Deep Plane Research Articles

A Randomized Controlled Trial of Adding Deep Parasternal Intercostal Plane Block to Interpectoral-Pectoserratus Plane Block in Breast Cancer Surgery.

The interpectoral-pectoserratus plane block is expected to anesthetize the lateral breast, but it is unclear whether the deep parasternal intercostal plane block may enhance recovery by providing analgesia to the medial breast. Patients undergoing breast cancer surgery were randomly assigned to receive either the interpectoral-pectoserratus block (single block) or interpectoral-pectoserratus combined with deep parasternal intercostal block (combined block). The primary outcome was the quality of recovery-15 questionnaire score assessed at 24 hours postoperatively. Secondary measures included dermatomal block assessment, pain severity, opioid consumption, opioid-related adverse events, hospital length of stay, and chronic postsurgical pain at 3 months after surgery. One hundred and sixteen patients were recruited, 58 in the single block group and 58 in the combined block group. There was no important difference in the 24-hour quality of recovery scores with mean (standard deviation [SD]) 123.6 (6.3) in the single block group and 123.2 (7.1) in the combined block group (mean difference, 0.4; 95% confidence interval [CI], -2.0 to 2.9; P =.731). There was greater dermatomal block on medial breast in the combined block group. There were no differences in other secondary outcomes. Addition of deep parasternal intercostal plane block was not superior to interpectoral-pectoserratus plane block alone for the quality of recovery in patients undergoing breast cancer surgery.

Ultrasound-Guided Deep Serratus Plane Block in Cat Cadavers (Felis catus): A Description of Dye and Contrast Media Distribution.

The serratus plane block is an ultrasound-guided anaesthetic technique that aims to provide analgesia to the lateral thoracic wall cranial to the 8th rib. This block can be performed in a superficial (between the latissimus dorsi and the serratus ventralis thoracis (SVT) muscles) or deep plane (between the intercostales externi and the SVT muscles). This study aimed to assess the distribution and nerve staining of a mixture of 0.4 mL kg-1 of methylene blue and iopromide 50:50 performing a deep serratus plane (DSP) block at the level of the 5th rib. We hypothesise that this technique would be feasible and could stain the rami cutanei laterales (RCL) of the intercostales nerves cranial to the 8th rib in cat cadavers. This study was divided into two phases. Phase 1 consisted of an anatomical study of the thoracic wall (2 cadavers). Phase 2 consisted of the ultrasound-guided injection of the aforementioned mixture and the assessment of its distribution by computed tomography and anatomical dissection (12 cadavers). Contrast media spread a median of 5.5 (2.5-7.5) intercostal spaces. The dye stained a median of 3 (0-5) RCL, affecting RCL 2 (17.39%), RCL 3 (57.17%), RCL 4 (78.26%), RCL 5 (91.30%), RCL 6 (78.26%), and RCL 7 (8.70%) within the DSP. Occasionally, the rami dorsales laterales and the thoracicus longus nerve were stained. Based on these findings, the DSP block performed with a volume of 0.4 mL kg-1 of an anaesthetic could provide analgesia in the area innervated from T4 to T6.

A Systematic Review and Comparative Analysis of Reconstructive Rhytidectomy: Advantages, Disadvantages, and Patient Outcomes.

Reconstructive rhytidectomy, commonly known as facelift surgery, is a prominent cosmetic procedure aimed at rejuvenating facial appearance by addressing signs of aging. This paper critically evaluates the advantages and disadvantages of various surgical techniques involved in rhytidectomy, including the superficial musculoaponeurotic system (SMAS), deep plane facelift, and subperiosteal approaches. This systematic review of recent literature highlights key outcomes such as scar quality, postoperative pain management, and patient satisfaction. While the techniques demonstrate significant improvements in aesthetic results and patient quality of life, they also present risks including complications, dissatisfaction with outcomes, and the financial burden of surgery. Future directions indicate a trend toward minimally invasive approaches, integration of regenerative medicine, and personalized surgical planning, aiming to optimize results and minimize risks.

8159 Single Nuclei RNA-Sequencing Reveals Novel Cellular Diversity in Human Neck Adipose Tissue

Abstract Disclosure: H. Camara: None. S.D. Kodani: Employee; Self; Hoxton Farm. S. Yang: None. V. Efthymiou: None. K. An: None. A. Gupta: None. F. Shamsi: None. A. Streets: None. M.E. Patti: Advisory Board Member; Self; Fractyl Laboratories. Consulting Fee; Self; AstraZeneca, Hamni, MBX Biosciences. Grant Recipient; Self; Dexcom. Y. Tseng: Consulting Fee; Self; LyGenesis. Other; Self; BioHaven. Adipose tissue plays a crucial role in maintaining metabolic health. It fulfills distinct functions through two types of fat: white adipose tissue (WAT), the primary site of triglyceride storage, and brown adipose tissue (BAT) along with related beige fat, specializing in thermogenic energy expenditure. Despite the scarcity of BAT in humans, these thermogenic adipocytes efficiently utilize glucose and triglycerides and act as an endocrine organ by secreting batokines. Hence, increased BAT activity is associated with improved metabolic health in humans. In adults, thermogenic adipose tissue is localized in deep neck planes, exhibiting a gradient from white to beige/brown from superficial to deep layers. Mounting evidence suggests the diverse cell types within the adipose tissue and their dynamic interactions play an important role in its versatile functions. To understand the cellular compositions of human adipose tissue and directly compare the differences between human BAT vs. WAT, we collected 30 paired samples of superficial, intermediate and deep human neck adipose tissue from 15 participants who underwent anterior cervical discectomy fusion or thyroid surgery and subjected the frozen tissues to single-nucleus RNA sequencing (snRNA-seq). The integration of the samples yielded 41,337 good-quality nuclei. As expected, white adipocytes (WAd) were the dominant cell type, comprising 38% of the total cells captured. Further analysis of the WAd cluster revealed increased expression of brown adipocyte-associated genes, such as EBF2 and COBL, and enrichment of oxidative phosphorylation pathway score in cells from deep neck samples, indicating increased thermogenic potential. Bona fide brown adipocytes (BAds), marked by the expression of PPARGC1A, were predominantly located in the deep neck samples (>80%) but comprised less than 2% of the dataset. Despite their low numbers, cell-cell communication analysis by CellChat predicted that BAds account for most of the communication events within this niche, highlighting their endocrine importance. snRNA-seq also captured non-adipocyte cells, including adipocyte progenitors, smooth muscle, immune, Schwann and neuron-associated cells. Among these, a novel Neuron-Associated Cell-1, marked by the expression of CNTNAP2, emerged as the second most abundant in the dataset (∼10% of total). Another neuron-associated cell population marked by expression of DNAH11, though less abundant (∼1%), was enriched in deep neck samples, potentially regulating the high levels of thermogenic potential in this region. Taken together, the identified subpopulations and their gene expression profiles offer new insights into the tissue's role in metabolic regulation. This knowledge could be pivotal for developing targeted therapies for obesity and related disorders. Presentation: 6/1/2024

Computed tomographic features of Morel-Lavallée lesions in 3 cats.

To describe the CT features of Morel-Lavallée lesions (MLLs) and their association with trauma in cats. This study aimed to investigate whether MLL fluid in cats accumulates between the dermis and deep fascia near superficial trauma, exhibits a vertical attenuation gradient, and shows no or only mild contrast enhancement on CT images. 3 young cats: a 1-year-old neutered male domestic shorthair cat, a 2-year-old neutered male domestic shorthair cat, and a 3-year-old neutered female British Shorthair cat. The clinical presentation of the 3 cats in the study involved recurrent swelling and fluid accumulation affecting at least 1 pelvic limb following trauma. In all cases, there was a fluid-filled space deep to the skin and superficial subcutaneous layer but superficial to the deep fascial plane overlying the muscular component of the pelvic limbs. The MLL fluid had a vertical attenuation gradient and no or only mild contrast enhancement. Morel-Lavallée lesions are often initially overlooked, likely due to distraction by concomitant significant bone injuries, and can be mistaken for hematomas, seromas, subcutaneous edema, contusions, or cellulitis, leading to less aggressive treatment. If left untreated, MLLs present a significant risk of extensive skin necrosis compared to other types of subcutaneous swelling.

Is the combination of interfascial plane blocks sufficient for awake breast cancer surgery? An observational, prospective, proof-of-concept study

IntroductionBreast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference.MethodsThis prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18–80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved.ResultsSeventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed.ConclusionThe combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups.

Integrating SMAS plication and deep plane techniques in facial rejuvenation: A novel approach

IntroductionIn the realm of facial rejuvenation surgeries, deep plane facelift and SMAS plication techniques have been applied with notable efficacy over an extended period, yielding aesthetically pleasing outcomes.Both methods have their own advantages and disadvantages depending on individual circumstances.We endeavored to formulate an effective facelift method by integrating both approaches, aiming to harness the advantageous aspects of each method while addressing their respective drawbacks in a comprehensive manner. MethodsFollowing the preparation of the subcutaneous plane overlying the fixed SMAS, the mobile SMAS was elevated from the deep plane, and a SMAS flap was fashioned.The SMAS flap in the prezygomatic and premasseteric areas was inwardly folded, and a plication procedure was applied using loop sutures from its most medial to lateral aspects. Subsequently, it was secured to the preauricular area with U stitches. The results were statistically evaluated preoperatively and postoperatively using WSRS scores. ResultsA total of 40 patients underwent operative procedures effectively performed by the senior author(F.C.). Preoperative WSRS scores were measured at 4.2 ± 0.52. Postoperative WSRS scores at 3 months were significantly lower at 1.25 ± 0.44 (p<0.05). The facelift procedure was effectively applied in all patients without the development of major complications. ConclusionsThis method combines deep plane facelift and surgical SMAS plication, utilizing the advantages of both techniques to directly address nasolabial folds and achieve gratifying outcomes in facial and neck rejuvenation.

Update: Prevention and Treatment of Parotid/Submandibular Gland Fistula/Sialocele Following Rhytidectomy with Botulinum Toxin A.

Dissecting deep to the superficial musculoaponeurotic system, SMAS, a popular option for facelifts, has the potential for injury to the parotid gland leading to post operative sialoceles and fistulas. Similarly, deep plane procedures in the neck which include partial submandibular gland resection may lead to salivary gland leaks. We previously described the management of sialocele following rhytidectomy.1 Since then, administration of Botulinum toxin A has emerged as the primary treatment and prevention of this rare complication. The technique of administration and dosage of botulinum toxin in the treatment algorithm is not well-defined. We present a literature review and our current protocol of the most efficacious injection technique and dosing to prevent and treat injury to the parotid and submandibular glands.

Case study: chemical contaimnent in parrots (Amazona SP - Lesson, 1830) from de Quinzinho de Barros Zoological Park, municipality of Sorocaba, São Paulo

The containment and anesthesia of wild animals is extremely important for veterinarians who intend to or already practice in this field. However, before administering anesthesia, it is essential to understand the pharmacology of anesthetics and the biological aspects related to the anatomical, physiological, and behavioral peculiarities of the species to be restrained. The aim of this research was to evaluate parameters such as heart rate (HR), respiratory rate (RR), temperature (T°), muscle relaxation, reflexes (palpebral, ocular, and pedal), and respiratory pattern in four anesthetic protocols: ketamine 5% at a dose of 30mg/kg combined with xylazine 2%-2mg/kg; ketamine 5% at doses of 15mg/kg and 20mg/kg with diazepam 1% at a dose of 1mg/kg; diazepam 0.5% at a dose of 5mg/kg 15 minutes before isoflurane administration; and the use of isoflurane alone in parrots (Amazona sp) kept at the Quinzinho de Barros Municipal Park, Sorocaba, São Paulo. Eleven animals were used: three with the ketamine combined with xylazine protocol, three with ketamine plus diazepam, three with diazepam before isoflurane, and two with the isolated use of isoflurane. The results of this research showed that with the use of ketamine combined with xylazine at this dosage, only superficial sedation was achieved. With the supplementary dose of ketamine and xylazine, the animal reached a moderate anesthetic plane, but respiratory depression occurred. The use of diazepam combined with ketamine 5% at a dose of 15mg/kg is only recommended for minor procedures. Recovery was slightly less prolonged and with less cardiorespiratory depression compared to the use of ketamine combined with xylazine. Diazepam 0.5%-5mg/kg before isoflurane did not allow for the intubation of the animal; it served to reduce the stress of restraint, requiring a lower concentration of isoflurane for induction. Apnea was observed with the increase of isoflurane concentration, even with the use of diazepam before isoflurane. With the isolated use of isoflurane, the animal reached a moderate to deep anesthetic plane, which would allow for more invasive procedures.

Complete Platysma Muscle Suspension in Deep Plane Facelift Surgery.

Deep plane facelift surgery is not new, having originally been described over 30 years ago, however the technique has seen a recent surge in popularity. While proponents emphasize its ability to deliver very natural results, critics often cite the possibility of additional risk of the procedure due to its technically challenging dissection in proximity to branches of the facial nerve and other critical structures. These risks are perhaps greatest when operating in what have historically been described as the "danger zones," particularly when releasing the zygomatic retaining ligaments, when performing the medial deep plane dissection in the midface, and when extending the platysma flap over the angle of the mandible into the neck. The senior author (DBR) has performed deep plane facelift surgery for over 20 years, training many novice surgeons to perform this procedure safely and incrementally. Herein, we illustrate surgical techniques to optimize safety when performing deep plane dissections. A novel vertical midline platysmaplasty combined with extended release of the low cervical platysma provide rejuvenation of the neck that extends to the clavicles.

Suppurative Cervicomediastinitis From the Perspective of the Head and Neck Surgeon in a Tertiary Treatment Unit.

Introduction Cervical suppurations represent an emergency pathology, with a dramatic evolution in the absence of adequate treatment. It frequently affects young people, hence the medico-legal implications of these cases. The anatomical substrate for the development of these deep cervical suppurations is represented by the cervical fascia and spaces. A distinct and extremely serious sub-chapter within diffuse cervical suppurations is necrotic cervical fasciitis, a polymicrobial infection with the most common oropharyngeal or odontogenic starting point, with rapidly progressive, destructive evolution in the deep fascial planes of the neck. Materials and method We will present a retrospective clinical study carried out on 26 cases diagnosed and treated between September 2013 and September 2018 in the ENT Clinic Department of the Bucharest University Emergency Hospital. Results Our retrospective analysis of a cohort of 26 patients in a tertiary referral center showed that deep cervical suppurations are slightly more common in men than in women. The most affected age groups were 50-59 years, followed by 20-29 years, representing a percentage of 53.84% of all cases. Also, 53.84% of the studied patients with deep cervical suppurations had a precarious and modest status. The most common clinical signs at presentation were malaise, cervical swelling, neck pain, dysphagia, fever, dysphonia, dyspnea, and cervical erythema. More than 60% of suppurations were odontogenic and 23% were caused by a traumatic element. Diabetes mellitus represents a comorbidity in 30.8% of patients, while 42.3% of patients had no personal pathological history, and thus this pathology has a lethal potential also in a patient in full health. In the study group, 46 (15%) had cervicomediastinitis, and 61.53% developed necrotizing fasciitis. One-third (34.61%) of our patients had undergone previous drainage surgery. Bacteriological examinations of the wound were with group C, D, G betahemolytic streptococcus, while 61.53% of the cultures were negative. Most patients required at least two cervicotomies. The average duration of hospitalization was 28.26 days, and the mortality rate was 23.07%; therefore, practically, one out of four cases resulted in death. In the studied group, no direct relationship can be established between the length of hospitalization and the favorable and unfavorable evolution of the patient. We propose a 10-step management protocol for the management of a cervical suppuration. Conclusion The multidisciplinary approach to these suppurations by the head and neck surgeon, the thoracic surgeon, the oromaxillofacial surgeon, anesthetist, imagist, specialist in infectious diseases, pathologist, psychologist, and so on, is the key to success in a patient who presents not only a suppuration in the throat but also a disease with systemic resonance and significant lethal potential.

Pleomorphic adenoma in an adolescent, about a clinical case

Introduction: salivary gland tumors in children represent a low percentage of pediatric head and neck tumors; most of them are diagnosed in association with the Parotid salivary gland and present a higher proportion of malignancy than in adults. Objective: to present a case with a diagnosis of Pleomorphic Adenoma: clinical symptoms, complementary examinations, treatment and evolution. Case presentation: female patient, 13 years old, from a rural background and white race, attended the Maxillofacial Surgery consultation, in good general condition, accompanied by her parents, due to an increase in volume of a hard consistency, not fixed to deep planes ( mobile), asymptomatic, of 7 months of evolution and 3 cm in length located in the left parotid region. Ultrasound of soft tissues and neck was indicated, as well as contrast-enhanced facial mass tomography, which showed a mass in relation to the left parotid gland that captured contrast. In addition, complementary examinations and a fine needle aspiration biopsy (FNAB) were performed, resulting in a benign parotid gland tumor (Pleomorphic Adenoma). Superficial parotidectomy was performed with preservation of the facial nerve. The patient progressed satisfactorily and continues to be followed up by consultation. Conclusions: pleomorphic adenomas are discovered in practice as slowly growing asymptomatic masses; the size is variable and will always depend on the stage at which it is detected.

Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy: An Anatomical Basis for Improved Outcomes.

Background: This study introduces variations of a limited delamination approach to the deep plane face- and necklift. Objectives: To report surgeons' perceptions of limited delamination deep plane rhytidectomy, define the anatomical basis to support these modifications, and report complication rates. Methods: This retrospective multi-institutional chart review study of patients undergoing a modified classical deep plane face- and necklift. Surgeons' perception of outcomes and self-reported complications were collected. Results: In total, 3964 patients having undergone face- and necklift with six surgeons being included. Most patients were female (87.9%) with an age range of 31-83 years (mean 58 years). Most were primary procedures (2672/3964; 67.4%) with a median follow-up of 425 days (range 21-5470). Preliminary surgeon experience demonstrated increased ease of flap management, improved biomechanics, smaller perceived rates of skin discoloration, and telangiectasia of the skin and lower revisions rate (n = 11; 0.8%). Complication rates were low for hematoma (n = 24; 1.9%) and seroma requiring needle aspiration (n = 26; 2%) and minor infection (n = 18; 1.4%). Conclusions: A multicenter surgeon experience with the limited delamination extended deep plane rhytidectomy is based on anatomical evidence and demonstrates low complication rates and surgeon-perceived improved long-term outcomes. Prospective comparative outcomes of these evolving techniques are warranted.

Anatomie de la région frontale

The forehead is an anatomic region located between the frontal hairline cranially, the eyebrow and the glabella caudally, and the anterior border of the temporal fossa laterally on both sides. Its vertical situation, due to the telencephalon growth, is specific of the human species. From surface to deep planes, the skin and sub-cutaneous fat pads are described first. The muscular plane is constituted of the frontal muscles elevators of the forehead and the eyebrow, and the depressors which are the procerus and orbicularis oculi muscles superficially, the depressor supercilii muscle, and the corrugator supercilii in a deep plane. The galea aponeurotica, located deep to the frontal muscles, is a fibrous lamina on which the muscles of the skull insert. There is a sexual dimorphism of the frontal bone. The male forehead has extensive supraorbital bossing, and above this there is often a flat area, in teh femalethe supraorbital bossing is often nonexistent and above, there is a continous mild curvature. Blood supply to the forehead is given by an anterior pedicle constituted by the supraorbital and supratrochlear vessels and a lateral pedicle made of the anterior branches from the superficial temporal vessels. The sensory innervation of the forehead is given by the ophtalmic nerve which divides in frontal, nasociliar and lacrymal nerves. The motor innervation is given by the temporal ramus of the facial nerve which passes laterally to the zygomatic arch, and gives the innervation of the frontal, corrugator supercilii and procerus muscles.

Nonsurgical Rhinoplasty: Results from a Retrospective Study of Rino-4-Puntos Technique with Hyaluronic Acid.

Nonsurgical rhinoplasty (NSR) utilizing hyaluronic acid (HA) filler injections is increasingly used to address nose shape issues. While refinements have been proposed, the technique lacks standardization. Our study aimed to evaluate the aesthetic outcome, longevity of results, safety, and patient satisfaction with the novel Rino-4-Puntos (R4P) NSR technique. This is a retrospective study of consecutive individuals treated with R4P between January 2021 and July 2023. All participants had one of the four indications: rectification of the dorsum (21%), triangulation of the tip (32%), projection (25%), and strengthening of the columella (22%). Each patient received two hyaluronic acid (HA) fillers: one with intermediate G prime (G') at Points 1-3 and another with high G' at Point 4, which is further divided into Points 4.1, 4.2, 4.3, and 4.4. The injection points were as follows: P1 (radix, 0.05-0.15mL, supraperiosteal), P2 (supratip, 0.025mL, suprachondrial), P3 (tip, 0.15mL, deep fat), P4 (columella, 0.30mL, supraperiosteal [4.1], or deep fat [4.2, 4.3, and 4.4]). Four hundred individuals (n=284 [71%] females) are included. The mean filler volume used was 0.65±0.17mL. Injecting small boluses (≤0.05mL) in the midline at deep planes minimized the risk of adverse effects, as no vascular complications occurred. Ninety-three percent of participants considered the overall outcome at least satisfactory ("good," "very good," or "excellent"). The treatment effect was maintained for a median of 11months. The R4P technique refines NSR by combining enhanced aesthetic outcome, longevity, and safety. 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 .

Dual-Plane Midface Lift Through Transoral and Transtemporal Approach.

The surge in the popularity of midface and temporal lifting procedures can be attributed to evolving social media trends and heightened patient expectations, particularly among younger individuals seeking "beautification" rather than traditional rejuvenation. Scarless techniques, such as transtemporal/transoral approaches, are increasingly preferred. This study aimed to combine the advantages of both superficial and deep dissection planes in midface and temporal lifting procedures. This retrospective study included 184 patients who underwent surgery using a dual-plane midface and temporal lift technique. Preoperative and postoperative assessments, including P1/P2 ratio calculations, were performed to evaluate volumetric distribution in the midface. The study cohort exhibited a significant improvement in the P1/P2 ratio postoperatively (p < 0.05), indicating successful volume redistribution. Complications, including hypoesthesia, bruising, and infection, were managed effectively. Minor asymmetries were observed, with revisions offered, but declined by the patient. This technique offers hidden incisions and reduces the risk of scar-related complications, making it suitable for patients seeking facial enhancement. Addressing the tear trough area and the lateral canthus provides comprehensive facial rejuvenation. The dual-plane approach facilitates both skin mobilization and volume shift, yielding favorable aesthetic outcomes. The dual-plane midface and temporal lift technique presented in this study offers a bi-vectoral approach to midfacial lifting, suitable for both beautification and rejuvenation goals. Despite the potential limitations, including infection risk, this method is an effective option for facial enhancement. 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 .

Vulvar leiomyosarcoma: A clinical image

Medical record analysis and literature review at scientific Database. MP, a 48-year-old female, presented with a 3-month history of a ten-centimeter vulvar mass on the left major labia, adhered to a deep plane, and associated with local pain (Figure 1).

THE PILOMATRICOMA: A CASE REPORT OF PALPEBRAL LOCALIZATION

Pilomatricoma, formerly called calcified epithelioma of Malherbe, is a rare and benign skin tumor occurring during the first two decades of life, generally located in the upper part of the body (neck and head). In its typical form, it manifests clinically as a small, solitary, asymptomatic, sometimes painful subcutaneous nodule. The usual size is less than 3 cm. The diagnosis is made clinically and requires histological confirmation. The prognosis is generally good. Carcinomatous transformation remains controversial. Healing without recurrence is the rule after surgical excision. Ocular or palpebral localization is exceptional. We report the case of Mrs. G.E, 26 years old, without any notable pathological history, who consulted for a mass on the right eyelid that had been developing for 1 year. Objective clinical examination: a polylobed mass, well defined, 3 cm long axis, hard, painless and mobile in relation to the deep plane. The surrounding skin is normal in appearance. In addition, motor skills and ocular mobility remain preserved. A total surgical excision is performed. Histological study of the biopsy specimen reveals the presence of basaloid cells covering layers of mummified cells with eosinophilic cytoplasm, suggestive of a Malherbe Pilomatricoma. No recurrence was detected after a 12-month follow-up.

Why Deep Plane Face and Neck Lifting Results in the Maximum Short- and Long-term Results? My Primary Choice for Rhytidectomy in My Practice.

I converted to the extended deep plane facelift and neck lift with a shorter skin flap elevation in the face to achieve a more complete release of the facial ligaments to obtain more mobilization of the skin/superficial musculoaponeurotic system composite flap, and a more medial suspension resulting in improved correction of the midface, nasolabial fold, marionette fold and jowl. Treatment of the deep neck structures allowed for more refinement of the submentum in the deep neck lift procedures as well. In this article, we shall review the surgical technique of the deep plane facelift and neck lift as well as postoperative management pearls, the management of complications from the procedure, and the incorporation of ancillary procedures.

Anatomy, Diagnosis, and Clinical Management of Deep Neck Space Infections

Any surgeon providing care to patients with congenital, oncologic, infectious, or traumatic processes impacting the head and neck should have an intimate knowledge of the local anatomy. The complex fascial system in this region results in a series of loosely and tightly bound spaces that can both harbor and/or facilitate the rapid spread of infections through these fascial planes and potential spaces. Deep neck space infections may occur spontaneously from cutaneous, lymphatic, odontogenic, otologic, salivary gland, sinus, and hematogenous sources or develop as the result of surgical/iatrogenic manipulation. These infections are typically polymicrobial, involving a mixture of Gram-positive cocci, Gram-negative rods, and beta-lactam-resistant anaerobes commonly found in the oropharyngeal flora. Other populations, such as immunocompromised or hospitalized patients, are particularly vulnerable to infection by certain opportunistic and antibiotic-resistant pathogens. Understanding the deep neck anatomy is crucial for predicting the spread of infection and guiding treatment strategies. The superficial and deep cervical fascial planes form a series of compartments and spaces including the retropharyngeal, danger, prevertebral, carotid, parapharyngeal, submandibular, sublingual, parotid, masticator, temporal, and infrahyoid spaces. Despite their rarity in the post-antibiotic era, deep neck space infections pose a significant threat as they progress rapidly and can quickly lead to life-threatening complications. Delayed clinical presentation is common due to the compartmentalization by fascial planes, therefore early recognition requires a high index of suspicion, thorough clinical examination, and diagnostic imaging studies, typically contrast-enhanced computed tomography (CECT). Treatment requires a multidisciplinary approach, including advanced airway management, administration of empirical broad-spectrum antibiotics, and surgical drainage when indicated. This review provides a comprehensive overview of deep neck space anatomy and its defining fascial planes, as well as discussions on epidemiology, specific microbiology, clinical presentation, diagnosis, antibiotic selection, and surgical treatment options.