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This study aimed to clarify the anatomy of middle rectal artery and pelvic vasculature patterns, and to provide schematic information in a manner applicable to the total mesorectal excision. Forty sides of pelvis from 20 formalin-embalmed cadavers (10 male, 10 female) were dissected, and all the pelvic vasculatures from the internal iliac artery were investigated, focusing on the middle rectal artery. Middle rectal arteries were classified into major types depending on their vascular origins. Each type was subdivided into minor types according to variability of the pelvic vasculature. A middle rectal artery was identified in 18 out of 20 cadavers, and in 25 out of 40 pelvic sides. In most cases, the middle rectal artery originated from the internal pudendal artery or inferior gluteal artery. These two arteries arose directly from the anterior trunk of the internal iliac artery or were bifurcated from the gluteal-pudendal trunk. In rare cases, these arteries arose from the posterior trunk of the internal iliac artery. The other origins of the middle rectal artery included the gluteal pudendal trunk, inferior vesical artery, internal iliac artery, obturator artery, and the prostatic artery, and the pelvic vasculatures in these cases also presented variability. The detailed anatomical findings related to the middle rectal artery and pelvic vasculatures are noteworthy for their improved clinical applicability.

The aim of this study was to use ultrasonography to determine the locations and distributions of the superior labial artery (SLA) and the inferior labial artery (ILA) relative to the vermilion border (VB). Sixty healthy Korean volunteers (35 males, 25 females; age, 21-36 years) were investigated using ultrasonography. The participants had not received any noninvasive treatment or surgical procedure in the facial regions during the previous 6 months. Based on the VB, the overall thicknesses of the upper and lower lips were 9.4 ± 0.4 mm (mean ± SD) and 10.9 ± 0.7 mm, respectively. In most cases, the labial arteries were located in the wet mucosal layer on both the upper (35-57%) and lower lips (28-55%), respectively. In the upper lip, the SLA was in the intramuscular layer in 20-45% of cases, making it the second most common type. At some of the measuring points, the SLA was observed more often in the intramuscular layer than in the wet mucosal layer. In the lower lip, the ILA was also located in the dry mucosa (5-27%). The dry-wet mucosal junction is unclear in the lip area, and the ILA was commonly observed at the dry-wet mucosal junction. The arterial depth was 5.3 ± 0.3 mm in the upper lip and 4.2 ± 0.4 mm in the lower lip. The SLA and ILA are evenly distributed over all parts of the oral mucosa. Injection procedures for lip augmentation should therefore use very superficial approaches. Clin. Anat. 33:158-164, 2020. © 2019 Wiley Periodicals, Inc.

The variations in the tibialis posterior tendon (TPT) could not be defined by previous classification, thus, this study used a larger-scale cadaver with the aim to classify the types of TPT insertion based on the combination of the number and location of TPT insertions. A total of 118 feet from adult formalin-fixed cadavers were dissected (68 males, 50 females). The morphological characteristics and measurements of TPT insertion were evaluated. Four types of TPT insertions were classified, wherein the most common type was type 4 (quadruple insertions, 78 feet, 66.1%), which was divided into four new subtypes that were not defined in the previous classification. The second most common type was type 3 (triple insertions, 25 feet, 21.2%) with three subtypes, including the new subtype. Type 2 was found in 13 feet (11%), and the rarest type was type 1 (2 feet, 1.7%), wherein the main tendon was only attached to the navicular bone and the medial cuneiform bone. We suggest high morphological variability of the TPT in relation to the insertion location, along with the possibility of significant differences according to race and gender. Moreover, this classification will help clinicians understand adult flatfoot deformity-related posterior tibial tendon dysfunction (PTTD).

The forehead is a region with boundaries of the hairline as the upper border and the eyebrow as the lower border. In this region, the frontalis m. is broadly placed. The function of this muscle is related to facial expressions, and as people age, they develop facial wrinkles.

The area covered by the orbicularis oculi (OOc) m. is called the “periorbital region.” The territory extends from the upper and lower eyelids to the eyebrows. The OOc m. is the muscle that determines the shape of the eyes and facial expressions. The OOc m. is an elliptically broad and flat muscle that acts in closing the eyelid, which protects the eyeballs. The component of the OOc m. can be subdivided as the orbital and the palpebral part by its location. More in detail, the palpebral portion can be classified by preseptal and pretarsal portions (Fig. 4.1). These portions are positioned in the superficial layer of both the tarsal plate and the orbital septum. The palpebral part of the muscle involuntarily closes the eyelids by making vertical wrinkles in the area of the medial canthus.

The cervical region has layers that consist of the skin, the subcutaneous or fat layer, and the superficial and deep fascia covering muscles and visceral structures (Fig. 7.1). Understanding the fascial layer and compartments is critical in a clinical setting since infectious and inflammatory spreading can be caused by invasive treatments.

Since treatment indications for fillers have developed beyond past extent, a broader comprehension regarding the facial anatomy is required. The advent of filler injection into practically any facial area has introduced a plethora of complications. Complications such as skin necrosis, blindness, and embolism can be detrimental, thus leaving practitioners wondering for a novel method that can reduce vessel-related complications. Incessant research on the vessel anatomy and distribution has been thoroughly executed, leading to fewer complications. Still, distinguishing every variation in each individual is impossible, and there will always be a limitation with blind injection. Implementing US imaging with fillers will be a revolutionary introduction to the field.

The midface includes the area of nose and cheek covering the middle third of the face. The upper border of the midface extends from the inferior orbital rim to the upper zygomatic arch. The midface is occupied by the zygomatic bone and a large amount of superficial fat. These convex structures contribute to making one look younger. However, the aging of the midface is noticeable by decreased fat volume and sagged soft tissue.

The facial soft tissues can be divided into five layers: (1) skin, (2) subcutaneous layer, (3) superficial musculoaponeurotic system (SMAS), (4) retaining ligaments and spaces, and (5) periosteum and deep fascia (Fig. 2.1). The skin is the most superficial layer that moves freely over the loose areolar connective tissue layer. Exceptionally, the skin in the auricle and nose ala area is less elastic for its connecting cartilage.

The perioral area includes several anatomical regions: the upper lip including the philtrum area, lower lip, nasolabial fold region, mouth corner, cheek, and chin. The appearance of the perioral region changes with the aging process, repeated movements, loss of bony support, and sagging of the fat tissue. Other environmental factors, such as smoking, sunlight hazard, and poor oral hygiene, can accelerate the aging process. Rejuvenation of the perioral region can be challenging. However, the perioral region is a high risky area in minimally invasive procedures; therefore, anatomical understanding is critical to prevent serious complications.

Thread lifting is now widely used to improve the facial sagging and the relocation of facial fat. Recently, one of the most noticeable minimally invasive aesthetic procedures is the use of dissolving threads. As the thread manufacturing techniques develop, various thicknesses and several types of threads such as a barbed or cog thread are available for clinical uses in addition to the initial thin 6-0 monotype thread.

Imaging by ultrasonography (US) utilizes the interaction of sound waves with tissue to produce an image or to determine the velocity of moving contents such as blood in the Doppler image. Furthermore, US has been used in many different fields to detect objects and measure distances. US waves are produced by a transducer, which can both emit US waves and detect reflected US echoes.

Botulinum toxin is usually injected into the muscles and glands, except during intradermal injection procedures. Botulinum toxin injection requires thorough anatomical understanding because even though target muscles for each indication are specific, we can only rely on the surface anatomy when injecting. In the last 15 years, anatomical research related to minimally invasive aesthetic treatments has greatly contributed to improving the precision compared to blind injection techniques.

The present study aimed to determine the arrangement and terminal attachments of the zygomaticus minor (Zmi) muscle fibers connecting the orbital and mouth regions. The Zmi was examined in 32 specimens of embalmed Korean adult cadavers. The Zmi was present in all 32 specimens (100%). In 31 of the specimens (96.9%), the Zmi that inserted into the upper lip was formed by muscle fibers that arose from the zygomatic bone and muscle fibers that extended from the orbicularis oculi (OOc) muscle. In 14 of the specimens (43.8%), some fibers of the Zmi that arose from the zygomatic bone blended with the inferior margin of the OOc, while the other fibers inserted into the upper lip. After the Zmi fibers blended with the inferior margin of the OOc, these fibers constituted the inferior and medial margins of the OOc. These fibers were then attached to the medial palpebral ligament, the maxilla, the levator labii superioris alaeque nasi muscle, and the depressor supercilii muscle. In 30 of 32 specimens (93.8%), muscle fibers that extended from the OOc constituted the lateral margin of the Zmi, usually descending to the level between the nasal ala and the vermilion border of the upper lip and inserting into the upper lip. The obtained data will be helpful for understanding their connected movements and in kinematics and electromyographic analyses, therapies involving injections of botulinum toxin Type A, and various types of facial surgery. Clin. Anat. 31:974-980, 2018. © 2018 Wiley Periodicals, Inc.

This study aimed to provide a comprehensive description of the arterial supply to the subscapularis (SSC) muscle. This will provide critical information for various surgical procedures. Ten specimens of embalmed Korean cadavers were dissected and subjected to modified Sihler's method to reveal the branching pattern of the arteries surrounding the subscapularis, and its intramuscular blood supply. The SSC muscle was generally supplied by branches from the subclavian artery (suprascapular artery, supraSA; circumflex scapular artery, CxSA; and dorsal scapular artery, dSA) and the axillary artery (subscapular artery, subSA; lateral thoracic artery, LTA; posterior circumflex humeral artery, PCxHA; and a branch of the axillary artery, AAbr). The anterior aspect of the muscle was supplied by the subSA, LTA, CxSA, supraSA, and AAbr. The posterior aspect of the muscle was supplied by the supraSA, PCxHA, and subSA. The dSA was more scarcely distributed than the other arteries. In two cases, the dSA supplied the portion of the muscle near the medial border of the scapular. The anterior side of the muscle tendon was supplied by the CxSA, and its posterior side was supplied by the PCxHA. The subSA can be considered to be the main branch supplying the SSA based on its distribution area of arteries. It was mostly situated within the lower region of the SSC. After distributing to the anterior surface of the SSC, some branches of the subSA reached the posterior surface as perforating branches. Clin. Anat. 32:642-647, 2019. © 2019 Wiley Periodicals, Inc.

The present study aimed to determine the arrangement and terminal attachments of the zygomaticus minor (Zmi) muscle fibers connecting the orbital and mouth regions. The Zmi was examined in 32 specimens of embalmed Korean adult cadavers. The Zmi was present in all 32 specimens (100%). In 31 of the specimens (96.9%), the Zmi that inserted into the upper lip was formed by muscle fibers that arose from the zygomatic bone and muscle fibers that extended from the orbicularis oculi (OOc) muscle. In 14 of the specimens (43.8%), some fibers of the Zmi that arose from the zygomatic bone blended with the inferior margin of the OOc, while the other fibers inserted into the upper lip. After the Zmi fibers blended with the inferior margin of the OOc, these fibers constituted the inferior and medial margins of the OOc. These fibers were then attached to the medial palpebral ligament, the maxilla, the levator labii superioris alaeque nasi muscle, and the depressor supercilii muscle. In 30 of 32 specimens (93.8%), muscle fibers that extended from the OOc constituted the lateral margin of the Zmi, usually descending to the level between the nasal ala and the vermilion border of the upper lip and inserting into the upper lip. The obtained data will be helpful for understanding their connected movements and in kinematics and electromyographic analyses, therapies involving injections of botulinum toxin Type A, and various types of facial surgery. Clin. Anat. 31:974-980, 2018. © 2018 Wiley Periodicals, Inc.

Background Injections of filler into the nose for dorsum augmentation have a higher risk of complications due to the complicated blood supply and anastomotic channels in this area. Objectives The aim of this study was to determine the anatomical features and location of the dorsal nasal artery (DNA), and to provide clinical anatomical information to reduce side effects and severe complications in the perinasal area. Methods Using the 31 cadaveric noses in Asians, dissections and histologic examinations were performed to identify the location and depth of the vascular structures including DNA. Results Dorsal nasal artery ran downward at 20.3 ± 3.5 mm from the intercanthal line and the communicating branch that connected the bilateral DNAs was located 8.5 ± 3.5 mm inferior to the intercanthal line. The DNA was located at 4.4 ± 3.2 mm, 4.6 ± 4.4 mm, and 5.2 ± 4.4 mm lateral to the midline of the nose on the intercanthal, quadrisected, and bisected lines, respectively. At the level of nasal bone, DNA was located superficial to the muscular layer and it runs inferolaterally on dorsum on nose. It was running more deeply and located beneath the fibromuscular layer at the cartilaginous portion of the dorsum of nose. Conclusions Injection into deep fatty layer may reduce the risk of arterial injury and the consequent complications. However, in a hooked nose, the tip of the needle traveling along the deep layer approaches the superficial layer due to the convexity of the hump as it passes over it, which can increase the probability of damaging the DNA.

Background: Confusion exists as to the plane of the risorius with respect to the superficial musculoaponeurotic system (SMAS), the parotid fascia, and the masseteric fascia, which generally are considered origins of the risorius. Objectives: The authors attempted to clarify the origin of the risorius by topographic examination and dissection, which would provide valuable anatomic information for flap dissection in facelift surgery. Methods: Detailed dissection was performed in the perioral region of 46 cadaveric specimens to discern the origin of the risorius in relation to the fascial layer. The anatomic aspects of the muscular arrangement and origin of the risorius were classified according to the location of attachment. Results: The risorius originated solely from the fascial layer superficial to the SMAS in 27 specimens (58.7%; type A). It originated solely from the masseter tendon in 3 specimens (6.5%; type B) and from the fascial layers, both superficial and deep to the SMAS, in 16 specimens (34.8%; type C). Conclusions: The patterns of risorius origination identified in this study represent important anatomic reference information for flap dissection in facelift surgery.

The aim of this study was to clarify the topography of the longitudinal pharyngeal muscles and to relate the findings to pharyngeal muscular function. Forty-four specimens (22 right and 22 left sides) from embalmed Korean adult cadavers (13 males, 9 females; age range, 46-89 years; mean age, 69.2 years) were used in this study. The palatopharyngeus muscle originated from the palatine aponeurosis and the median part of the soft palate on oral aspect; it ran downward and lateralward, respectively. The palatopharyngeus muscle, which held the levator veli palatini, was divided into two bundles, medial and lateral, according to the positional relationship with the levator veli palatini. The lateral bundle of the palatopharyngeus muscle was divided into two parts: longitudinal and transverse. The pharyngeal longitudinal muscles were classified into the following four types (I-IV) depending on the area of insertion: they were inserted into the palatine tonsil, epiglottis, arytenoid cartilage, piriform recess, thyroid cartilage, and pharyngeal wall. The transverse part of the palatopharyngeus muscle plays a role as a sphincter. Palatopharyngeus and levator veli palatini muscles help each other to function effectively in the soft palate. The present findings suggest that the pharyngeal muscles are involved not only in swallowing but also in respiration and phonation via their attachment to the laryngeal cartilage.

Background The superficial facial fascia comprises the superficial musculoaponeurotic system (SMAS) and the temporoparietal fascia (TPF) and is regarded as a continuous monolayer. However, some evidence indicates that the superficial facial fascia consists of 2 layers in specific areas. Objectives The authors evaluated the superficial facial fascia for bilayered regions. Methods Twenty fresh cadavers (40 hemifaces) were dissected to observe the superficial facial fascia. Twelve cadavers were dissected to assess tensile strengths of the superficial and deep layers of the SMAS. Specimens were obtained from 2 cadavers for histologic analysis. Results The SMAS and TPF were separable into superficial and deep layers, with intervening areolar tissue. The deep TPF was continuous with the deep SMAS inferiorly and the subgalea anteriorly. The superficial orbicularis oculi was invested by the superficial SMAS, whereas the deep orbicularis and the platysma were invested by the deep SMAS. Thus, 2 key structures addressed in facial rejuvenation are positioned in different surgical planes. Conclusions Study results support the belief that the superficial facial fascia comprises 2 layers, with the superficial orbicularis oculi and platysma invested by different layers. These findings have implications for facial rejuvenation techniques that involve management of the SMAS and TPF.

Little is currently known about the variations in the muscular band around the orbicularis oculi muscle (OOc) region, and so the aim of the current study was to describe in anatomic terms the morphologic patterns of the lateral muscular bands of the OOc. Sixty-one hemifaces from embalmed Korean adult cadavers (34 males, 27 females; age range, 45-85 years; mean age, 62.6 years; 28 bilateral and 5 unilateral) were dissected to reveal the anatomic features of the region around the OOc. The lateral muscular band originating from the superficial temporal fascia lateral to the OOc was observed in 54.1% of cases. It terminated at the zygomatic arch region in 17 cases (type A, 27.9%), at the cheek region in 11 cases (type B, 18%), and at the angle of the mouth in 5 cases (type C, 8.2%). When the linear length from the lateral canthus to the tragion was set as 100, the length from the lateral canthus to the lateral edge of OOc was 34.0 (male, 34.1; female, 33.7), and the length between the lateral edge of OOc and the lateral muscular bands of OOc was 6.4 (male, 6.5; female, 6.2). The results of this study suggest that the lateral muscular bands of the OOc may play a significant role in facial animation and dimple formation. In addition, these data provide an index of suggested regions to be injected in patients with periorbital rhytides.

The aim of this study was to clarify the morphology and topography of the dilator naris vestibularis, dilator naris anterior, and alar part of the nasalis. Anatomical variations in the topographic relationships are also described to provide critical data for understanding nasal muscular functions. Anatomical and histological examinations were performed on 40 specimens of embalmed Korean adult cadavers. The dilator naris vestibularis muscle (named by the present authors) was located between the external and vestibular skin of the alar lobule. The muscle fibers radiated along the dome-shaped nasal vestibule. The dilator naris anterior muscle originated from the frontal surfaces of the lateral half of the lateral crus and the accessory alar cartilage adjacent to the lateral crus. The extent of the lower insertion of the dilator naris anterior muscle was at the alar groove. The alar part of the nasalis originated with the transverse part of nasalis from the maxilla. It ascended to attach to the alar crease and the adjacent deep surface of external skin of the alar lobule. These findings may provide anatomical knowledge required to understand the structure and function of these nasal muscles such as during rhinoplasty or other surgery of the face.

Background: The aim of this study was to clarify the arrangement of the zygomaticus major muscle by means of topographic examination, and to evaluate the anatomical variations in the insertion of the zygomaticus major at the perioral region. Methods: After a detailed dissection in the modiolar region, the insertion area of the zygomaticus major was observed in 70 embalmed cadavers. Results: At the perioral region of the dissected specimens, the anatomical aspects of the muscular arrangement and attachment of the zygomaticus major muscle were classified into four categories. In type I, the superficial muscle band of the zygomaticus major is blended and interlaced with the levator anguli oris, whereas the fibers of the deep muscle band blend into the buccinator, passing deeper to the levator anguli oris; this was the situation most commonly encountered (54.3 percent). It was found that the insertion of the zygomaticus major was divided into superficial and deep bands (types I and IV) [42 cases (60 percent)] and into three layers of superficial, middle, and deep fibers (type II) [17 cases (24.3 percent)]. The others were cases where the zygomaticus major was inserted deep into the levator anguli oris as a single muscle band (type III) [11 cases (15.7 percent)]. Conclusion: The arrangement and insertion patterns of the zygomaticus major in this study are expected to provide critical information for surgical planning for the procedure of facial reanimation surgery.

The aim of this study was to clarify the spatial relationship between the facial artery and the insertion of the zygomaticus major muscle in the perioral region. In 30 of 70 dissections (42.9%), the facial artery passed through the separate muscle bands of the zygomaticus major muscle. The mean diameter of the facial artery passing through the zygomaticus major muscle in this region was 1.74 mm (range 0.82-2.86 mm). The relationship between the facial artery and the insertion of the zygomaticus major muscle in the perioral region described in this study is expected to provide critical information for surgical planning and procedures around the perioral region.

Until now there has been no definitive anatomical study describing the area where the parotid duct enters the buccinator muscle. In this study, we performed anatomical and histological examinations to investigate the relationship between the parotid duct and the buccinator muscle. Thirty specimens (including the buccinator and the terminal portion of the parotid duct) were obtained from embalmed Korean cadavers. Dissection was performed on 22 of these specimens, and the remaining eight specimens were prepared for histological examination and stained with haematoxylin–eosin or Gomori trichrome. In all specimens, small, distinct muscle fibres originating from the buccinator muscle extended to and inserted into the terminal portion of the parotid duct. The topography of these fibres varied, and we classified them into three categories according to where they originated. Type I buccinator muscle fibres, which inserted into the terminal portion of the parotid duct, originated simultaneously from the anterior and posterior aspects of the duct (ten cases, 45.5%). Type II fibres originated from the anterior aspect of the duct and inserted into the anterior side of the duct (seven cases, 31.8%). Type III fibres originated from the posterior aspect of the parotid duct and ran anteriorly toward the duct (five cases, 22.7%). These results were confirmed in the histological examination of all eight specimens. Based on these findings, we have proposed a tentative description of the physiological role of the buccinator muscle fibres in salivary secretion and in the formation of the sialoliths.

Background:Despite the area of insertion of the facial portion of the platysma being broad and highly variable, the details of its pattern of extension and morphology are not well described in the medical literature. The aim of this study was to clarify the extension patterns of the platysma on the

The mandibular symphysis is preferred as a donor site for the relatively small grafts needed for the autogeneous bone graft procedure. This study was undertaken to determine the morphology and composition of the cortical and trabecular bone in the mandibular symphyseal region using 35 mandible specimens from Koreans. The topographical patterns through the thickness of the cortical plate and the width of the trabecular bone were observed. In this study, the labial cortical plate of the mandible became thicker from the superior to the inferior aspects (P < 0.05). However, the trabecular bone width exhibited a different distribution pattern compared to the thickness of the labial cortical plate. This observation concerning the cortical and trabecular bones assists in determination of the depth of osteotomy. The results provide useful information on the mandibular symphysis graft prior to dental implant placement. These results will enable the volume of the cortical plate in the mandibular symphyseal region and its proper size, depth, and location to be predicted when removing a graft block.

This study examines the anatomic relationships and variability of the facial nerve trunk and its branches, with emphasis on the intraparotid connections between the divisions. Microdissections were performed on 30 Korean half-heads, and the facial nerve trunks and branches were exposed. The average depth of the stylomastoid foramen from the skin surface was 21.0 +/- 3.1 mm, and the distance between the stylomastoid foramen and the bifurcation of the temporofacial (upper) and cervicofacial (lower) divisions was 13.0 +/- 2.8 mm. In 26 of 30 dissections (86.7%), the facial nerve trunk bifurcated into two main divisions, and a trifurcation pattern was seen in the other four cases (13.3%). According to the origin of the buccal branches, we classified the branching patterns of the facial nerve into four categories. In type I (13.8% of cases), the buccal branches arose from the two main divisions of the trunk but not from other branches of the facial nerve. In type II (44.8% of cases), the buccal branches arising from the two main divisions were interconnected with the zygomatic branch. In type III (17.3% of cases), the marginal mandibular branch sent nerve twigs to the buccal branch, which originated from the upper and lower divisions. In type IV (17.3% of cases), the nerve twigs from the zygomatic and marginal mandibular branches merged to the buccal branch arising from the two main divisions. Communications between the facial and auriculotemporal nerve branches, which are known as "communicating auriculotemporal nerves," were observed in 28 of the 30 cases (93.3%). Familiarity with these common variations in the facial anatomy provides useful information for the surgeon in careful dissection, preservation of the facial nerve, and complete removal of the tumors in parotidectomies.

The aim of this study was to examine in detail the anatomic variations in the orbicularis oculi muscle (OOc) and relationship of the zygomaticus minor muscle (ZMi) with the OOc, thereby providing an anatomic basis for explaining facial animation and attachment to the periorbital muscle. Sixty-one hemifaces from embalmed Korean adult cadavers (34 males, 27 females; age range, 45-85 years; mean age, 62.6 years) were used in this study. The prevalence of cases in which the ZMi did not run straight from the upper lip, rather running straight to the corner of the levator labii superioris, was 36.1% (22/61), because the origin of ZMi covered the inferior border of the OOc. The prevalence of mixing of the belly of the orbital part of the outer edge of the OOc with the ZMi was 88.5%, and that of blending of the ZMi band into the lower inner corner of the OOc was 55.7%. The area of blending of the OOc and ZMi was located 17.8 mm down from the Frankfort plane and 8.9 mm lateral to the vertical line between the lateral canthus and the Frankfort plane in the lateral part of the OOc. At this position, the mixed belly extends medially for a distance of 16 mm. This research has identified the exact location where the ZMi and OOc blend and determined the relationship between the ZMi and the suborbicularis oculi fat. This result will be given as basic data for understanding facial expressions and for performing composite rhytidectomy.

Despite the importance of anatomic variations in the muscular bands around the orbicularis oculi muscle (OOc), little is known about them. The morphology and variations therein of the medial muscular band of the OOc were thus examined in the current study. Sixty-one hemifaces of Korean cadavers were dissected to enable examination of the anatomic organization of the muscles around the OOc. A medial muscular band of the OOc was observed in 40 cases (65.6%). Three patterns of attachment were found. In type A (14 cases, 23%), it attached to the frontal belly without being attached to the medial canthal tendon; in type B (14 cases, 23%), it originated from the medial canthal tendon at the lower portion of the OOc and inserted into the cheek skin, and in type C (12 cases, 19.7%), it was also observed to insert into the cheek skin and attach to the frontal belly without being attached to the medial canthal tendon. The distance between the inferior edge of the OOc and the subnasale was 16.3 (SD, 4.3) mm and 14.5 (SD, 4.4) mm in cases with and without a medial muscular band, respectively. A space was observed on the inferolateral side of the OOc in about 67.2% of cases. These findings regarding the medial muscular band of the OOc increase further the anatomic variations associated with this region. In addition, it appears that this medial muscular band of the OOc can help to prevent drooping of the OOc.

The zygomaticus minor muscle (Zmi) is involved in the expression of many different facial emotions. However, the details of its insertion pattern and morphology are not well described.The aim of this study was to clarify the morphology and insertion pattern of the Zmi, and to provide clinical anatomic information that will help elucidate its roles in animation.Fifty-four embalmed adult hemifaces (18 men and 12 women; mean age, 67.4 years) from 30 cadavers were used in this study. The dissection was performed with the aid of a surgical microscope.This muscle could be classified into 3 types (A-C). Type A, in which the Zmi attached only to the upper lip, was observed in 63.0% of cases (34/54) and could be subdivided into 2 types: straight (A-1; 31.5%, 17 cases) and curved (A-2; 31.5%, 17 cases). Type B, in which the Zmi was attached to both the upper lip and the lateral alar region, occurred in 27.8% of cases (15/54). In Type C (9.2% of cases, 5/54), there was either no or only undeveloped Zmi fibers.The present finding of Zmi fibers being attached to the alar region in many cases (27.8%) suggests that this muscle is involved in elevation of both the nose ala and upper lip during various facial animations.

The middle temporal vein (MTV) traverses the temporal fossa between the superficial and deep layers of the deep temporal fascia. During filler injection into a deficient temporal fossa, filling agents may be inadvertently injected into the MTV, which results in vascular complications.To investigate the course of the MTV to enable safe filler injection in the temple area.The course and diameter of the MTV were measured in 18 hemifaces from 9 Korean cadavers.The MTV was located 23.5 and 18.5 mm above the zygomatic arch at the jugale and the zygion, respectively. The diameter of the MTV at its thickest point was 5.1 mm. A splitting and reuniting pattern, such that the MTV occupied more space than a single trunk, was observed in 28% of cases.We propose that the safest area for filler injection in temporal fossa augmentation is one finger width above the zygomatic arch.

The medial zygomaticotemporal vein (MZTV), clinically known as sentinel vein, has been observed in the vicinity of the temporal branch of the facial nerve during endoscopic procedures aiming to lift the upper face. The aim of the present study was to describe the topography of the MZTV with reference to the superficial landmarks for providing detailed anatomical information during injectable treatment procedures. Eighteen hemifaces were harvested from nine embalmed Korean adult cadavers (5 males and 4 females, mean age 76 years). The piercing location, vascular diameter, drainage pattern of the MZTV, and its relationship with the orbicularis oculi muscle (OOc) were recorded photographically, and using diagrams and written notes. The piercing point of the MZTV was located 26.8 ± 5.9 mm from the lateral epicanthus, 18.8 ± 6.9 mm lateral to the plane (HP) through the tragus and the lateral epicanthus, and 19.0 ± 5.4 mm superior to the plane (VP) through the lateral epicanthus point and perpendicular to the HP. The diameter of the MZTV at the piercing point was 1.9 ± 0.8 mm. All of the MZTV ultimately connected with the middle temporal vein (MTV). In particular, the MZTV was connected the MTV by anastomosing with the periorbital vein. Anastomosis of the MZTV and a well-developed periorbital vein was found in 27.8 % of cases. The physician must determine the location of the MZTV and should be able to accurately estimate its connection with significant veins at the temple to reduce the risk of severe complications during injectable treatments.

The levator labii superioris (LLS) muscle is well known as one of the upper-lip elevators; however, there have been few reports about the anatomic description of the LLS. Especially, the shape of the LLS and its relationship with the nasal ala were not clearly shown in the literature. The aim of this study was to clarify and describe the morphology and topography of the LLS and the anatomic variations to understand the function of the LLS related with the nasal ala. The LLS was examined in 102 specimens of embalmed Korean and French adult cadavers. The LLS was classified into 3 categories according to its shape and attachment: rectangular (83%), fan (10%), or trapezoid (7%) type. The medial fibers of the LLS were attached to the deep surface of the alar facial crease and were mainly intermingled with the alar part of the nasalis. Some of the deeper muscle fibers of the LLS extended to the vestibular skin of the nasal lobule. These new anatomic findings in the current study could be useful information for understanding the function of the LLS and the various surgical procedures of the perinasal region.

The dramatic changes in facial expression are most remarkable in the perioral region. Among the perioral musculatures, the zygomaticus major (ZMj) muscle plays an important role in the facial expression. The aim of this study was to determine the anatomic patterns of the bifid ZMj through a topographic examination at the perioral region. Through 70 dissections of the hemifaces, the insertion area of the ZMj was observed in 70 embalmed cadavers. The bifid ZMj was observed in 28 cases (40%). In most cases of the bifid ZMj, the superior muscle fibers were larger and wider than the inferior fibers. Bilateral bifid ZMj was found in 71.4% of the bifid ZMj specimens. The arrangement and insertion patterns of the ZMj in this study are expected to provide critical information for the surgical planning and procedure for facial reanimation surgery.