Review of the Nomenclature of the Retaining Ligaments of the Cheek: Frequently Confused Terminology

Since the time of its inception within facial anatomy, wide variability in the terminology as well as the location and extent of retaining ligaments has resulted in confusion over nomenclature. Confusion over nomenclature also arises with regard to the subcutaneous ligamentous attachments, and in the anatomic location and extent described, particularly for zygomatic and masseteric ligaments. Certain historical terms—McGregor's patch, the platysma auricular ligament, parotid cutaneous ligament, platysma auricular fascia, temporoparotid fasica (Lore's fascia), anterior platysma-cutaneous ligament, and platysma cutaneous ligament—delineate retaining ligaments of related anatomic structures that have been conceptualized in various ways. Confusion around the masseteric cutaneous ligaments arises from inconsistencies in their reported locations in the literature because the size and location of the parotid gland varies so much, and this affects the relationship between the parotid gland and the fascia of the masseter muscle. For the zygomatic ligaments, there is disagreement over how far they extend, with descriptions varying over whether they extend medially beyond the zygomaticus minor muscle. Even the ‘main’ zygomatic ligament's denotation may vary depending on which subcutaneous plane is used as a reference for naming it. Recent popularity in procedures using threads or injectables has required not only an accurate understanding of the nomenclature of retaining ligaments, but also of their location and extent. The authors have here summarized each retaining ligament with a survey of the different nomenclature that has been introduced by different authors within the most commonly cited published papers.

Duration of External Bleeding For Venous Connection in Fingertip Replantation

To overcome venous congestion in fingertip replantation, we have used "salvage procedure" which consists of continuous external bleeding via a stab incision on paraungal area and dripping of heparinized saline solution at the incision site to maintain external bleeding. As this method requires continuous bleeding for a certain period of time, it may be a great burden for patients, therefore it is most important to minimize the duration of bleeding for patients. Many authors have studied on the new venous channel formation of the flap. However, to our knowledge a study on the new vascular connection in fingertip replantation has not yet been carried out. Between January of 1994 to August of 1999, we performed replantations for 60 fingers in 59 patients using our salvage procedure in the Korea University Guro Hospital. Among 60 cases, 49 cases were survived including partial necrosis. We reviewed medical records of these 49 cases retrospectively. We compared and analyzed the period of external bleeding according to sex, age, level, cause of amputation, and the type of injury. The average period of the salvage procedure was K4 days. 6.0 days was required for the patients under the age of 10, and 7.6 days for the teens, which were the shortest salvage period groups. Based on the types of injuries, it is shorter in guillotine injury group (6.9 days) than in crush (9.0 days) or avulsion (K7 days) groups. On the other hand, the sex and level of injury did not show much difference in the duration of the procedure.