The Sentinel Fat Pads: The Relationship of the ROOF and SOOF to the Temporal Nerve in Facial Rejuvenation

Singh, Devinder P.; Forte, Antonio J.; Apostolides, John G.; Stromberg, Jeffrey A.; Zahiri, H. Reza; Alonso, Nivaldo; Persing, John A.

doi:10.1177/1090820x10391395

Cited by 11 publications

(10 citation statements)

References 22 publications

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“…This is in agreement with several previous anatomic studies that found 1 to 4 branches of the temporal branch of median nerve with a median of 3 branches. 2,9,15,16,12,14,17,18,4,19,20,5,6,21 In the temporal region, the layer of the temporal fascia in which the TBFN lies is another controversial and perplexing topic. We found 21 studies that looked at the course of TBFN in the temporal region.…”

Section: Discussionmentioning

confidence: 99%

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

Hashmi

Zahed

Hamamdjian

et al. 2021

Journal of Craniofacial Surgery

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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 þ/-0.69 cm superior and 2.54 þ/-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.

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Section: Discussionmentioning

confidence: 99%

“…Nerve was reported to be either within the deepest part of TPF or deep to the TPF, in all studies. 10,22,11,2,23,14,7 Abul-Hassan et al 10 reported that it was found deep to the TPF in a pocket of fat between superficial and deep layer of deep temporal fascia. Above the zygomatic arch, it was most commonly found deep to the TPF.…”

Section: Discussionmentioning

confidence: 99%

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

Hashmi

Zahed

Hamamdjian

et al. 2021

Journal of Craniofacial Surgery

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“…However, this description was based on intraoperative findings, and the limited operative field prevented the anatomy of the ROOF from being fully explored (15). The relationships between the ROOF layer and other important structures in the periorbital region, including lateral orbital thickening, deep temporal fascia, and the zygomatio-temporal nerve, have only recently been elucidated (16).…”

Section: Discussionmentioning

confidence: 99%

Investigation of retro-orbicularis oculi fat and associated orbital septum connective tissues in upper eyelid surgery

Chun

Zhang

et al. 2020

Ann Palliat Med

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Background: To study the anatomical characteristics of retro-orbicularis oculi fat (ROOF) in the upper eyelid and to investigate its relevance in upper eyelid surgery.Methods: Thirty-eight Chinese hemifacial cadaver specimens were used. Several sagittal plane section planes were recorded from the medial canthus to the lateral canthus of the eyelid after P45 sheet plastination.ROOF and the associated orbital septum connective tissues in the 38 hemifaces were studied. According to the anatomic results, the lowest point of the junction of the orbital septum and the ROOF (SRJ) was raised for surgical dissection. We improved the intraoperative management of patients who underwent upper eyelid surgery in the plastic surgery department of the First Affiliated Hospital of Dalian Medical University in 2019. Patients were evaluated by observation and self-assessment.Results: ROOF is fascia adipose tissue. In the upper portion of upper eyelid, ROOF fibers were observed to be extremely dense and continuous with the fascia on the surfaces of orbicularis oculi muscle, the periosteum of the orbital margin, and the orbital septum. In the middle portion, positional relationships were identified between the lowest point of the SRJ and the lowest point of the junction of the orbital septum and the levator palpebrae superioris (SAJ). Lifting the SRJ significantly increased the upper eyelid reflex distance in all 57 patients. Conclusions: ROOF is an important factor in upper eyelid surgery. Lifting the SRJ effectively improves the retraction force of the levator palpebrae superioris muscle (LPS)

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“…10,11,21 More recent reports, however, have confirmed the frontal branch to have between two and five rami crossing the central third to half of the zygomatic arch. 14,17,21 Moreover, some of these reports have found that there is arborization between the various rami of the frontal nerve but not with other branches of the facial nerve. 14 Nevertheless, the interconnections between the rami can likely explain the return of function by 6 months often seen after inadvertent injury.…”

Section: Frontal Branch Anatomymentioning

confidence: 98%

“…26,27 In a recent article, Singh et al described the depth of the nerve relative to the sub-orbicularis oculi fat pad and retro-orbicularis oculi fat pad. 28 They found that the frontal branch passes lateral to the suborbicularis oculi fat pad and lies just superficial to the retro-orbicularis oculi fat pad and therefore dissection deep to this plane would keep the nerve protected. The retro-orbicularis oculi fat pad is contiguous with the sub-SMAS fat, therefore again confirming the safety of dissection deep to loose areolar tissue just above the deep temporal fascia.…”

Section: Frontal Branch Anatomymentioning

confidence: 99%

Anatomical Considerations to Prevent Facial Nerve Injury

Roostaeian

Rohrich

Stuzin

2015

Plastic and Reconstructive Surgery

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Injury to the facial nerve during a face lift is a relatively rare but serious complication. A large body of literature has been dedicated toward bettering the understanding of the anatomical course of the facial nerve and the relative danger zones. Most of these prior reports, however, have focused on identifying the location of facial nerve branches based on their trajectory mostly in two dimensions and rarely in three dimensions. Unfortunately, the exact location of the facial nerve relative to palpable or visible facial landmarks is quite variable. Although the precise location of facial nerve branches is variable, its relationship to soft-tissue planes is relatively constant. The focus of this report is to improve understanding of facial soft-tissue anatomy so that safe planes of dissection during surgical undermining may be identified for each branch of the facial nerve. Certain anatomical locations more prone to injury and high-risk patient parameters are further emphasized to help minimize the risk of facial nerve injury during rhytidectomy.

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The Sentinel Fat Pads: The Relationship of the ROOF and SOOF to the Temporal Nerve in Facial Rejuvenation

Cited by 11 publications

References 22 publications

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

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

Investigation of retro-orbicularis oculi fat and associated orbital septum connective tissues in upper eyelid surgery

Anatomical Considerations to Prevent Facial Nerve Injury

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