[Anatomy of the midface]. / Anatomie descriptive du tiers moyen de la face.

The middle third of the face comes in three areas: malar, zygomatic and orbital. Its bone's base, essentially formed by the maxilla and the zygoma, shows an orbital edge whose projection is not flat and offers an integration to the arcus marginalis. The orbicularis oculi muscle (OOM), wide muscular sheet, is held by several ligamentary structures, one of which is the orbicularis retaining ligament (ORL), peripheric around the orbit and by malar septa. The two layers of fat, one superficial and one deep, are split by the OOM. The deep malar fat pad (or suborbicularis oculi fat pad [SOOF]) is compact with the tracti that cover it and acts as a syssarcosis. The superficial malar fat pad is thick and divided by retinaculi cutis. It acts as a buffer zone in the interorificial role allowing different functions like the gradation in the comical expression and the wide opening for the mouth prehension. This anatomic disposition complies with Lambros' clinical observations who noticed few cutaneous moves of the malar area.

[Approach to augmentation mammaplasty]. / Les voies d'abord et les plans de l'augmentation mammaire par prothèse.

The anatomy give a description of the fixation of breast ligaments, on submammary fold, on the vascularisation of the areola-nipple complex and the surgical consequence on sensibility. The innervation areola-nipple complex comes from the 4th lateral cutaneous branch. The sensitive troubles are frequent but compensed by the sensual gratification of the breast. Skin incisions have been analyticly study. Periareolar incision is less pratice than submammary or axillary incision. The concept of adequation parenchyma-implant is fondamental however the pocket is pre- or retropectoral.

[Endoscopic axillary breast augmentation]. / Augmentation mammaire endoscopique par voie axillaire.

Endoscopic axillary breast augmentation combine advantages against few inconvenients. The authors discribe the surgical endoscopic technique and the medical patient management. A study on 48 patients shows the efficiency on quick professional activity (3 days) thanks to the control of inflamatory syndrom with a quick procedure and perioperatoire treatment.

[Anatomy of the superficial parts of the face and neck]. / Anatomie des plans superficiels de la face et du cou.

The author presents four chapters concerning classical anatomy, an anatomical contribution to new facelifts, aesthetic anatomy, which recalls the aesthetic relations of the face, and finally a brief review of the mode of ageing of the face. The embryology of the superficial plane of the face and neck shows that the development of muscles of facial expression, deep and superficial fatty tissues, the facial nerve and the parotid is the result of divergent migratory movements and confluences. The anatomy is discussed in two parts: the first concerns conventional anatomy, and reviews the anatomical data acquired to date, the second proposes anatomical conclusions adapted to new surgical techniques of rejuvenation. The branches of the facial nerve are unusual in terms of their great variability. However, by using anatomical landmarks, it is possible to localize them precisely. The blood supply of the superficial tissues of the face and neck has been the subject of many studies. Deep monoblock facelifts, by sparing the blood supply of certain anatomical planes, allow the perfectly safe creation of extensive skin flaps. Some muscles of the face and neck are useful surgically. The orbicularis oculi muscle is also a muscle of the orbital margins by its depressing action on the eyebrows and levator action on the superficial malar adipose tissue. The corrugator muscle is a central element of new frontal endoscopy techniques. Elevation of the eyebrows is then ensured by the occipitofrontal complex which occupies only the medial two-thirds of the eyebrows. The zygomaticus major muscle must be released over its entire length because excessive traction on a SMAS flap can induce a disorder of facial expression. The platysma muscle plays an increasingly important role in cervical surgery and constitutes the deep guarantee of the cervical corset. The four fixed osteocutaneous points of the face: zygomatic (Mac Gregor), mandibular (Furnas), orbital (Psillakis) and masseteric play an antigravitational and functional role in facial expression. A macroscopic anatomical and histological study, performed on 60 dissections of hemifaces with several preparations defined the anatomy of the superficial musculoaponeurotic system (SMAS), jugomalar adipose planes and the nasolabial fold. The SMAS is a strictly superficial surgical anatomy structure derived from the primitive platysma muscle, and does not possess any bony insertion. It is composed exclusively of platysma and risorius muscles. There is no parotid aponeurosis. The parotid is surrounded by a capsule. Its is limited in depth by the superficial cervical aponeurosis which lines the styloid curtain (Jost, Levet).(ABSTRACT TRUNCATED AT 400 WORDS)

[Contribution of videoendoscopy to the surgery of face rejuvenation]. / L'apport de la vidéo-endoscopie dans la chirurgie du rajeunissement de la face.

After a delay of several years, endoscopic surgery was introduced into cosmetic surgery of the face in 1992. Initially, its indications were very limited as they only concerned resection of corrugator muscles for the treatment of wrinkles between the eyebrows. Today, it has a new lease of life, with the ambition of replacing classical forehead facelift, by constituting a surgical approach. It replaces the bicoronal incision by means of 5 small incisions which allow detachment and resection of the depressor supercilii muscles similar to that obtained via a bicoronal incision. The skin or scalp excess is absorbed by various techniques. However, endoscopy now has other ambitions: functional fronto-orbital surgery. It tries to achieve a new muscular equilibrium by resection of the depressor supercilii muscles and release of the levators: occipitofrontal muscle. In this way, this new technique achieves an entirely natural repositioning of the eyebrow. The authors describe all of the technical possibilities by endoscopy, median frontal endoscopy, endoscopic frontal facelift, endoscopic extraperiosteal masklift and endoscopic subperiosteal masklift, in the case of the forehead. A special technique has been developed: temporomalar facelift. Lastly, although cervicofacial dissection is technically possible using videoendoscopy, there nevertheless remains a major stumbling block: the excess skin. Based on an experience of more than a hundred cases over a period of more than 18 months, this technique provides extremely encouraging results leading the authors to adopt this technique definitively.

[Fractures of the condylar region]. / Fractures de la région condylienne.

Condylar fracture are responsible for: homolateral TMJ disorders following discal apparatus lesions such as: disc displacement, discal lesion, osteoarthrosis of articular surfaces (condylar and temporal), contralateral TMJ disorders, more frequent, with destabilisation of the masticatory apparatus and decrease of ramus height or compensatory hypermobility. Functional treatment can prevent articular and muscular ankylosis. It is often indicated: non-displaced low undercondylar fractures or after surgery. Surgical reduction is indicated in two cases: displaced-low undercondylar fracture. The discal apparatus is intact and function usually excellent, displaced-high undercondylar fractures with 90 degrees head luxation. The bone reduction and contention must be associated to discal apparatus control. If dislocated or displaced, the apparatus should be replaced and sutured. Four factors are implicated in articular function: the fracture position, bone displacement (condylar head in or out of the glenoid fossa), discal apparatus integrity (the lower layer of the retrodiscal tissue is involved in bone regeneration especially in infants), and the quality of occlusion.

[Enophthalmos of the enucleated eye]. / Enophtalmie de l'énucléé.

Even when it is corrected by an ocular prosthesis, enucleation often causes enophthalmos. After studying the integrality of the walls of the orbits with CT, the presence and position of the intraorbital implant must be controlled and the enophthalmos treated by compensating for the residual volume loss of the orbital content (bone or biomaterials) and, sometimes, filling up the upper palpebral space (dermal graft, galea flaps or biomaterials). The retraction of palpebral scars limits the possibilities of correction.