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The article titled "Myomodulation with Facial Fillers: A Comprehensive Technical Guide and Retrospective Case Series" by Coimbra et al. in Aesthetic Plastic Surgery presents a technical guide for holistic facial treatment using hyaluronic acid (HA) fillers and a map for addressing individual facial units through myomodulation. The authors' approach is appreciated for its value. However, concerns arise about the employed methodologies. Understanding HA's properties is vital for treatment standardization. The significance of HA's rheological properties, encompassing viscosity, elasticity, and cohesiveness, is critical for optimal dermal filler selection. The authors' insights are acknowledged, yet further analysis considering these factors is recommended. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Placement of fillers in close proximity to the mimetic or sphincter muscles of the face appears to enhance or suppress muscle action in a relatively predictable way. Methods: From June 2016 to June 2021, patients who underwent the first author's technique of myomodulation with dermal fillers to address aesthetic concerns or to manage facial spasms or synkinesis were evaluated in a retrospective case series. Additionally, the authors provide a technical guide for a whole-face approach to treatment with fillers and a conceptual map for treatment of each facial subunit with a focus on myomodulation. Results: A total of 1352 patients (1108 women, 244 men; mean age, 51 years) underwent at least 1 treatment session during the 5-year study period. The treatment patterns of the study population and details of 2 representative cases are presented. Conclusions: Although not well understood mechanistically, myomodulation with injectable fillers shows promise for significant and reliable results of facial rejuvenation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Facial musculature in mammals underlies mastication and nonverbal communicative facial displays. Our understanding of primate facial expression comes primarily from haplorrhines (monkeys and apes), while our understanding of strepsirrhine (lemurs and lorises) facial expression remains incomplete. We examined the facial muscles of six specimens from three Nycticebus species (Nycticebus coucang, Nycticebus javanicus, and Nycticebus menagensis) using traditional dissection methodology and novel three-dimensional facial scanning to produce a detailed facial muscle map, and compared these results to another nocturnal strepsirrhine genus, the greater bushbaby (Otolemur spp.). We observed 19 muscles with no differences among Nycticebus specimens. A total of 17 muscles were observed in both Nycticebus and Otolemur, with little difference in attachment and function but some difference in directionality of movement. In the oral region, we note the presence of the depressor anguli oris, which has been reported in other primate species but is absent in Otolemur. The remaining muscle is a previously undescribed constrictor nasalis muscle located on the lateral nasal alar region, likely responsible for constriction of the nares. We propose this newly described muscle may relate to vomeronasal organ functioning and the importance of the use of nasal musculature in olfactory communication. We discuss how this combined methodology enabled imaging of small complex muscles. We further discuss how the facial anatomy of Nycticebus spp. relates to their unique physiology and behavioral ecology., (© 2024 The Author(s). The Anatomical Record published by Wiley Periodicals LLC on behalf of American Association for Anatomy.)

Background: Tissue fillers are generally safe and well tolerated by patients. However, complications do occur and may be very severe, such as intravascular injection (with occasional residual tissue loss, visual and neurological sequelae) and late nodularity and swelling. Methods to lessen the likelihood of complications have been the subject of much recent literature. Depth of injection has been identified as a key safety consideration. Patients/Methods: The role of injection of facial filler into the muscular layer of the face is explored in this article. Literature was explored using available search facilities to study the role of injections in or around this layer in the production of significant adverse reactions. Results: A body of literature seems to suggest that injection into mimetic musculature of the face especially the musculature in the periorbital and perioral regions is prone to adverse reactions. Conclusions: Injection of agents into the perioral and periorbital mimetic muscular layer may produce, product clumping, displacement, and tendency to late nodularity and swelling. It also risks intravascular injection as compared to injection of other layers of the face. Injection into the mimetic muscles especially the sphincteric muscles should be avoided to minimize the risk of complications. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Using surface electrostimulation, we aimed to use facial nerve mapping (FNM) in healthy subjects and patients with postparetic facial synkinesis (PPFS) to define functional facial target regions that can be stimulated selectively.Study Design: Single-center prospective cohort study.Methods: FNM was performed bilaterally in 20 healthy subjects and 20 patients with PPFS. Single-pulse surface FNM started at the main trunk of the facial nerve and followed the peripheral branches in a distal direction. Stimulation started with 0.1 mA and increased in 0.1 mA increments. The procedure was simultaneously video recorded and evaluated offline.Results: A total of 1,873 spots were stimulated, and 1,875 facial movements were evaluated. The stimulation threshold was higher on the PPFS side (average = 9.8 ± 1.0 mA) compared to the contralateral side (4.1 ± 0.8 mA) for all stimulation sites or compared to healthy subjects (4.1 ± 0.5 mA; all P < .01). In healthy subjects, selective electrostimulation ± one unintended coactivation was possible at all sites in >80% of cases, with the exception of pulling up the corner of the mouth (65%-75%). On the PPFS side, stimulation was possible for puckering lips movements in 60%/75% (selective stimulation ± one coactivation, respectively), blinking in 55%/80%, pulling up the corner of the mouth in 50%/85%, brow raising in 5%/85, and raising the chin in 0%/35% of patients, respectively.Conclusions: FNM mapping for surgical planning and selective electrostimulation of functional facial regions is possible even in patients with PPFS. FNM may be a tool for patient-specific evaluation and placement of electrodes to stimulate the correct nerve branches in future bionic devices (e.g., for a bionic eye blink).Level Of Evidence: 2b Laryngoscope, 130:E320-E326, 2020. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate optimal stimulation parameters with regard to discomfort and tolerability for transcutaneous electrostimulation of facial muscles in healthy participants and patients with postparetic facial synkinesis. Methods: Two prospective studies were performed. First, single pulse monophasic stimulation with rectangular pulses was compared to triangular pulses in 48 healthy controls. Second, 30 healthy controls were compared to 30 patients with postparetic facial synkinesis with rectangular pulse form. Motor twitch threshold, tolerability threshold, and discomfort were assessed using a numeric rating scale at both thresholds. Results: Discomfort at motor threshold was significantly lower for rectangular than for triangular pulses. Average motor and tolerability thresholds were higher for patients than for healthy participants. Discomfort at motor threshold was significantly lower for healthy controls compared to patients. Major side effects were not seen. Conclusions: Surface electrostimulation for selective functional and tolerable facial muscle contractions in patients with postparetic facial synkinesis is feasible. [ABSTRACT FROM AUTHOR]

Background: The number of TOETVA surgeries has increased worldwide but the anatomical passage of trocars is not clearly defined. We aimed to define detailed surgical anatomical passage of the trocars in cadavers. The incisions in oral vestibule, anatomical pathways of trocars, affected mimetic muscles, neurovascular relations of trocars and histological correlation of surgical anatomy were investigated.Methods: Four cadavers and 6 six patient oral vestibules were used. The locations of optimised vestibular incisions were measured photogrammetrically. Initial steps of TOETVA surgery were performed on cadavers according to those optimal incisions. TOETVA preformed cadavers dissected to determine anatomical passages of the trocars. Afterwards, flap of lower lip and chin were zoned by software appropriate to the trocars routes. Histological analyses of the zones were made in correlation with dissections.Results: Mimetic muscles associated with median (MT) and lateral trocars (LT) are orbicularis oris, mentalis, depressor anguli oris, depressor labii inferioris and platysma muscles. Trocars affect mimetic muscles in the perioral, chin and submental regions in different ways. The risk of mental nerve injury by MT is low. LT pass through the DLI muscle. The transmission of LT to the subplatysmal plane in the submental regions can be in two different ways. The arterial injury risk is higher with LT than the MT.Conclusions: The surgical anatomy of the perioral, chin and submental regions for the initial TOETVA steps has been defined. Detailed surgical anatomical passages of the MT and LT were determined. Anatomical pattern to reach subplatysmal plane are presented. Mimetic muscles effected by trocars were determined. Endocrine surgeons should know the anatomical passage of TOETVA trocars. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Early persistent facial paralysis is characterized by intact muscles of facial expression through maintained perfusion but lacking nerve supply. In facial reanimation procedures aiming at restoration of facial tone and dynamics, neurotization through a donor nerve is performed. Critical for reanimating target muscles is axonal capacity of both donor and recipient nerves. In cases of complete paralysis, the proximal stump of the extratemporal facial nerve trunk may be selected as a recipient site for coaptation. To further clarify the histological basis of this facial reanimation procedure we conducted a human cadaver study examining macro and micro anatomical features of the facial nerve trunk including its axonal capacity in human cadavers. Axonal loads, morphology and morbidity of different donor nerves are discussed reviewing literature in context of nerve transfers. METHODS: From 6/2015 to 9/2016 in a group of 53 fresh frozen cadavers a total of 106 facial halves were dissected. Biopsies of the extratemporal facial nerve trunk (FN) were obtained at 1 cm distal to the stylomastoid foramen. After histological processing and digitalization of 99 specimens available, 97 were selected eligible for fascicle counts and 87 fulfilled quality criteria for a semi-automated computer-based axon quantification software using ImageJ/Fiji. RESULTS: An average of 3.82 fascicles (range, 1 to 9) were noted (n = 97). 6684±1884 axons (range, 2655– 12457) were counted for the entire group (n = 87). Right facial halves showed 6364±1904 axons (n = 43). Left facial halves demonstrated 6996±1833 axons (n = 44) with no significant difference (p = 0.73). Female cadavers featured 6247±2230 (n = 22), male showed 6769±1809 axons (n = 40). No statistical difference was seen between genders (p = 0.59). A comparison with different studies in literature is made. The nerve diameter in 82 of our specimens could be measured at 1933±424 μm (range, 975 to 3012). CONCLUSIONS: No donor nerve has been described to match axonal load or fascicle number of the extratemporal facial nerve main trunk. However, the masseteric nerve may be coapted for neurotization of facial muscles with a low complication rate and good clinical outcomes. Nerve transfer is indicated from 6 months after onset of facial paralysis if no recovery of facial nerve function is seen. [ABSTRACT FROM AUTHOR]

Background: The presence or hyperactivity of the depressor septi nasi muscle has been proposed to cause a visible crease in the upper labial region that is esthetically disturbing to patients. The objective of this paper was to determine how often an upper labial crease is evident in women and to find a straightforward treatment. Muscular creases can be ameliorated with botulinum toxin. However, weakening the depressor septi nasi muscles with botulinum toxin did not eradicate existing upper labial creases at rest or during facial animation. Therefore, we proposed that a complex interplay exists between the upper labial muscles, and we sought to determine which of these muscles are responsible for the existence of the upper labial crease. Methods: A total of 100 consecutive female volunteers who visited a plastic surgery clinic were prospectively examined. The presence and localization of the upper labial crease were assessed at rest and during animation prompted with the 'smile test' and during snuffling. Additionally, the appearance and symmetry of the upper labial crease were assessed and correlated with the type of smile to identify the dominant muscles involved. Results: In total, 38% of women older than 40 years presented with an upper labial crease at rest, and 70% presented with a crease during animation. Only one third of the women were aware that they had such a crease when they smiled. When the crease was present, it was bilateral in 98% of the women. When it was asymmetrical, which was the case for 10% of women, the fold was longer, shorter, or less visible on one half of the upper lip. The localization was highly variable and ranged from the base of the columella to the caudal third of the upper lip. When an upper labial crease was present at rest and/or during facial animation, it was associated with a type B smile, i.e., the 'canine' smile, due a dominant levator labii superioris muscle. Conclusions: This study showed that upper labial creases are present more often than women are aware of them. The injection of botulinum toxin into the levator labii superioris muscles can eradicate an upper labial crease. Level of Evidence: Level IV, risk / prognostic study. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To examine by intraoperative electric stimulation which peripheral facial nerve (FN) branches are functionally connected to which facial muscle functions.Study Design: Single-center prospective clinical study.Methods: Seven patients whose peripheral FN branching was exposed during parotidectomy under FN monitoring received a systematic electrostimulation of each branch starting with 0.1 mA and stepwise increase to 2 mA with a frequency of 3 Hz. The electrostimulation and the facial and neck movements were video recorded simultaneously and evaluated independently by two investigators.Results: A uniform functional allocation of specific peripheral FN branches to a specific mimic movement was not possible. Stimulation of the whole spectrum of branches of the temporofacial division could lead to eye closure (orbicularis oculi muscle function). Stimulation of the spectrum of nerve branches of the cervicofacial division could lead to reactions in the midface (nasal and zygomatic muscles) as well as around the mouth (orbicularis oris and depressor anguli oris muscle function). Frontal and eye region were exclusively supplied by the temporofacial division. The region of the mouth and the neck was exclusively supplied by the cervicofacial division. Nose and zygomatic region were mainly supplied by the temporofacial division, but some patients had also nerve branches of the cervicofacial division functionally supplying the nasal and zygomatic region.Conclusions: FN branches distal to temporofacial and cervicofacial division are not necessarily covered by common facial nerve monitoring. Future bionic devices will need a patient-specific evaluation to stimulate the correct peripheral nerve branches to trigger distinct muscle functions.Level Of Evidence: 4 Laryngoscope, 127:1288-1295, 2017. [ABSTRACT FROM AUTHOR]

Introduction: In this study we correlated results of ultrasonographic muscle thickness and contractility with facial electromyography (EMG) in patients with unilateral peripheral acute or chronic facial palsy.Methods: Two hundred twenty measurements of 4 facial muscles (frontalis, orbicularis oculi, zygomaticus, and orbicularis oris) were performed in 44 patients.Results: Facial muscle thickness at rest and during muscle contraction correlated best with EMG insertional activity, and facial muscle contractility correlated with EMG voluntary activity. The correlation was much higher at >14 days after onset of facial palsy. The orbicularis oris, followed by the frontalis muscle, showed the best correlation between ultrasound and EMG.Conclusions: Quantitative ultrasound of facial muscles helps confirm the results of facial EMG and is of particular additional value in the first 14 days after onset when the reliability of EMG is low. [ABSTRACT FROM AUTHOR]

Introduction: In this study we introduce quantitative facial muscle ultrasound as a diagnostic tool for patients with chronic unilateral facial palsy. Methods: Muscle area, thickness, and echo intensity of 6 facial muscles (frontalis, orbicularis oculi, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis) and of 2 chewing muscles (temporalis and masseter, as controls) were measured in 20 patients with chronic facial palsy. Results: Aside from 1, all facial muscles were significantly smaller on the paralyzed side. With exception of frontalis and orbicularis oculi muscles, all other facial muscles showed significantly higher echo intensity on the affected side. Muscle size and echo intensity of the chewing muscles showed no sideto- side asymmetry. Conclusions: Quantitative ultrasound of facial muscles helps to better characterize their status in patients with chronic facial palsy in the phase of denervation and during regeneration. [ABSTRACT FROM AUTHOR]

Objectives: To elucidate the points that require attention when interpreting fluorine-18-labelled fluoro-2-deoxy-D-glucose (18F-FDG)/positron emission tomography (PET) images by demonstration of 18F-FDG accumulation in various areas of the oral cavity other than primary lesions in patients with oral cancers. Methods: 18F-FDG accumulations with a maximal standardized uptake value of over 2.5 in various areas of the oral cavity other than primary lesions were identified in 82 patients with oral cancers. Results: 18F-FDG/PET-positive areas, excluding primary tumours, included the front intrinsic muscles of the tongue (89.0%), upper and lower marginal parts of the orbicularis oris muscle (64.6%), sublingual glands, palatine tonsil, pharyngeal tonsil, and lingual tonsil. In addition, some areas in the jaws also showed accumulation. Conclusions: In patients with oral cancers, areas of 18F-FDG accumulation in the oral cavity should be precisely identified and appropriately diagnosed, because accumulations can be seen in areas other than the primary tumour. [ABSTRACT FROM AUTHOR]

Background: A surgical technique was developed to soften the nasolabial folds by liposuction and severing of the cutaneous insertions of the mimetic muscles. This procedure was used for 11 patients from September 2006 to June 2009. Methods: With the patients under local tumescent anesthesia, extraoral incisions were made in nine cases and intraoral incisions in two cases. Liposuction was performed superior and lateral to the nasolabial fold using an order-made one-hole 2.5-mm cannula. After liposuction, the fibrae septa and the cutaneous insertions of the mimetic muscles in the nasolabial region were severed by a sharp-edge eye scissors. Compressive dressings were maintained for 3 days. Results: All the patients, followed up from 3 months to 3 years, were satisfied with the aesthetic results. Both the depth and the length of the nasolabial folds were decreased conspicuously. The most obvious change was improvement in the lateral part of the nasolabial folds. The extraoral scars were almost imperceptible. Severe complications were not observed in this series. Conclusion: Surgical softening of the nasolabial folds by liposuction and severing of the cutaneous insertions of the mimetic muscles is especially suitable for 40- to 60-year-old women with aging faces who are unwilling to undergo a face-lift. The procedure is simple, and the anatomic causes for deepening of the nasolabial folds can be corrected. Patients usually are satisfied with the final postoperative results. [ABSTRACT FROM AUTHOR]

Background: The midfacial region is a challenging area for plastic surgeons and may vary among different races. Objectives: The aim of this study was to determine the patterns of midfacial muscles in Persian (Iranian) subjects. Methods: Hemifacial fresh cadaver dissection was performed. For each cadaver, demographics, side of dissection, variation in midfacial muscles (levator alae nasi, levator labii superioris, zygomaticus major [single and bifid], zygomaticus minor, and risorius), midfacial pattern (based on Pessa classification), nasolabial shape (concave, convex, straight) and length were obtained. Results: Fifty-two hemifacial dissections were performed on 27 cadavers, of which 22 were male (81.4%). The mean age of the subjects was 40.1 ± 14.8 years. The mean of nasolabial length was 46.4 ± 8.3 mm (ranged from 28 to 63 mm). Straight form of nasolabial crease was the most frequent type (n = 26.50%). Levator alae nasi, levator labii superioris, and zygomaticus major were found in 100% of the subjects; however, it was not the same regarding other muscles. The incidence of bifid zygomaticus major was 19.2% (10 hemifacials) in our series. Midfacial pattern type 3 was the most common in our study, which found this type in 21 hemifacials (40.3%). We also found a new type of facial pattern in three cadavers. In this type, which is relatively similar to the type 5 of Pessa's classification, zygomaticus minor was absent and the zygomaticus major was bifid. Conclusions: This study revealed that midfacial pattern and nasolabial crease shape are different between Persian (Iranian) and Western subjects. It seems that based on these differences and some other unknown anatomic diversity between different races, some of the defined cosmetic frames may need minor revisions to be applicable for Persian faces. More studies in this field are recommended. [ABSTRACT FROM AUTHOR]

The application of the Face Recurve theory gives rise to new technical opportunities in the fields of both aesthetic medicine and aesthetic surgery to block the action of the age marker fascicules largely responsible for aging of the paramedian folds. With respect to aesthetic medicine, the combination of botulinum toxin and soft tissue fillers has proven effective. On the basis of the authors’ theory, however, two new technical refinements become pertinent. First, the filler must be injected predominantly deep to the muscle to treat the skin depressions in a more natural manner, bringing restoration to the curve of the overlying muscle. Second, a very low number of botulinum toxin units (one-fourth to one unit) should be injected into specific muscles to diminish their resting tone without diminishing their maximal contraction strength. With respect to aesthetic surgery, the authors present new techniques for the treatment of early aging, specifically a combination of segmental muscular section, microliposuction, and retromuscular fat grafting, all of which can be performed readily with the patient under local anesthesia. For more advanced aging, surgery offers new treatment opportunities that include the concentric malar lift for correction of the midface region, with repositioning of suborbicularis oculi fat back onto the orbital rim from its descended eccentric displacement at the hands of repeated orbicularis oculi contractions. At the same time, specific muscles can be weakened and fat volume restored. Each area can be studied in a specific way and treated definitively. Currently, the skin does not need to be tensioned to a maximum during a face-lift for treatment of the irregular jaw line, the palpebromalar groove, and so forth. Skin tension can be moderated to remove only the true excess of skin. Facial contour is improved, whereas the specific glide is restored between muscles and their underlying fat. [ABSTRACT FROM AUTHOR]

Objectives To analyze characteristic features and details on motor-evoked potentials (MEPs) of the orbicularis oculi muscle resulting from cortical transcranial magnetic stimulation (TMS) in normal subjects as a basis for further investigations on motorcortical representation in patients presenting with facial nerve diseases. Study Design MEPs of the orbicularis oculi muscle resulting from focal cortical TMS with a figure-8-shaped coil were investigated in 17 healthy subjects with special regard to amplitude and onset latency as a function of the coil position on the head surface along the interaural line and in the anterior-posterior direction. The results were then compared with our data on lower-lip mimetic muscles and on the frontalis muscle obtained in previous studies. Results Bilateral reproducible responses could be observed at coil positions varying from 1 to 13 cm lateral to the vertex. During moderate muscle activation, maximum responses (mean amplitude 0.75 ± 0.44 mV contralateral, 0.74 ± 0.36 mV ipsilateral) were obtained at a mean stimulus position of 8.6 ± 1.6 cm lateral and 2.0 ± 2.2 cm anterior to the vertex for contralateral responses, and of 8.6 ± 2.0 cm lateral and 2.8 ± 2.4 cm anterior to the vertex for ipsilateral responses, respectively. Voluntary muscle activation by forced eye-closure was associated with a further increase in mean amplitudes. At rest, bilateral responses could be elicited in 15 subjects (88.2%). During moderate muscle activation, the shortest mean onset latencies were obtained at the optimum stimulus position on the interaural line, both for contralateral (10.2 ± 1.3 ms) and ipsilateral (10.6 ± 1.5 ms) MEPs. Comparing our data on the orbicularis oculi muscle with those obtained on lower-lip muscles and on the frontalis muscle, there was a considerable overlap of coil positions from which reproducible MEPs could be elicited in all three groups of mimetic muscles, but with the orbicularis oculi area being placed between forehead and lower-lip motorcortical areas. Conclusions A statistically significant separation of the cortical representation areas of forehead, orbicularis oris, and lower-lip mimetic muscles is possible by focal cortical TMS reflecting a kind of somatotopic organization of the face-associated motorcortex. Compared with the results on lower-lip and forehead muscles, orbicularis oculi muscle responses show characteristics of both. [ABSTRACT FROM AUTHOR]

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The facial muscles have significant roles for vocalization, feeding, and facial expression in both human and non-human primates. Of these, the anatomy of the incisivus labii superioris (ILS) and incisivus labii inferioris (ILI), which are considered as the accessory bundle of the orbicularis oris (OO) in humans, has rarely been documented in the literature. Our current understanding of the function of the ILS and ILI is that they probably retract the upper and lower lips. Also, there is no account of these muscles in non-human primates in the current literature. The aim of this study was to reveal the ILS and ILI in non-human primates. Five Macaca fascicularis, one Macaca fuscata, one Macaca fuscata yakui, and one Pan troglodytes were dissected. Seven formalin-fixed cadavers and one fresh cadaver were included. Both the ILS and ILI were observed in all specimens. The ILS originated from the incisive fossa of the maxilla and inserted into the OO. The mentalis (MT) and ILI arose from the incisive fossa of the mandible and inserted into the OO and the skin of the chin area. The MT and ILI in the P. troglodytes examined were thicker than in the other three non-human species, and the ILS and ILI in the three macaques were similar in shape to those of humans. The difference of these muscles may result in different functions of the lip such as during vocalization, feeding, and facial expression., (© 2020 American Association for Anatomy.)

Facial-nerve palsy is the most common complication during facial surgery. However, there are few detailed reports on the distribution of the terminal branches of the facial nerve to the mimetic muscles. This also applies to the communicating branches. The aim of our study was to assess the variability of communicant and terminal branches of the facial nerve in humans. This prospective study involved anatomical dissections and intraoperative electric stimulation of facial nerves. We first performed 30 dissections to define the branching patterns of the extracranial facial nerve, with particular focus on the penetrating points into the mimetic muscles. We then studied and compared these preliminary data with 14 operative facial stimulations conducted during parotidectomies. Each trunk and branch received systematic electrostimulation. The electrostimulation and facial-and-neck movements were analyzed by two independent reviewers. The peripheral branching and intercommunication of the facial branches were highly variable. Combining electrostimulation and dissections, the frontalis muscle, the depressor labii inferioris and the platysma showed little nerve recuperation whereas the sphincter muscles (orbicularis ori and oculi) were anatomically protected. Facial-muscle innervation differed among individuals. We found complex variations in the facial branching mode. Our study highlights the branches and corresponding areas that could be considered anatomically risky. Clin. Anat. 32:169-175, 2019. © 2018 Wiley Periodicals, Inc., (© 2018 Wiley Periodicals, Inc.)

The zygomaticus major (ZM) is important for the human smile. There are conflicting data about whether the zygomatic or buccal branches of the facial nerve are responsible for its motor innervation. The literature provides no precise distinction of the transition zone between these two branch systems. In this study, a definition to distinguish the facial nerve branches at the level of the body of the zygoma is proposed. In the light of this definition, we conducted an anatomical study to determine how the source of innervation of the ZM was distributed. A total of 96 fresh-frozen cadaveric facial halves were dissected under loupe magnification. A hemiparotidectomy was followed by antegrade microsurgical dissection. Any branch topographically lying superficial to the zygoma or touching it was classed as zygomatic, and any neighboring inferior branch was considered buccal. The arborization of the facial nerve was diffuse in all cases. In 64 out of 96 specimens (67%, 95% CI: 56% to 76%), zygomatic branches innervated the ZM. Buccal branches innervated ZM in the other 32 facial halves (33%, 95% CI: 24% to 44%). There were no differences in respect of sex or facial side. All facial halves displayed additional branches, which crossed the muscle on its inner surface without supplying it. In 31 specimens, a nerve branch ran superficial to ZM in its cranial third. According to our classification, the zygomaticus major is innervated by zygomatic branches in 67% of cases and by buccal branches in 33%. Clin. Anat. 31:560-565, 2018. © 2018 Wiley Periodicals, Inc., (© 2018 Wiley Periodicals, Inc.)

Objectives: To elucidate the points that require attention when interpreting fluorine-18-labelled fluoro-2-deoxy-d-glucose ((18)F-FDG)/positron emission tomography (PET) images by demonstration of (18)F-FDG accumulation in various areas of the oral cavity other than primary lesions in patients with oral cancers., Methods: (18)F-FDG accumulations with a maximal standardized uptake value of over 2.5 in various areas of the oral cavity other than primary lesions were identified in 82 patients with oral cancers., Results: (18)F-FDG/PET-positive areas, excluding primary tumours, included the front intrinsic muscles of the tongue (89.0%), upper and lower marginal parts of the orbicularis oris muscle (64.6%), sublingual glands, palatine tonsil, pharyngeal tonsil, and lingual tonsil. In addition, some areas in the jaws also showed accumulation., Conclusions: In patients with oral cancers, areas of (18)F-FDG accumulation in the oral cavity should be precisely identified and appropriately diagnosed, because accumulations can be seen in areas other than the primary tumour.