Surgical Anatomy of the Middle Premasseter Space and Its Application in Sub-SMAS Face Lift Surgery
Surgical Anatomy of the Middle Premasseter Space and Its Application in Sub-SMAS Face Lift Surgery
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DOI：
10.1097/prs.0b013e3182910b70
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发表时间：
2013-07-01
影响因子：
3.6
通讯作者：
Wong, Chin-Ho
中科院分区：
文献类型：
--
作者：
Mendelson, Bryan C.;Wong, Chin-Ho
背景：咬肌前间隙是一种公认的浅表肌腱膜系统(SMAS)软组织间隙，位于紧靠腮腺前方的下咬肌上。当使用空间时，复合式面部提升的性能、安全性和有效性都得到了提高。方法：对20具新鲜身体的上颌前区进行解剖，并在数百例复合体面部提升术中对上颌前区进行解剖。结果：上咬肌上方有一个小的、横向的矩形软组织间隙，命名为中部咬前间隙。该间隙(横向宽度，25-28 mm；垂直宽度，10 mm)与最初描述的(较低的)咬前间隙由双层膜隔开。它是面神经的上、下颊干之间的安全空间，面神经的上、下颊干紧靠在这个空间的外面，并被各自的上、下界膜隔开。结论：咬前间隙的中间间隙意义重大，因为它是紧靠头侧至下咬前间隙的关键解剖中心。当用于复合面提升术时，该间隙在面神经的颊干之间提供了可预见的SMAS下分离，到达咬肌前缘以外的活动区，SMAS覆盖在颊脂肪垫上。
Background: The premasseter space is a recognized, sub-superficial musculoaponeurotic system (SMAS) soft-tissue space overlying the lower masseter immediately anterior to the parotid. The performance, safety, and effectiveness of composite face lifts are enhanced when the space is used. This has drawn attention to the need for better understanding of the premasseter anatomy above the space.Methods: The anatomy of the upper premasseter region was investigated in 20 fresh cadaver dissections as well as intraoperatively in hundreds of composite face lifts.Results: A small, transverse, rectangular soft-tissue space overlies the upper masseter and was named the middle premasseter space. The space (transverse width, 25 to 28 mm; vertical width, 10 mm) is separated from the originally described (lower) premasseter space by a double membrane. It is a safe space between the upper and lower buccal trunks of the facial nerve, which are immediately outside the space and separated from it by the respective upper and lower boundary membranes. The parotid duct immediately beneath the floor of the space usually underlies the upper boundary membrane.Conclusions: The middle premasseter space is significant, as it is the center of the key anatomy immediately cephalad to the lower premasseter space. When used in composite face lifts, the space provides predictable sub-SMAS dissection between the buccal trunks of the facial nerve to the mobile area beyond the anterior border of the masseter where the SMAS overlies the buccal fat pad.