed glob- Kiyokawa, Professor of Plastic Surgery, for kindly contributing ally in recent years. This may be because nowadays medical stu- the above comments to the preface. ix