Temporal Branch Research Articles

Channels of the glacial river Jökulsá á Breiðamerkursandi

The glacial river Jökulsá á Breiðamerkursandi drains the Jökulsárlón tidal lagoon (27 km2), in Southeast Iceland. Despite being the shortest glacial outlet (0.6 km), it is among the most voluminous rivers in Iceland, with an estimated average drainage of 250–300 m3/s and has doubled its volume at peak runoff. Until a bridge was established, this was one of Iceland’s most infamous river and for travellers, cruising on horseback, the greatest obstacle to cross on the main road. The river began shaping its present channel in the late 19th century but was not permanently settled until the mid-20th century. Before that it used to wander around the fan, occasionally in several branches, or as a single heavy moving water. In this paper we present a map of its known runoffs and channels that were formed in the 19th and 20th centuries. Few channels were digitized from old maps, but several of those were identified and recorded by the late Flosi Björnsson (1906–1993), a farmer from the Kvísker, who guided travellers across the river before the bridge was built. The Breiðamerkurjökull outlet glacier of Vatnajökull, Southeast Iceland, advanced 10–15 km during the Little Ice Age. During the LIA advance the wide fan shaped shore in front of Breiðamerkurjökull gradually extended outward by >1 km, mainly due to sediment deposition by the Jökulsá river and few other temporal glacial river branches. At the turn of the 20th century the outlet glacier started to retreat slowly and in the 1930s terminal lakes were formed. With the formation of the Jökulsárlón tidal lagoon river dumping at the shore terminated and was replaced by a progressive coastal erosion. Currently ca. 0.9 km has eroded off the coast since the 1930s. A 0.65 km wide strip now remains between the coast and Jökulsárlón tidal lagoon, where the Jökulsá river and the remains of its former runway channels are located.

Safe Zone for Dissection in Frontotemporal Region to Avoid Injury to the Temporal Branch of Facial Nerve.

The objective of this study is to provide a reliable roadmap for temporal branch of the facial nerve, in order to minimize, the risk of injury to the nerve during surgical dissections. A literature search was conducted on temporal branch of facial nerve. The date search range was 1950 to 2017. Databases searched included Medline, Web of science, Biosis, SciELO, Data Citation, and Zoologic Records. Data were collected on, author specialty, date of publication, and the relationship of the temporal branch of facial nerve to various landmarks in the frontotemporal region reported in human anatomic studies. Among the 48 studies reviewed, a total of 3477 anatomic dissections were performed in the craniofacial region. Temporal branch of facial nerve was located between 2.5 and 3 cm from lateral orbital rim. In relation to the zygomatic arch, it was found anywhere from the midpoint of the arch to 1 finger breath posterior to the arch. For the plane, it was most commonly described as being under the superficial temporal fascia (STF) or within the loose areolar tissue. Most anatomic dissections found 2 to 4 twigs of the temporal branch of facial nerve. In relation to the lateral canthus, it was found to be 2.85 +/- 0.69 cm superior and 2.54 +/- 0.43 cm lateral to the lateral canthus. Our study suggests consolidated data on surgical landmarks in order to ensure safe dissection in temporal region and prevent injury to the temporal branch of facial nerve.

External Carotid Artery-to-Middle Cerebral Artery Bypass Using a Saphenous Vein Graft With 3-Vessel Anastomosis for the Treatment of a Large, Ruptured Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video.

Cerebral revascularization is the treatment of choice for select complex intracranial aneurysms unamenable to traditional approaches.1 Complex middle cerebral artery (MCA) bifurcation aneurysms can include the origins of 1 or both M2 branches and may benefit from a revascularization strategy.2,3 A novel 3-vessel anastomosis technique combining side-to-side and end-to-side anastomoses, allowing for bihemispheric anterior cerebral artery revascularization, was recently reported.4 This 2-dimensional operative video presents the case of a 73-yr-old woman who presented as a Hunt-Hess grade 4 subarachnoid hemorrhage due to the rupture of a large right MCA bifurcation aneurysm. The aneurysm incorporated the origins of the frontal and temporal M2 branches and was deemed unfavorable for endovascular treatment. A strategy using a high-flow bypass from the external carotid artery to the MCA with a saphenous vein (SV) graft was planned to revascularize both M2 branches simultaneously, followed by clip-trapping of the aneurysm. Intraoperatively, the back walls of both M2 segments distal to the aneurysm were connected with a standard running suture, and the SV graft was then attached to the side-to-side construct in an end-to-side fashion. Catheter angiograms on postoperative days 1 and 6 demonstrated sustained patency of the anastomosis and good filling through the bypass. The patient's clinical course was complicated by vasospasm-related right MCA territory strokes, resulting in left-sided weakness, which significantly improved upon 3-mo follow-up with no new ischemia. The patient consented for inclusion in a prospective Institutional Review Board (IRB)-approved database from which this IRB-approved retrospective report was created.

Optimizing Location of Subdermal Recording Electrodes for Intraoperative Facial Nerve Monitoring

The purpose of this study is to determine if different facial muscle groups demonstrate different responses to facial nerve stimulation, the results of which could potentially improve intraoperative facial nerve monitoring (IOFNM). IOFNM data were prospectively collected from patients undergoing cochlear implantation. At different stages of nerve exposure, three sites were stimulated using a monopolar pulse. Peak electromyography (EMG) amplitude (μV) in four muscle groups innervated by four different branches of the facial nerve (frontalis-temporal, inferior orbicularis oculi-zygomatic, superior oribularis oris-buccal, and mentalis-marginal mandibular) were recorded. A total of 279 peak EMG amplitudes were recorded in 93 patients. At all three stimulating sites, the zygomatic branch mean peak EMG amplitudes were statistically greater than those of the temporal, buccal, and marginal mandibular branches (P< .05). At stimulating Site C, the marginal mandibular branch mean peak EMG was stronger than the temporal or buccal branches (P< .05). Of the 279 stimulations, the zygomatic branch demonstrated the highest amplitude in 128 (45.9%) trials, followed by the marginal mandibular branch (22.2%). When utilized, IOFNM should be performed with at least two electrodes, one of which is placed in the orbicularis oculi muscles and the other in the mentalis muscle. However, there is wide variability between patients. As such, in cases of suspected variant nerve anatomy or increased risk of injury (intradural procedures), surgeons should consider using more than two recording electrodes, with at least one in the orbicularis oculi muscle. 3 Laryngoscope, 131:E2329-E2334, 2021.

Anatomic Variation of the Superficial Temporal Artery and Posterior Auricular Artery in a Pediatric Moyamoya Disease Population.

In certain cases of pediatric patients with Moyamoya disease undergoing encephaloduroarteriosynangiosis (EDAS) treatment, the posterior auricular artery can be used as an alternative when the parietal branch of the superficial temporal artery is unavailable. In this study, anatomic variations of the superficial temporal and posterior auricular arteries in pediatric patients with Moyamoya disease and postoperative outcomes of posterior auricular artery-EDAS are explored. Medical records of 572 patients with Moyamoya disease who underwent surgical procedures from 2007 to 2017 at the Seoul National University Children's Hospital were reviewed. Anatomic classifications of the superficial temporal and posterior auricular arteries were based on previous classifications. Postoperative hemodynamic changes of posterior auricular artery-EDAS were analyzed using the Matsushima grade. Also, Karnofsky Performance Scale and mRS scores of posterior auricular artery-EDAS cases were reviewed to identify postoperative clinical outcomes. Among 1144 hemispheres, 24 were considered posterior auricular artery-EDAS candidates (2.1%). Of those, 10 hemispheres underwent posterior auricular artery-EDAS (41.7%, in total hemispheres 0.9%). Comparing the Matsushima grades of the superficial temporal artery-EDAS and posterior auricular artery-EDAS groups showed similar postoperative revascularization. Postoperative Karnofsky Performance Scale and mRS scores of patients having undergone posterior auricular artery-EDAS did not show deterioration. In approximately 2% of pediatric patients with Moyamoya disease for whom the superficial temporal artery is unavailable as the EDAS donor, the posterior auricular artery can be considered an alternative. On the basis of the results, the clinical outcome of posterior auricular artery-EDAS was not inferior to that of superficial temporal artery-EDAS. Hence, we suggest an in-depth consideration of the posterior auricular artery as the donor artery if the superficial temporal artery parietal branch is unavailable.

Clinical observation on the effect of electroacupuncture treatment for chloasma in young and middle-aged women: 电针治疗中青年女性黄褐斑的临床疗效观察

ObjectiveTo evaluate the clinical effect of electroacupuncture treatment for chloasma in young and middle-aged women. MethodsSixty young and middle-aged female patients with chloasma were divided into treatment group (n = 30) and control group (n = 30) according to random number table. In the treatment group, the electroacupuncture was applied to the facial acupoints and “Vagus” in the cavity of concha in the ear. The selection of facial acupoints was relating to the running course of facial nerve trunk: Yìfēng (翳风 TE17), Shàngguān (上关 GB3)—Sīzhúkōng (丝竹空 TE 23) (Temporal branch), Xiàguān (下关 ST7)—Sìbái (四白 ST2) (Zygomatic branch), Qiānzhèng (牵正 Extra) —Quánliáo (颧髎 SI18) (Zygomatic branch), Jiāchē (颊车 ST6) —Jiāchéngjiāng (夹承浆Extra) (Buccal branch), Hégǔ (合谷LI 4). Electro-stimulation was adopted at “Vagus” in the cavity of concha in the ear (two distribution points of the vagus in the cavity of concha of each ear). The control group received conventional acupuncture (surrounding method of needling at the Ashi points in the facial lesion area and 15 acupoints which were selected in the highest frequency in the conventional acupuncture treatment). After 8 weeks of treatment, the clinical effects were compared.The total score of facial skin lesion, score of skin lesion color, score of lesion area, and effective rate of treatment for chloasma were used to evaluate the clinical effect of the two groups before and after treatment. ResultsAfter treatment, the effective rate of the treatment group was 95.00%, that of the control group was 67.50%. The effect of the treatment group was better than that of the control group, and the difference was statistically significant (χ2 = 9.928, P = 0.002). Before treatment, there was no difference in the area score, color score, and total score of skin lesions between the two groups (P>0.05). After treatment, the area score, color score, and total score of skin lesions in the treatment group were (1.05±0.64), (1.05±0.64), and (2.10±0.98) points respectively, while those in the control group were (1.38±0.63), (1.28±0.75), and (2.65±1.19) points respectively.The area score, color score, and total score of skin lesions in the treatment group were lower than those in the control group, with statistically significant differences (all P<0.05). Conclusionelectroacupuncture is more effective than conventional acupuncture in treating chloasma in young and middle-aged women.

Use of facial vein graft with vascularized composite auricular helical rim flap for alar rim defects

Nasal alar defects lead to facial disfigurement, and nasal ala reconstruction is an important treatment option. The vascularized composite auricular flap based on the superficial temporal artery is an ideal option for a full-thickness nasal alar defect. However, the pedicle length and the discrepancy in artery diameter between the recipient vessel and flap pedicle continue to be major problems for free auricular composite tissue transfer. Considering that the angular artery is occasionally absent and the course of the infraorbital segment of the facial vein is constant, there are often no suitable vessels around the recipient site for anastomoses to the short pedicle of the flap. In the absence of a suitable recipient artery, an infraorbital segment of the facial vein measuring 2.5cm in length was taken as a graft for the anastomosis of the superficial temporal artery and superior labial artery. End-to-end anastomosis was performed easily. The flap was inset to reconstruct the contralateral ala. The facial vein graft for anastomosis of the superficial temporal artery and branch of the facial artery is a reliable and easy method to resolve the problem of a short pedicle and large artery discrepancy for nasal ala reconstruction with a vascularized composite helical rim flap.

Associations among temporal and large artery abnormalities on vascular ultrasound in giant cell arteritis

Objectives: Giant cell arteritis (GCA) can manifest in cranial and/or extracranial arteries. We investigated the distribution of affected arteries on vascular ultrasound (VUS) among patients with new-onset or prior-onset GCA. Method: We retrospectively studied patients with either new-onset or prior-onset GCA and an abnormal VUS, from 2013 to 2017. Trained vascular technologists imaged the bilateral temporal arteries and carotid, axillary, and subclavian arteries. Vascular medicine physicians interpreted the images. Vasculitis-related abnormalities in individual vessels and their distribution (temporal artery, large artery, or both) were evaluated. Phi coefficients (φ) and Fisher’s exact test were used to assess correlations among individual abnormal arteries. Results: Among 66 GCA patients, 28.8% had prior-onset GCA (median duration 17.8 months). Acute arteritis on VUS was observed in the majority of patients with both new-onset (72.3%) and prior-onset GCA (68.4%); the remainder had hyperechoic wall thickening without acute arteritis. Involvement of the temporal arteries only (45.5%) or large arteries only (34.8%) was more common than involvement of both (19.7%); this finding was similar in new-onset and prior-onset GCA. There were moderate positive correlations among temporal artery branches (φ = 0.51–0.58, p < 0.003) and among axillary and subclavian arteries (φ = 0.51–0.77, p < 0.003), and moderate negative correlations between abnormalities in the temporal and large arteries (φ = −0.46 to −0.58, p < 0.003). Conclusion: On VUS, vasculitis-related abnormalities in the temporal arteries only or large arteries only were more common than concurrent temporal and large artery abnormalities in patients with both new-onset GCA and prior-onset GCA.

Deep Spatio-temporal Learning Model for Air Quality Forecasting

In recent years, air pollution has seriously affected people’s production and life, so the air prediction has become a research hotspot in recent years. When analyzing air data, it is found that this type of data has not only temporal correlation, but also spatial correlation. For these temporal and spatial characteristics, this paper studies deep spatio-temporal learning method to global prediction. The purpose is to learn the evolution rule behind the spatio-temporal sequence, and give an estimation for future state. To be specific, we propose two novel forecasting models based on video processing technology: Spatio-temporal Orthogonal Cube model (STOR-cube) and Spatio-temporal Dynamic Advection model (ST-DA), which effectively capture the spatio-temporal correlation and accurately predict the long-term air quality. STOR-cube contains three branches, i.e., a spatial branch for capturing moving objects, a temporal branch for processing motion, and an output branch for coupling the first two mutually orthogonal branches to generate a prediction frame. ST-DA constructs a spatio-temporal reasoning network to learn the characteristics of the spatio-temporal domain, and its impact on the future is explicitly modeled by pixel motion. Experiments results on the real-world datasets demonstrate our proposed approach significantly outperforms the state-of-the-art ones. Moreover, our model can be extended to other spatio-temporal data prediction tasks.

A New Target for Temple Volumization? An Anatomical and Ultrasound-Guided Study of the Intermediate Temporal Fat Pad.

Current techniques for temple volumization primarily focus on deep or superficial targets. Further anatomical exploration of intermediate injection targets is warranted. The purpose of this study was to examine the anatomy of the intermediate temporal fat pad (ITFP) as it relates to filler injection procedures and to explore the utilization of ultrasound technology for clinical localization. Ultrasound technology was utilized to identify and inject red dyed hyaluronic acid filler into the ITFP in 20 hemifacial fresh cadavers. Cross-sectional dissection was performed to confirm injection accuracy and document pertinent anatomical relationships. The same technique was performed in a single clinical patient case employing ultrasound guidance and injectable saline. The ITFP is a quadrangular structure located in the anterior-inferior bony trough. The ITFP is supplied by a middle temporal artery branch and encased between the superficial and deep layers of deep temporal fascia. In 18 of 20 (90%) injections performed under ultrasound guidance, the injected product was accurately delivered to the substance of the ITFP, and in 2 of 20 (10%), the product was found immediately below the deep layer of deep temporal fascia within the temporalis muscle. In the single clinical case, saline was successfully injected in the ITFP under ultrasound guidance. The ITFP is a consistent anatomical structure in the anterior-inferior trough of the temporal fossa. Ultrasound technology can be utilized to identify and inject the fat pad. Further clinical evaluation will determine the role of this fat pad as a potential intermediate injection target for temple volumization procedures.

Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery.

Background: A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres. Few studies have investigated the imaging characteristics and endovascular treatment (EVT) of brain arteriovenous malformations (BAVMs) in this area.Methods: A retrospective study was performed for patients who were diagnosed with PCA-BAVMs from January 2015 to December 2019. The PCA-BAVMs were divided into type I and type II according to their feeding arteries. Type I PCA-BAVMs were supplied by the posterior choroidal artery (PchA) from the PCA. They could be further subdivided into type Ia and type Ib. Type II PCA-BAVMs were supplied by the temporal or occipital branch from the PCA. They could also be further subdivided into type IIa and IIb. Targeted embolization of the risk factors was the main aim of EVT.Results: Forty-two patients were identified, with age ranging from 6 to 63 years. Twenty-four cases belonged to type I (57.1%, 24/42), including 6 Ia cases and 18 Ib cases. Eighteen cases belonged to type II (42.9%, 18/42), including 7 IIa cases and 11 IIb cases. Immediate complete or nearly complete embolization was achieved in 17 (40.5%, 17/42) cases. Partial embolization was achieved in 25 (59.5%, 25/42) cases. Two (4.8%, 2/42) patients experienced intraoperative or postoperative bleeding. The GOS scores at discharge were 3, 4, and 5 in 2 (4.8%, 2/42), 2 (4.8%, 2/42), and 38 (90.4%, 38/42) cases, respectively. There was no statistical difference between patients in type I and type II groups regarding age, BAVM rupture, SM grade, immediate extent of obliteration, and prognosis. Deep venous drainage was more common in patients of the type I group (P < 0.001).Conclusions: Our classification of the PCA-BAVMs was based on the segmentation of the PCA, which is a reasonable approach and could guide the strategy of EVT. EVT is a reasonable option for the PCA-BAVMs. The main aim of EVT is to secure the weak structures. A targeted EVT aimed at the ruptured part of the BAVM can reduce the risk of early rebleeding.

Modified Temporal Incision for the Management of Zygomatic Arch fractures-A Retrospective Study for 7 Years.

Retrospective cross-sectional study. The objective of this retrospective study was to evaluate the clinical outcomes of Modified temporal incision in the management of zygomatic arch fractures (ZAF). Records of 34 patients who underwent open reduction for zygomatic arch fractures were retrieved and included in the study between 2011 and 2018. These patients were followed up at 4 weeks, 8 weeks and 12 weeks respectively. Clinical parameters such as post-operative infection, hematoma, scarring, degree of mouth opening, palpability of plates, alopecia and weakness of temporal branch of Facial nerve recorded were analyzed for complications of modified temporal incision in the management of ZAF. A thorough analysis of the clinical parameters revealed that at the end of 4 weeks scarring was present in 4 patients and temporal branch of Facial nerve weakness was present in 21 patients. None of the patients had hematoma, infection or palpability of miniplates. At the end of 8 weeks the only complication recorded was weakness of temporal branch of Facial nerve in 21 patients. By 12 weeks, all patients had complete recovery and none of the patient had weakness of temporal branch of Facial nerve. The results obtained proved that the Modified temporal incision can be considered as a reliable method in the management of zygomatic arch fractures. The incision can be adopted with confidence in suitable cases of zygomatic arch fractures without any permanent morbidity.

Stellar Neuroretinitis as Presenting Sign of Behcet’s Disease

A 40-year-old One-eyed patient (right eye) acuity history of post-traumatic burst in his left eye at the age of 6 years. Consult for a decrease of vision on his right eye that has progressed for 3 weeks. Ophthalmic examination found visual acuity: 2/10 P10 in the right eye, the left eye presents enophthalmos with an opacified cornea; the anterior segment was normal in the right eye, fundus examination shows hyalitis graded 1+, papillary edema, peripapillary hemorrhages and stellar macular exudates, cottony nodules, copper arteries with vascular sheathing of the superior temporal branch and areas of retinal ischemia (Figure 1). The inflammatory and serological assessment is negative. Fluorescein retinal angiography shows papillary diffusion of fluorescein and vasculitis (Figure 2). We find serous retinal detachment on OCT (Figure 3). The general examination found bipolar aphthosis. The diagnosis of Behçet’s disease is retained. Treatment with immunosuppressants allowed the regression of papillary edema with persistence of some macular exudates and great improvingin visual acuity.

Exploring Rich and Efficient Spatial Temporal Interactions for Real-Time Video Salient Object Detection

We have witnessed a growing interest in video salient object detection (VSOD) techniques in today's computer vision applications. In contrast with temporal information (which is still considered a rather unstable source thus far), the spatial information is more stable and ubiquitous, thus it could influence our vision system more. As a result, the current main-stream VSOD approaches have inferred and obtained their saliency primarily from the spatial perspective, still treating temporal information as subordinate. Although the aforementioned methodology of focusing on the spatial aspect is effective in achieving a numeric performance gain, it still has two critical limitations. First, to ensure the dominance by the spatial information, its temporal counterpart remains inadequately used, though in some complex video scenes, the temporal information may represent the only reliable data source, which is critical to derive the correct VSOD. Second, both spatial and temporal saliency cues are often computed independently in advance and then integrated later on, while the interactions between them are omitted completely, resulting in saliency cues with limited quality. To combat these challenges, this paper advocates a novel spatiotemporal network, where the key innovation is the design of its temporal unit. Compared with other existing competitors (e.g., convLSTM), the proposed temporal unit exhibits an extremely lightweight design that does not degrade its strong ability to sense temporal information. Furthermore, it fully enables the computation of temporal saliency cues that interact with their spatial counterparts, ultimately boosting the overall VSOD performance and realizing its full potential towards mutual performance improvement for each. The proposed method is easy to implement yet still effective, achieving high-quality VSOD at 50 FPS in real-time applications.

Learning Self-Supervised Space-Time CNN for Fast Video Style Transfer.

Style transfer on images has achieved significant advances in recent years, with the deep convolutional neural network (CNN). Directly applying image style transfer algorithms to each frame of a video independently often leads to flickering and unstable results. In this work, we present a self-supervised space-time convolutional neural network (CNN) based method for online video style transfer, named as VTNet, which is end-to-end trained from nearly unlimited unlabeled video data to produce temporally coherent stylized videos in real-time. Specifically, our VTNet transfer the style of a reference image to the source video frames, which is formed by the temporal prediction branch and the stylizing branch. The temporal prediction branch is used to capture discriminative spatiotemporal features for temporal consistency, pretrained in an adversarial manner from unlabeled video data. The stylizing branch is used to transfer the style image to a video frame with the guidance from the temporal prediction branch to ensure temporal consistency. To guide the training of VTNet, we introduce the style-coherence loss net (SCNet), which assembles the content loss, the style loss, and the new designed coherence loss. These losses are computed based on high-level features extracted from a pretrained VGG-16 network. The content loss is used to preserve high-level abstract contents of the input frames, and the style loss introduces new colors and patterns from the style image. Instead of using optical flow to explicitly redress the stylized video frames, we design the coherence loss to make the stylized video inherit the dynamics and motion patterns from the source video to remove temporal flickering. Extensive subjective and objective evaluations on various styles demonstrate that the proposed method achieves favorable results against the state-of-the-arts with high efficiency.

Multi-Stage Feature Fusion Network for Video Super-Resolution.

Video super-resolution (VSR) is to restore a photo-realistic high-resolution (HR) frame from both its corresponding low-resolution (LR) frame (reference frame) and multiple neighboring frames (supporting frames). An important step in VSR is to fuse the feature of the reference frame with the features of the supporting frames. The major issue with existing VSR methods is that the fusion is conducted in a one-stage manner, and the fused feature may deviate greatly from the visual information in the original LR reference frame. In this paper, we propose an end-to-end Multi-Stage Feature Fusion Network that fuses the temporally aligned features of the supporting frames and the spatial feature of the original reference frame at different stages of a feed-forward neural network architecture. In our network, the Temporal Alignment Branch is designed as an inter-frame temporal alignment module used to mitigate the misalignment between the supporting frames and the reference frame. Specifically, we apply the multi-scale dilated deformable convolution as the basic operation to generate temporally aligned features of the supporting frames. Afterwards, the Modulative Feature Fusion Branch, the other branch of our network accepts the temporally aligned feature map as a conditional input and modulates the feature of the reference frame at different stages of the branch backbone. This enables the feature of the reference frame to be referenced at each stage of the feature fusion process, leading to an enhanced feature from LR to HR. Experimental results on several benchmark datasets demonstrate that our proposed method can achieve state-of-the-art performance on VSR task.

Assessment of facial nerve injury using Deep Subfascial approach to Temporo-mandibular joint

Background: Surgical access to the temporomandibular joint (TMJ) and zygomatic arch is a challenge even to the experienced maxillofacial surgeon. The conventional subfascial approach to these structures carries the potential risk of transient paralysis of the frontalis and orbicularis oculi muscles. The deep subfascial approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the facial nerve and thus, is the safest method to avoid facial nerve injury.&#x0D; Aims and Objective: To assess facial nerve injury (FN) following TMJ surgery using deep Subfascial approach and measuring it on House and Brackman facial nerve grading system (HBFNGS).&#x0D; Materials and Methods: A randomized study was performed from August 2013 to March 2017 on 24 patients with unilateral and bilateral TMJ ankylosis. All patients were evaluated objectively for facial nerve injury using with house and brackmann facial nerve injury grading system post-operatively and subjectively inthe various time periods, i.e. 24 hours, 1 week, 1month, 3 months and 6 months.&#x0D; Results: Brackmann facial nerve grading system at 24 hours post operatively– in the deep subfascial approach group, 91.7% of patients (23 cases) had Grade 1 injury and 8.3% (1case) had Grade 3 injury. The condition improved with time with full recovery of facial nerve injury (FN) at all surgical sites at 6 months.&#x0D; Conclusion: The deep subfascial approach has a distinct advantage over the conventional approaches when dissecting the temporal region and is thesafest method to avoid injury to facial nerve injury (FN).

Hippocampal vascularization: Proposal for a new classification

Background: Anatomy of the hippocampal arterial supply is key to successful surgeries in this area. The goal of the current study is to present the results we obtained from our microsurgical dissections of the temporal lobe and to propose a new classification for the hippocampal arteries (HAs).Methods: Fifty-six brain hemispheres were analyzed. All dissections in this study were made using 3–40× at the surgical microscope.Results: The hippocampal arterial vasculature can be divided into six groups, according to their frequencies: Group A: mixed arterial vasculature originating from the anterior choroidal artery anterior choroidal artery, posterior cerebral artery (PCA), anterior infratemporal artery (AIA), and splenic artery (SA). Group B: Main origin at the temporal branches – main inferotemporal trunk, middle inferotemporal artery, posterior inferotemporal artery, AIA, or main branch of PCA. Group C: AIA as the main branch of the hippocampus. Group D: HAs originating from the main branch of PCA. Group E: A single hippocampal artery with the origin at the main branch of PCA. This single artery covered all of the structure and is named Ushimura’s artery. Group F: The hippocampal vessels arose exclusively from the parieto-occipital artery, calcarine artery (CA), and the SA.Conclusion: This study proposes a new classification for the hippocampal vascularization, according to the origin of HAs. One of the groups has not yet been described in the literature – in which the HAs arise from the parieto-occipital artery, SA, and CA.

The Anatomy of the Temporal and Zygomatic Branches of the Facial Nerve: Application to Crow's Feet Wrinkles.

Advances in the understanding of wrinkling crow's feet while improving the safety and efficacy of botulinum toxin type A injection has pointed to drug dispersion in the lateral orbital wrinkles as a cause of adverse events of botulinum toxin type A injection. The purpose of this study is to identify the distribution of temporal and zygomatic branches of facial nerve in the orbicularis oculi muscles. Anatomical dissection of cadavers was performed in 31 cadavers, 13 females and 18 males, with ages ranging from 20 to 60 years, which of all had been embalmed by 10% formalin solution. The facial nerve was identified within subcutaneous tissue close periorbital region and both traced proximal and distal. Its temporal branch, zygomatic branch, facial and muscular entrance were located and accurately measured relative to established surface landmarks. Dissection of the facial nerve revealed 2 to 6 entrances of the temporal branch into the orbicularis oculi and 1 to 5 entrances of the zygomatic branch into the orbicularis oculi. Concerning the measurements of neural entering points, distance and angle from orbicularis oculi muscle to lateral ocular angle, a distribution map of its muscular entrance and their patterns of distribution were constructed. According to the dense area of the coordinate map, there were 3 points determined as the muscular entrance points to established surface landmarks. An anatomical dissection of cadavers was performed to identify the distribution of temporal and zygomatic branches of the facial nerve in the orbicularis oculi. According to the dense area of the coordinate map, the surface landmarks of 3 points were established as the muscular entrance of the facial nerve (MEF).

Cadaveric Study of Topographic Anatomy of Temporal and Marginal Mandibular Branches of the Facial Nerve in Relation to Temporomandibular Joint Surgery

Detailed anatomy of the facial nerve, including the variations among different ethnic groups, is essential to prevent an iatrogenic injury. The purpose of the study was to document topographic anatomy of temporal and marginal mandibular (MM) branches of the facial nerve in relation to temporomandibular joint (TMJ) surgery. The specific aim was to demonstrate detailed course of temporal and MM nerves, their surgical implications, and to compare the results obtained with the previous studies. The investigators implemented a prospective cadaveric study. A dissection was carried out on 52 facial halves. The facial nerve was dissected according to the instructions described in the Cunningham's dissection manual. Anatomic landmarks were selected as determined by Al-Kayat and Bramley, and results obtained were compared with previous published articles. The study sample was composed of 52 facial halves (males, n=35; females, n=17). The number of branches of temporal nerve varied in dissected facial halves from 3 (n=37 [70%]), 2 (n=14 [26%]), to 1 (n=1 [2%]). The distance between the lowest concavity of the bony external auditory meatus to the point at which the facial nerve bifurcates (distance B) was considerably less in the study population (1.79cm) when compared with the reported literature (2.3cm). There was no significant influence of gender and cephalic index on distances measured. There was 1 branch in 15% of the dissected facial halves (1 in 52) and 2 branches in 85% (44 of 52). The MM nerve was seen coursing below the inferior border of the mandible, and in 44 (85%), the nerve was present above the inferior border of mandible all along the course. The topographic anatomy of the temporal and MM nerves is the same as reported in the literature. The only considerable difference was found in distance B; hence, surgical procedures involving the distance B require special consideration.