A deep fascia exists in the midface: the missing plane coming from the temporal region (913.4)

Abstract

Objective of the study: to demonstrate that the deep temporal fascia is connected to the muscles of the infraorbital prezygomatic area and that a deep fascial layer exists in the midface.Methods: 24 hemifaces of 14 caucasian cadavers were dissected. Skin was incised over the temporal and prezygomatic area. The temporoparietal fascia and the Smas layer were dissected and reflected. The superficial sheet of the deep temporal fascia was incised and elevated.In 4 specimens full thickness biopsies were harvested at the level of the zygomatic bones, in the area between the temporal region and the prezygomatic region and observed after cryopreservation.Results: In 12 specimens dissections showed a continuous layer of fascia coming from the temporal area: the superficial sheet of the deep temporal fascia reached directly the prezygomatic area. In 16 specimens the superficial sheet of the deep temporal fascia inserted at the level of the zygomatic as classically described and continued, after inserting, over the prezygomatic area.In all specimens this deep fascial layer devided the fat deep to the orbicularis oculi muscle into 2 layers (suborbicularis oculi and preperiosteal fat) and the deepest one was on the same plane of the temporal fat pad.Histologic examination confirmed the surgical findings: a continuous layer coming from the temporal region reaches the prezygomatic area and devides the fat deep to the orbicularis oculi muscle into 2 layers.Conclusions: A deep fascial plane connected to the superficial sheet of the deep temporal fascia exists in the midface and devides the fat deep to the orbicularis oculi muscle into 2 layers. It can either continue directly from the temporal area or insert over the zygomatic bone and then reach the prezygomatic area. The temporal fat pad situated between the superficial and the deep temporal sheet can be compared to the deep fat layer below the orbicularis oculi muscle.