Publications by authors named "Shin-Hyo Lee"

46 Publications

Morphological changes after lower eyelid epiblepharon surgery in Asian children.

BMC Ophthalmol 2021 Aug 6;21(1):293. Epub 2021 Aug 6.

Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.

Background: This study aimed to determine the morphological changes in Asian lower eyelid epiblepharon patients after surgery.

Methods: The medical records of 59 patients who underwent lower eyelid epiblepharon repair were reviewed retrospectively. Eighty-nine patients who underwent strabismus surgery were set as the control group. The photographs for each group were analyzed based on the following factors: inferior half area (IHA) of the eye, eyelash angular direction (EAD), angle between the eyelashes and the cornea, marginal reflex distance 1 (MRD) and marginal reflex distance 2 (MRD).

Results: After surgery, the medial EAD changed from 92.45° ± 20.21° (mean ± SD) to 79.43° ± 23.31°, while the central and lateral EADs were unchanged. IHA increased from 36.33 ± 9.78 mm to 43.06 ± 10.57 mm, and MRD increased from 1.92 ± 0.99 mm to 2.50 ± 0.93 mm, whereas MRD did not change. The mean angle between the eyelashes and the cornea increased from 39.64° to 72.19° immediately postoperatively, but had reduced to 58.75° 3 months later, followed by no further significant change at the 6-month and 9-month postoperative follow-ups.

Conclusions: There is morphological changes of the eyelid after lower eyelid epiblepharon surgery, with increases in the IHA and MRD In addition, contact between the eyelashes and the cornea occurred mainly in the medial portion of the eyelid the position, which everted and stabilized over 3 months. Thus, follow-up observations are required for at least 3 months to properly evaluate the surgical outcome.
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http://dx.doi.org/10.1186/s12886-021-02052-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348859PMC
August 2021

Investigation of the Orbital Arterial Distribution Using Image Superimposition to Determine Safe Zones for Retrobulbar Injection and to Prevent Filler Complications.

Plast Reconstr Surg 2021 Jun;147(6):1321-1328

From the Departments of Ophthalmology and Anatomy, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine; Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital; and Department of Anatomy, Yonsei University College of Medicine.

Background: Retrobulbar filler injection has recently been considered an ideal method for orbital volume enhancement due to its nontoxic, easily reversible, and noninvasive characteristics. This study determined the arterial distribution in the orbit with the aim of defining a safety zone for retrobulbar filler injections used to enhance the orbital volume.

Methods: Twenty-seven orbits of 24 formalin-embalmed cadavers were dissected. The orbital arteries were identified after removal of the eyeball, extraocular muscles, and connective tissues. The course of each orbital artery was then recorded in each specimen, and all of the courses were then superimposed to determine the arterial distribution in the orbit.

Results: The superimposition of lined images based on the orbital vasculature of each specimen revealed that the arterial density was highest in the superonasal region and lowest in the inferotemporal region. In particular, orbital arteries were scarce at 8 o'clock and 4 o'clock in the right and left orbits, respectively, and an artery-free zone was demonstrated in the outer part of those directions.

Conclusions: When performing a transcutaneous retrobulbar injection of filler for orbital volume enhancement, the relative safety zone could be considered to be located at 8 o'clock and 4 o'clock in the right and left orbits, respectively. The detailed topographic information about the arterial distribution in the orbit, provided by the present study, may help oculofacial surgeons to avoid injury to major vessels and decrease the risk of retrobulbar hemorrhage and vision-threatening complications.
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http://dx.doi.org/10.1097/PRS.0000000000007944DOI Listing
June 2021

Improvement in Near Vision Following Silodosin Treatment in Patients With Lower Urinary Tract Symptoms.

Int Neurourol J 2021 Jun 19;25(2):164-171. Epub 2021 Jan 19.

Department of Urology, Konkuk University School of Medicine, Seoul, Korea.

Purpose: The objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS).

Methods: This prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality).

Results: Of 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004).

Conclusion: This preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.
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http://dx.doi.org/10.5213/inj.2040274.137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255821PMC
June 2021

Transconjunctival versus Transcutaneous Injection of Botulinum Toxin into the Lacrimal Gland to Reduce Lacrimal Production: A Randomized Controlled Trial.

Toxins (Basel) 2021 01 21;13(2). Epub 2021 Jan 21.

Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea.

The purpose of this study was to determine and compare the effects between injecting botulinum toxin A (BTX-A) transconjunctivally into the palpebral lobe and transcutaneously into the orbital lobe of the lacrimal gland in patients with epiphora due to lacrimal outflow obstruction. This randomized controlled study included 53 eyes of 31 patients with unilateral or bilateral epiphora. Patients were randomly allocated to receive an injection of BTX-A (3 units) either transconjunctivally ( = 15, 25 eyes) or transcutaneously ( = 16, 28 eyes). For objective assessments, the tear meniscus height and Schirmer's I test with topical anesthesia were measured at baseline and after 2, 6, 12, and 24 weeks of follow-up. Subjective evaluations were performed using the Munk score. After BTX-A injection, patients in both groups experienced significant objective and subjective reductions in tearing at all follow-up times compared to pre-injection (success rate 86.8%), and the effect lasted for a mean duration of 5.63 months. The two delivery routes showed similar clinical effectiveness for a single injected dose of BTX-A. In conclusion, injecting BTX-A via either a transconjunctival or transcutaneous route helps to reduce normal tear production and results in significant improvements in the symptoms in patients with epiphora.
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http://dx.doi.org/10.3390/toxins13020077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911887PMC
January 2021

Quantitative measurement of passive duction force tension in intermittent exotropia and its clinical implications.

Graefes Arch Clin Exp Ophthalmol 2021 Jun 7;259(6):1617-1623. Epub 2021 Jan 7.

Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.

Purpose: To evaluate the passive duction force (PDF) in extraocular muscles (EOMs) in patients with intermittent exotropia (IXT) using a quantitative tension-measuring device.

Methods: This prospective, case-control study enrolled 25 patients with IXT and 26 age- and sex-matched controls. PDF was measured under general anesthesia as the eyeball was rotated medially or laterally away from the direction of the force being tested. The preferred eye for fixation was determined using a cover-uncover test.

Results: The PDF in the IXT and control groups were 60.9 g and 52.1 g, respectively, for the lateral rectus (LR) (p = 0.046) and 53.0 g and 48.8 g for the medial rectus (MR) (p = 0.293). When the eyes were examined separately in the IXT group, the PDF of LR was larger in the nonpreferred eye for fixation than in the control group (p = 0.039), whereas there was no difference in the preferred eye for fixation (p = 0.216). Additionally, the relative PDF of LR in the nonpreferred eye compared to the ipsilateral PDF of MR was positively associated with the duration of manifest deviation (p = 0.042) and the average angle of the near and far deviations (p = 0.023).

Conclusions: The PDF in the LR in patients with IXT in the nonpreferred eye for fixation was larger than normal and could increase with the duration of manifest deviation and the angle of deviation. Evaluating the PDF in EOMs could provide information that is useful for managing strabismus and understanding its pathophysiology.
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http://dx.doi.org/10.1007/s00417-020-05030-xDOI Listing
June 2021

Anatomic, histologic, and ultrasound analyses of the dorsum of the hand for volumetric rejuvenation.

J Plast Reconstr Aesthet Surg 2021 Jul 21;74(7):1615-1620. Epub 2020 Nov 21.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea. Electronic address:

Background: Volumetric rejuvenation of the dorsum of the hand with fat grafting or injectable fillers has increased in popularity in recent years. It has become widely accepted that the dorsum of the hand contains three fatty laminae: superficial, intermediate, and deep laminae. The dorsal venous plexus and dorsal cutaneous nerves are known to reside in the dorsal intermediate lamina. However, the superficial vein and cutaneous nerve might not be located in the same layer of subcutaneous tissue, as is the case in other body regions.

Materials And Methods: Eight hands were dissected in a layer-by-layer fashion from the skin to the extensor tendons. In another 13 hands from among 21 investigated cadavers, samples from the dorsum of the hand were harvested and stained using trichrome stains for histologic analysis. B-mode ultrasound was also performed for identifying structures of the dorsum of the hand.

Results: Anatomic dissection and histologic analysis of the dorsum of the hand revealed the presence of an unknown fascia in addition to the three known fascial layers. The additional fascia was located in the dorsal intermediate lamina and separated it into two compartments: one containing the dorsal venous plexus superficially and the other containing the dorsal cutaneous nerves deeply. Ultrasound showed corresponding structures including three hyperechoic fascial layers, three hypoechoic laminae, and additional hyperechoic fascia in dorsal intermediate lamina.

Conclusions: Accurate anatomic knowledge of the dorsum of the hand will help practitioners determine the optimal and safe locations for performing fat grafting and injecting dermal fillers.
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http://dx.doi.org/10.1016/j.bjps.2020.11.017DOI Listing
July 2021

New instrument for quantitative measurements of passive duction forces and its clinical implications.

Graefes Arch Clin Exp Ophthalmol 2020 Dec 17;258(12):2841-2848. Epub 2020 Aug 17.

Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.

Purpose: Evaluating the passive duction force of the extraocular muscles is important for the diagnosis of and surgical planning for strabismus. This is especially relevant in patients with an observable limitation of duction movement. The purpose of this study was to validate passive duction forces in healthy subjects using a novel instrument.

Methods: An instrument for making continuous quantitative measurements of passive duction forces was designed. Tension was measured as the eyeball was rotated horizontally or vertically from the resting position under general anesthesia 10 mm (50°) away from the direction of force to be tested (opposite side).

Results: Seventy eyes of 35 subjects were enrolled in this study (age range of 4-80 years and mean age of 36.3 years). The passive duction force was measured at 49.0 ± 15.3 g (mean ± standard deviation) for medial rotation, 44.8 ± 13.2 g for lateral rotation, 50.5 ± 14.8 g for superior rotation, and 53.5 ± 13.8 g for inferior rotation. The passive duction forces were similar for all gaze positions, but it was larger for inferior rotation than for lateral rotation (P = 0.009). The passive duction force was significantly larger for vertical rotation (51.9 ± 14.4 g) than for horizontal rotation (46.9 ± 14.4 g) (P = 0.006). The passive duction force did not differ significantly with sex (P = 0.355), side (P = 0.087), or age (P = 0.872).

Conclusions: These measurements of passive duction forces in a healthy population provide valuable information for diagnosing specific strabismic problems and could be useful for increasing the precision of strabismus surgery. Graphical abstract.
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http://dx.doi.org/10.1007/s00417-020-04848-9DOI Listing
December 2020

Macro/microscopic distribution of the dorsal nerve of penis in human glans penis.

J Anat 2020 11 19;237(5):849-853. Epub 2020 Jul 19.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.

This study aimed to elucidate the macroscopic and microscopic distributions of the dorsal nerve of penis (DNP) that provides the greatest sensitivity over the glans penis. The glandes of 23 penises of formalin-embalmed cadavers were investigated to confirm the macroscopic and microscopic distributions of the DNP within the glans penis by whole-mount Sihler's staining and histological sectioning. Superficial regions of the mid-glans were reconstructed in three dimensions to define the microstructure of terminal branches of the DNP that project towards the skin surface. A mean of 6.7 bundles of the DNP consisting of several nerve fibres converged linearly towards the distal end of the penis, rather than diverging laterally as they travelled. Lateral branches of the DNP extended linearly to the distal end with ramifications, while dorsomedial branches of the DNP gave off nerve fibres to the dorsum of the mid-glans and the corona. The intrastromal ramifications of the DNP were more developed in the distal half of the glans penis than the proximal glans containing the corpus cavernosum. These ramifications gave rise to radial nerve fibres that project towards the skin surface to form a plexiform network of terminal branches in the dermis. Linear projections of the main branches of the DNP throughout the glans and fine networks of terminal branches in the dermis were distinctly visualized in the human penis.
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http://dx.doi.org/10.1111/joa.13263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542186PMC
November 2020

Three-dimensional microstructures of the intracortical canals in the animal model of osteoporosis.

Anat Cell Biol 2020 Jun;53(2):162-168

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.

Osteoporosis is a major disease in aged women, increasing the risk for fractures accompanied by changes in the microarchitecture. The aim of this study was to investigate the three-dimensional (3D) histomorphology of femur diaphysis in the animal model for postmenopausal osteoporosis. The cortical bone of femur diaphysis of the rat was serially sectioned at a thickness of 5 μm and evaluated age-associated changes of the intracortical (osteonal) canal networks three-dimensionally. Cortical microstructures of 10-month old rats were not affected by ovariectomy. Intracortical canal networks were radial toward endosteal aspect and frequently interconnected across the neighboring canals with short arciform and irregular canals reminiscent for resorption spaces in ovarectomized 16-month old rats, contrary to intact canals in 16-month old control rat. Increased proportion of the periosteal circumference lamella and deformed endosteal regions with rare cortical canals hampered reconstructive histomorphology in ovarectomized rats of 26 month age. We have shown that 3D reconstruction of rat femur of the aged model over 16-month old is suitable methods that evaluate and microstructural change of the intracortical canals and cortical bone porosity by estrogen depletion.
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http://dx.doi.org/10.5115/acb.19.189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343558PMC
June 2020

Intramuscular Nerves of the Inferior Rectus Muscle: Distribution and Characteristics.

Curr Eye Res 2020 12 18;45(12):1598-1603. Epub 2020 Jun 18.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine , Seoul, Republic of Korea.

Purpose: Knowledge of the distribution of intramuscular nerves of the extraocular muscles is crucial for understanding their function. The purpose of this study was to elucidate the intramuscular distribution of the oculomotor nerve within the inferior rectus muscle (IRM) using Sihler's staining.

Method: Ninety-three IRM from 50 formalin-embalmed cadavers were investigated. The IRM including its branches of the oculomotor nerve was finely dissected from its origin to the point where it inserted into the sclera. The intramuscular nerve course was investigated after performing Sihler's whole-mount nerve staining technique that stains the nerves while rendering other soft tissues either translucent or transparent.

Results: The oculomotor nerve enters the IRM around the distal one-fourth of the muscle and then divides into multiple smaller branches. The intramuscular nerve course finishes around the distal three-fifth of the IRM in gross observations. The types of branching patterns of the IRM could be divided into two subcategories based on whether or not topographic segregation was present: (1) no significant compartmental segregation (55.9% of cases) and (2) a several-zone pattern with possible segregation (44.1% of cases). Possible compartmentalization was less clear for the IRM, which contained overlapping mixed branches between different trunks.

Conclusion: Sihler's staining is a useful technique for visualizing the gross nerve distribution of the IRM. The new information about the nerve distribution and morphological features provided by this study will improve the understanding of the biomechanics of the IRM, and could be useful for strabismus surgery.
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http://dx.doi.org/10.1080/02713683.2020.1776333DOI Listing
December 2020

Femoral nerve split with variant iliacus muscle: a potential source of femoral nerve entrapment.

Surg Radiol Anat 2020 Oct 22;42(10):1255-1257. Epub 2020 May 22.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.

The iliacus muscle is a large, flat, triangle-shaped muscle located in the iliac fossa. This muscle forms part of the iliopsoas muscle complex. Although anatomical variations of iliacus muscles are rare, some variations are clinically important due to the possible coexistence of an unusual course of the femoral nerve. The femoral nerve is the largest branch of the lumbar plexus and supplies the muscles and skin in the anterior aspect of the thigh. We encountered a case of a single aberrant slip of the iliacus muscle piercing the femoral nerve in the left iliac fossa of a male cadaver aged 97 years. The potential clinical importance of this variant iliacus muscle accompanied by a femoral nerve split would be femoral neuropathy and possible consequent alterations of sensation in the anterior and medial aspects of the thigh or motor deficit of the quadriceps muscle.
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http://dx.doi.org/10.1007/s00276-020-02502-xDOI Listing
October 2020

Location of the accessory infraorbital foramen with reference to external landmarks and its clinical implications.

Sci Rep 2020 05 22;10(1):8566. Epub 2020 May 22.

Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.

The aim of this study was to define the location of the accessory infraorbital foramen (AIOF) with reference to accessible external landmarks in order to facilitate orbital and oculoplastic surgical procedures in the maxillofacial region. Forty-four hemifaces from 25 cadavers were dissected. The lateral canthus, subnasal point, and lacrimal caruncle were used as anatomic reference points. The AIOF was observed in 8 of the 44 hemifaces (18.2%) and was situated at a mean distance of 7.2 mm superomedial to the IOF. The horizontal distance from the lacrimal caruncle to the AIOF was 0.3 mm. In all cases the AIOF was situated at a point that was no more than 8 mm from the intersection point of a vertical line passing through the lacrimal caruncle and an oblique line joining the lateral canthus and the subnasal point. Surgeons anesthetizing or performing surgical procedures in the maxillofacial region should be aware of the frequency of the AIOF (18.2%) and its location (on the superomedial side of the IOF). We propose that injecting at the intersection point of a vertical line passing through the lacrimal caruncle and an oblique line joining the lateral canthus and the subnasal point would successfully block the accessory branch of the infraorbital nerve. Likewise, surgeons operating in this region should be aware of the location of the AIOF in order to avoid inadvertent iatrogenic injury to a duplicated infraorbital nerve.
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http://dx.doi.org/10.1038/s41598-020-65330-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244752PMC
May 2020

Location of the split line of the deep temporal fascia when reducing a zygomatic arch fracture.

J Plast Reconstr Aesthet Surg 2020 Jun 21;73(6):1130-1134. Epub 2020 Jan 21.

Departments of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea. Electronic address:

Background: The deep temporal fascia (DTF) is known to separate into two layers that descend to attach to the zygomatic arch. When surgeons reduce an isolated fracture of the zygomatic arch through a temporal approach, the temporal incision site needs to be superior to the split line of the DTF.

Materials And Methods: Sixty-seven hemifacial cadavers were investigated after removing the skin, subcutaneous tissue, and superficial temporal fascia. The superficial layer of the DTF was exposed. We cut the superficial layer along the line along, which it adhered to the deep layer inseparably. The heights of the split line of the DTF from the superior border of the zygomatic arch and from the top of the helix were measured at three points: at the jugale, zygion, and 3 cm from the tragus.

Results: In all cases there were thick identifiable deep layers of the DTF. The mean heights of the split line of the DTF from the superior border of the zygomatic arch were 49.8, 46.7, and 42.6 mm at the jugale, zygion, and 3 cm from the tragus, respectively; the corresponding mean heights of the split line from the top of the helix were 19.1, 15.6, and 11.4 mm.

Conclusions: Knowledge of the mean height of the split line of the DTF will be helpful for surgeons to determine the temporal incision site for ensuring the safe reduction of a zygomatic arch fracture.
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http://dx.doi.org/10.1016/j.bjps.2020.01.017DOI Listing
June 2020

Treatment Outcome of Modified Argon Laser Photoablation for Conjunctival Cysts.

Cornea 2020 Apr;39(4):514-518

Department of Ophthalmology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

Purpose: To evaluate the effectiveness of conjunctival cyst removal using a modified method of argon laser photoablation.

Methods: Seventeen cases of symptomatic conjunctival cysts were included. After staining the surface of a conjunctival cyst with a dark purple marker, the cyst was incised using a 26-gauge needle. Low-energy argon laser photoablation was then applied around the incision site for a mean of 100 times.

Results: During a mean follow-up period of 13.3 months (range 6-28 months), all conjunctival cysts were successfully corrected by applying either one or 2 laser sessions. Complete resolution occurred after a single laser session in 14 eyes (82.4%). There were 3 cases of recurrence with medium to large cysts, and repeating the same procedure produced surgical success in all of these cases; the conjunctival cyst recurred again after the second laser session in one of the 3 eyes, but this spontaneously regressed without further treatment. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed.

Conclusions: Our modified method of argon laser photoablation uses staining of the conjunctival cyst surface to increase the amount of thermal laser energy absorbed by the target. This novel technique is simple and effective for treating conjunctival cysts in an outpatient clinic.
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http://dx.doi.org/10.1097/ICO.0000000000002245DOI Listing
April 2020

Location of the infraorbital foramen with reference to soft tissue landmarks for regional nerve blocks during midface surgery.

Clin Anat 2020 Nov 11;33(8):1159-1163. Epub 2020 Jan 11.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

Purpose: An infraorbital nerve (ION) block is widely used to accomplish regional anesthesia during surgical procedures involving the midface region. This study aimed to elucidate the exact location of the infraorbital foramen (IOF) in relation to clinically useful soft-tissue landmarks for achieving an effective ION block.

Methods: Forty-three hemifaces from 23 embalmed Korean cadavers were dissected. The lateral canthus, peak of Cupid's bow, medial limbus, and midline were used as reference points. The distances from the IOF to the midline and the lateral canthus were measured.

Results: The IOF was located approximately 25 mm below the lateral canthus and 27 mm lateral to the midline. In all cases, the IOF was situated within 9.0 mm of the crossing point of the oblique line connecting the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus.

Conclusion: Considering the spread of an anesthetic agent, injecting it into the crossing point of the oblique line through the lateral canthus to the peak of Cupid's bow and the vertical line through the medial limbus would successfully block the ION in most patients.
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http://dx.doi.org/10.1002/ca.23556DOI Listing
November 2020

Topography of the Central Retinal Artery Relevant to Retrobulbar Reperfusion in Filler Complications.

Plast Reconstr Surg 2019 12;144(6):1295-1300

From the Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine.

Background: Vision loss caused by retrograde occlusion of the central retinal artery is a serious complication of cosmetic filler injections. Salvage methods that involve applying hyaluronidases in the retrobulbar space to degrade filler materials have been proposed recently for rescuing the retinal circulation in an ophthalmic emergency.

Methods: Sixty-six eyeballs and orbital contents were extracted from formalin-embalmed cadavers and dissected carefully to examine the topographic relationship of the central retinal artery and optic nerve. To observe the three-dimensional course of a central retinal artery that invaginates into the optic nerve, serial sections reconstructed at 100-μm intervals using software were visualized in 11 specimens.

Results: The central retinal artery ramified from the ophthalmic artery and entered the optic nerve inferiorly at 8.7 ± 1.7 mm (mean ± SD) from the posterior margin of the eyeball. The intraneural course of a central retinal artery changed acutely between the periorbital environment of the fibrous optic nerve sheath, intermediate subarachnoid spaces, and center of the optic nerve stroma.

Conclusion: When applying a retrobulbar approach for central retinal artery reperfusion with hyaluronidases, the reliable access route is suggested to be at a depth of 3.0 to 3.5 cm from the border of the inferolateral orbital rim, based on consideration of the entry point of the central retinal artery into the optic nerve.
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http://dx.doi.org/10.1097/PRS.0000000000006205DOI Listing
December 2019

Position and size of the sphenoid door jamb in the lateral orbital wall for the orbital decompression.

Anat Cell Biol 2019 Sep 26;52(3):242-249. Epub 2019 Sep 26.

Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea.

The aim of this study was to identify the three-dimensional topography of the sphenoid door jamb (SDJ) in the lateral orbital wall and to propose navigational guidelines for safe deep lateral decompression using surgical landmarks. The 120 orbits and SDJs of 60 subjects were three-dimensionally reconstructed using Mimics software. The mean volumes of the orbit and SDJ were 24.3 mm and 2.0 mm, respectively. The mean distances from the lateral orbital margin (LOM) to the anterior and posterior margins of the SDJ were 13.2 and 36.3 mm, respectively. The mean distances from the superior orbital fissure to the LOM and to the posterior margin of the SDJ were 40.2 mm and 4.6 mm, respectively. The mean distances from the inferior orbital fissure (IOF) to the anterior and posterior margins of the SDJ were 3.8 mm and 20.5 mm, respectively. In the superior approach of the orbit, it can be predicted that the area up to 3 cm posterior from the LOM is safe, while 1 cm posterior from the safe zone could be a dangerous zone. In the inferior approach of the orbit, the safe area will be about 1 cm posterior from the anterior tip of the IOF, and the area up to 1 cm posterior from the safe zone should be approached with extreme care.
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http://dx.doi.org/10.5115/acb.19.101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773894PMC
September 2019

Intramuscular Nerve Distribution of the Inferior Oblique Muscle.

Curr Eye Res 2020 02 27;45(2):215-220. Epub 2019 Dec 27.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

: The intramuscular nerve distribution in the extraocular muscles is important for understanding their function. This study aimed to determine the intramuscular nerve distribution of the oculomotor nerve within the inferior oblique muscle (IO) using Sihler's staining.: Seventy-two IOs from 50 formalin-embalmed cadavers were investigated. The IO including its branch of the oculomotor nerve was finely dissected from its origin to its insertion point into the sclera. The total length of the muscle and its width were measured. The intramuscular nerve course was investigated after performing Sihler's staining, which is a whole-mount nerve-staining technique that stains the nerves while rendering other soft tissues either translucent or transparent.: The total length of the muscle and muscle width were 30.0 ± 2.8 mm (mean±standard deviation), 8.8 ± 1.2 mm, respectively. The oculomotor nerve enters the IO around the middle of the muscle and then divides into multiple smaller branches without distinct subdivisions. The intramuscular nerve distribution within the IO has a root-like arborization and supplies the entire width of the muscle. The Sihler's stained intramuscular nerve course (covering a length of 7.6 ± 1.2 mm) finishes around the distal one-third of the IO in gross observations.: Sihler's staining is a useful technique for visualizing the gross nerve distribution of the IO. This new information about the nerve distribution and morphological features will improve the understanding of the biomechanics of the IO.
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http://dx.doi.org/10.1080/02713683.2019.1662055DOI Listing
February 2020

Mini-incisional entropion repair for correcting involutional entropion: Full description and surgical outcome.

Medicine (Baltimore) 2019 Aug;98(33):e16731

Department of Ophthalmology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.

The aim of the study was to report the surgical outcome of mini-incisional correction method to treat involutional entropion.This is a retrospective interventional case series of 46 eyelids in 31 patients with involutional entropion and significant ocular irritation. In this technique, after turning the lower eyelid inside out, threads are introduced into it through the conjunctiva close to the inferior fornix. The lower lid retractor and tarsus are then connected using threads. These threads are applied at 3 locations of the lower eyelid and tightening them results in the eyelid being everted and the correction of entropion. Surgical success was defined as no contact between the eyelashes and the globe during forced closure of the eyelids. Surgical failure was defined as persistence of the eyelashes remaining in contact with the globe or cosmetic dissatisfaction.During the mean follow-up period of 22.1 months (range, 12-34 months), 43 of the eyelids (93.5%) were successfully corrected. Two patients (3 eyelids) experienced recurrence: 1 had involutional entropion combined with a cicatricial component, and the other had blepharospasm and apraxia of eyelid opening related to Parkinsonism. No postoperative complications such as overcorrection, suture-knot exposure, or ocular irritation were observed.Our mini-incisional entropion repair is based on reinforcement of the lower eyelid retractors using transconjunctival buried sutures. This technique is a quick, simple, and predictive for involutional entropion repair, and has a high success rate.
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http://dx.doi.org/10.1097/MD.0000000000016731DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831266PMC
August 2019

Consistency of the lateral canthus as an anatomic landmark and its clinical implications.

Clin Anat 2019 Jul 12;32(5):630-634. Epub 2019 Mar 12.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

Successful oculofacial procedures require the availability of a reliable surgical and anatomic landmark. This study aimed to determine the usefulness of the lateral canthus as a surface landmark. Seventy-seven from 42 Korean cadavers were dissected. The horizontal distance from the lateral canthus to the lateral orbital margin and the vertical distances from the zygomaticofrontal suture and the inferior orbital margin to the lateral canthus were measured. The mean horizontal distance from the lateral canthus to the lateral orbital margin was 7.8 mm. Although the horizontal position of the lateral canthus appears to alter with age, the variation was only 2-3 mm. The mean vertical distances from the zygomaticofrontal suture and inferior orbital margin to the lateral canthus were 8.1 and 17.2 mm. The vertical position of the lateral canthus did not vary with age, being located inferiorly within a fingernail width from the zygomaticofrontal suture. The lateral canthus, which is easily accessible and supported by muscular and fibrous lateral orbital attachments, exhibits small anatomic variations. Thus, the lateral canthus could act as a reliable surface landmark for identifying the location of underlying structures and describing a lesion on the face. Clin. Anat. 32:630-634, 2019. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23360DOI Listing
July 2019

External and Internal Diameters of the Facial Artery Relevant to Intravascular Filler Injection.

Plast Reconstr Surg 2019 Apr;143(4):1031-1037

From the Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine.

Background: Vision loss and skin necrosis caused by an accidental intraarterial embolism or vascular compression are rare but devastating complications when injecting filler materials into the face.

Methods: The external and internal diameters and wall thicknesses of the facial artery and its branches were measured from 41 formalin-embalmed cadavers after removing connective tissues attached to the arterial wall.

Results: The diameter and thickness of the facial artery exhibited significant interregional differences. The external and internal diameters of the facial artery were 1.9 ± 0.4 and 1.2 ± 0.3 mm (mean ± SD), respectively, at the inferior border of the mandible; 1.7 ± 0.3 and 1.2 ± 0.3 mm in the vicinity of the inferior labial artery; 1.5 ± 0.3 and 1.0 ± 0.3 mm at the mouth corner; 1.4 ± 0.3 and 0.9 ± 0.2 mm in the vicinity of the superior labial artery; and 1.1 ± 0.2 and 0.7 ± 0.2 mm in the vicinity of the lateral nasal artery. The external and internal diameters at the proximal parts of the inferior labial artery, superior labial artery, and lateral nasal artery were 1.0 ± 0.3 and 0.6 ± 0.2 mm, 0.9 ± 0.3 and 0.6 ± 0.2 mm, and 0.8 ± 0.2 and 0.5 ± 0.2 mm, respectively.

Conclusion: Morphometric examinations of the facial artery under stereomicroscope observation as performed in the present study are expected to be more accurate than direct measurements obtained during cadaveric dissection or conventional histologic evaluations.
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http://dx.doi.org/10.1097/PRS.0000000000005428DOI Listing
April 2019

Intramuscular Nerve Distribution in the Medial Rectus Muscle and Its Clinical Implications.

Curr Eye Res 2019 05 27;44(5):522-526. Epub 2019 Feb 27.

b Department of Anatomy, Research Institute of Medical Science , Konkuk University School of Medicine , Seoul , Republic of Korea.

Purpose: The intramuscular nerve distribution in the extraocular muscles may be crucial for understanding their physiological and pathological responses. This study aimed to determine the oculomotor nerve distribution in the medial rectus muscle (MR) using Sihler's staining.

Method: Thirty-seven MRs from 23 cadavers were investigated. The MR including the oculomotor nerve was finely dissected from its origin to its insertion point into the sclera. The total length of the muscle-belly, tendon length and maximum width of the muscle were measured. We evaluated the pattern of distribution and the length of the intramuscular nerve distribution by gross observation after performing Sihler's staining, which is a method for visualizing the distribution of nerve fibers without alteration of the nerve.

Results: The total length of the muscle-belly, tendon length, and muscle width were 37.6 ± 4.6 mm, 4.4 ± 1.9 mm, and 10 ± 1.8 mm, respectively. The oculomotor nerve enters the MR at a mean of two-fifths along the muscle (24 ± 2.0 mm posterior to the insertion point) and then typically divides into a few branches (mean of 2.1). The intramuscular nerve distribution showed a Y-shaped ramification, forming the terminal nerve plexus, and its course typically finished at around 17 ± 1.5 mm posterior to the muscle insertion point by gross observation. The nerve plexus in the upper part generally coursed more distally than the lower part.

Conclusion: This new information regarding the nerve distribution pattern of MR will be helpful for understanding MR function and the diverse pathophysiology of strabismus.
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http://dx.doi.org/10.1080/02713683.2018.1562556DOI Listing
May 2019

Ligamentous structures in human glans penis.

J Anat 2019 01 18;234(1):83-88. Epub 2018 Nov 18.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea.

The corpus spongiosum reportedly occupies a larger proportion of the human glans penis than does the penile body, embedding the end of the corpus cavernosus (CC). However, anatomic descriptions about the fibrous structures of glans penis in the literature cause confusion during dissection and reconstructive surgery. Forty-five penises of formalin-embalmed cadavers were dissected sagittally along the course of the distal urethra and observed macroscopically. Dense connective tissues adjacent to the fossa navicularis and spongiosum parts of the glans were cropped, and underwent Masson's trichrome and Verhoeff-Van-Gieson staining. Most (55.5%) of the specimens had distinct fibrous bands toward the distal tips of the glans penis, which elongated from the tunica albuginea of the CC. They comprised longitudinal collagen bundles continuous to the outer longitudinal layer of the tunica albuginea covering the CC and were intermingled with sparse elastic fibres. This architecture either did not reach the distal end of the glans penis (35.5% of cases), or was obscure or dispersed in all directions (9.0% of cases). The structural dimorphism and the variations in the ratio of dense connective tissue components of the fibrous skeleton are considered to contribute to the varying degrees of flexibility, distensibility and rigidity of the human glans penis.
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http://dx.doi.org/10.1111/joa.12896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284436PMC
January 2019

Asymmetric Protrusion of the Midface in Young Adults.

J Craniofac Surg 2018 Nov;29(8):2353-2357

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

Purpose: This study evaluated midfacial asymmetry using an alternative method that involved comparing bilateral patterns of the zygomaticomaxillary prominence in a young adult population.

Materials And Methods: Three-dimensional reconstructed images based on computed tomography scans of 100 Koreans (mean age, 24.7 years) were evaluated with reference to lines spaced at 30° intervals and radiating from the center of an interporion line in a superior view. The surface inclination of the zygomaticomaxillary region was quantified on the same reference lines using a 3-dimensional ruler.

Results: The 30°-interval line (at the level of the zygomaticotemporal suture) was longer on the left side than the right side in both males and females, whereas the left 60°-interval line (at the level of the zygomaticofrontal suture) was longer in females. Comparing the surface protrusion revealed that the zygomaticomaxillary region was more prognathic and inflated on the left side.

Conclusion: Functional deviations are considered to be causes of asymmetric craniofacial growth. Postnatal growth allometry across the circummaxillary sutures as elucidated by this study could be useful information in craniofacial surgery.
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http://dx.doi.org/10.1097/SCS.0000000000004988DOI Listing
November 2018

Effects of ostium granulomas and intralesional steroid injections on the surgical outcome in endoscopic dacryocystorhinostomy.

Graefes Arch Clin Exp Ophthalmol 2018 Oct 1;256(10):1993-2000. Epub 2018 Jun 1.

Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.

Purpose: To determine the effect of granuloma formation in the ostium and intralesional steroid injections (ISIs) on the surgical outcome after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO).

Methods: One hundred and eighty-three cases involving 142 patients were enrolled. The ostium granulomas were classified according to their location relative to the internal common opening (superior, anterior, and posterior positions) and to the vicinity of the ostium (inner, edge, and extra types). If an ostium granuloma was observed during the follow-up and its size increased, ISIs were performed using 0.3 ml of 40 mg/ml triamcinolone acetonide. The surgical outcomes were compared between cases with and without ostium granulomas and also between each granuloma position and type.

Results: Ostium granulomas occurred in 71 (38.8%) of the 183 cases, and an ISI was applied in 65 cases with a mean of 2.1 injections. All of the granulomas regressed successfully after ISIs, with the success rate not differing between the cases with (85.9%) and without (83.9%) granuloma. There was no association between granuloma location and surgical outcome. However, the functional outcome was worse (60%) for inner granulomas (which are located within the ostial base) than for extra (87.8%) and edge (98%) granulomas.

Conclusions: ISIs can be easily applied by a surgeon to help regress an ostium granuloma and improve the ostial patency after DCR. Inner ostium granulomas are associated with a worse functional outcome, and the initiation of an early corrective intervention such as an ISI should be considered.
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http://dx.doi.org/10.1007/s00417-018-4024-7DOI Listing
October 2018

Anatomical Consideration for the Safe Elevation of the Deep Circumflex Iliac Artery in Flap Surgery.

Plast Reconstr Surg 2018 07;142(1):193-201

From the Department of Anatomy and Cell Biology, Dong-A University, College of Medicine; and the Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine.

Background: Deep circumflex iliac artery osteocutaneous flap transfer has frequently been applied to large defects in the maxillary and mandible regions, but the use rate has decreased gradually because of the complicated anatomy of the deep circumflex iliac artery. This study investigated the comprehensive anatomy of the deep circumflex iliac artery in relation to flap surgery with the aim of providing navigational guidelines for safe deep circumflex iliac artery harvesting.

Methods: Sixty-two sides of the hemi-abdominal wall were dissected in fixed Korean cadavers. Several dimensions of the deep circumflex iliac artery and its positional relationships with surgical landmarks were measured, and the patterns of the arterial supply and anastomosis were identified.

Results: The mean distance between the anterior superior iliac spine and the lateral border of the femoral artery was 57.5 mm. The deep circumflex iliac artery generally originated almost at the same level as the inguinal ligament, and its highest level was 14.8 mm superior to that ligament. Emerging points of the ascending branch were observed both medial and lateral to the anterior superior iliac spine, but no transverse branch pierced the transversus abdominis muscle medial to the anterior superior iliac spine.

Conclusions: The incision line for safe deep circumflex iliac artery harvesting was parallel and 2 cm superior to the inguinal ligament and 6 cm from the anterior superior iliac spine. This position of the safe incision line can be easily determined using the thumb. Sex differences in the incidence of the deep circumflex iliac artery originating above or below the inguinal ligament will be another useful guide for easily detecting the deep circumflex iliac artery.
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http://dx.doi.org/10.1097/PRS.0000000000004514DOI Listing
July 2018

Intramuscular Distribution of the Abducens Nerve in the Lateral Rectus Muscle for the Management of Strabismus.

Curr Eye Res 2018 06 15;43(6):689-695. Epub 2018 Feb 15.

b Department of Anatomy, Research Institute of Medical Science , Konkuk University School of Medicine , Seoul , Republic of Korea.

Aims: To elucidate the intramuscular distribution and branching patterns of the abducens nerve in the lateral rectus (LR) muscle so as to provide anatomical confirmation of the presence of compartmentalization, including for use in clinical applications such as botulinum toxin injections.

Methods: Thirty whole-mount human cadaver specimens were dissected and then Sihler's stain was applied. The basic dimensions of the LR and its intramuscular nerve distribution were investigated. The distances from the muscle insertion to the point at which the abducens nerve enters the LR and to the terminal nerve plexus were also measured.

Results: The LR was 46.0 mm long. The abducens nerve enters the muscle on the posterior one-third of the LR and then typically divides into a few branches (average of 1.8). This supports a segregated abducens nerve selectively innervating compartments of the LR. The intramuscular nerve distribution showed a Y-shaped ramification with root-like arborization. The intramuscular nerve course finished around the middle of the LR (24.8 mm posterior to the insertion point) to form the terminal nerve plexus. This region should be considered the optimal target site for botulinum toxin injections. We have also identified the presence of an overlapping zone and communicating nerve branches between the neighboring LR compartments.

Conclusion: Sihler's staining is a useful technique for visualizing the entire nerve network of the LR. Improving the knowledge of the nerve distribution patterns is important not only for researchers but also clinicians to understand the functions of the LR and the diverse pathophysiology of strabismus.
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http://dx.doi.org/10.1080/02713683.2018.1438631DOI Listing
June 2018

Oblique thyroarytenoid muscle in humans: An independent muscle or an accessory belly?

Laryngoscope 2018 Jul 14;128(7):1634-1638. Epub 2018 Jan 14.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

Objectives/hypothesis: This study aimed to determine the prevalence and morphological variations of the oblique thyroarytenoid (TA) muscle in humans.

Study Design: Cadaveric anatomic dissections.

Methods: One hundred hemilarynges from 50 formalin-embalmed cadavers were dissected to investigate the morphology of muscle fibers of the TA muscle.

Results: Thirty-six (36%) hemilarynges were found to have a distinct oblique belly superficial to the TA muscle. In 28 cases, the belly had a relatively constant origin and an insertion that extended straight onto the TA muscle from the anterosuperior area of the internal surface of the thyroid lamina to the base of the muscular process of the arytenoid cartilage. Eight cases were located in a similar area but with some differences in the origin or insertion features.

Conclusions: We proposed that the oblique TA muscle has a high prevalence and probably acts to close and relax the vocal cords. It remains to be determined whether the oblique TA muscle is an independent muscle or an accessory belly of the main TA muscle.

Level Of Evidence: NA. Laryngoscope, 128:1634-1638, 2018.
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http://dx.doi.org/10.1002/lary.27090DOI Listing
July 2018

Macroscopic Innervation of the Dura Mater Covering the Middle Cranial Fossa in Humans Correlated to Neurovascular Headache.

Front Neuroanat 2017 19;11:127. Epub 2017 Dec 19.

Department of Medical Education, Konkuk University School of Medicine, Seoul, South Korea.

The trigeminovascular system within the cranial dura mater is a possible cause of headaches. The aim of this study is to investigate macroscopically dural innervation around the middle meningeal artery (MMA) in the middle cranial fossa. Forty-four sides of the cranial dura overlying the skull base obtained from 24 human cadavers were stained using Sihler's method. Overall, the nervus spinosus (NS) from either the maxillary or mandibular trigeminal divisions ran along the lateral wall of the middle meningeal vein rather than that of the MMA. Distinct bundles of the NS running along the course of the frontal branches of the MMA were present in 81.8% of cases ( = 36). Others did not form dominant nerve bundles, instead giving off free nerve endings along the course of the MMA or dural connective tissue. The distribution of these nerve endings was similar to that of the course of the frontal, parietal and petrosal branches of the MMA (11.4%). The others were not restricted to a perivascular plexus, crossing the dural connective tissues far from the MMA (6.8%). These findings indicate that the NS generally travels alongside the course of the frontal branches of the MMA and terminates in the vicinity of the pterion.
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http://dx.doi.org/10.3389/fnana.2017.00127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742225PMC
December 2017

Surgical anatomy of the superficial temporal artery to prevent facial nerve injury during arterial biopsy.

Clin Anat 2018 May 21;31(4):608-613. Epub 2017 Dec 21.

Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

To investigate the topographical relationship between the frontal branch of the superficial temporal artery (FSTA) and the temporal branch of the facial nerve (TFN) with the aim of preventing nerve injury during FSTA biopsy. Fifty-seven hemifaces of 33 cadavers were dissected. Vertical lines drawn to the lateral orbital margin (LOM) and the superior root of the helix were used as the anterior and posterior reference positions, respectively. Horizontal lines drawn through the supraorbital margin and lateral canthus were used as the superior and inferior reference points, respectively. The depth and course relationships of the FSTA and TFN were examined. Midpoints between the FSTA and TFN are situated approximately 6.0 and 4.5 cm posterior to the lateral orbital margin at the levels of the lateral canthus and supraorbital margin, respectively. The TFN is generally situated 1-2 cm anteriorly and inferiorly to the FSTA in the temporal region. However, in two cases (3.6%), the TFN ran just underneath the FSTA with only a very small safe distance, making it highly vulnerable to iatrogenic injury. In conclusion, when performing an FSTA biopsy, the surgeon should not dissect below the superficial temporal fascia because there is an overlap between the course of the FSTA and the TFN in a minority of cases. Also, surgical incisions should be made outside the area delineated by an oblique line passing through the points 6.0 and 4.5 cm posterior to the lateral orbital margin at the levels of the lateral canthus and the supraorbital margin, respectively. Clin. Anat. 31:608-613, 2018. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23033DOI Listing
May 2018
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