Facial Danger Zones: Avoiding Nerve Injury in Facial Plastic Surgery

66 Pages·2010·11.62 MB·English

by  Brooke Seckel

' Thieme

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Second Edition
Brooke R. Seckel, M.D.
Chairman Emeritus
Department of Plastic and Reconstructive Surgery
Lahey Clinic Medical Center
Burlington, Massachusetts
Assistant Professor of Surgery
Harvard Medical School
Boston, Massachusetts
Boston Plastic Surgery Associates
Concord, Massachusetts
ILLUSTRATOR
Anne Beard Greene
I
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To
my wife Debbie
my daughter Laura and
my son Tommy
who are my ultimate joy in life

Preface
The first edition of this book was an injury to these nerves, remains constant.
outgrowth of an invitation by A. Lee Therefore, other than a few editorial revi
Dellon, M.D., to participate in a panel dis sions and a new printing of the illustrations
cussion entitled "Don't Lose Your Nerve" from the original drawings, little has
held at the 1992 Annual Scientific Meeting changed in this edition.
of the American Society of Plastic and Re There has been a remarkable and pre
constructive Surgeons in Washington, D.C. dictable growth in the performance of aes
I was asked to speak on nerve injuries in aes thetic facial rejuvenation procedures. Not
thetic plastic surgery. A review of the litera surprisingly, this surge has paralleled the
ture stimulated further interest and expansion of the aging baby boomer popu
ultimately led to cadaver dissections in the lation in the United States and worldwide.
laboratory and exploration in the operating The expanded pool of patients seeking aes
room in preparation for the panel. I began thetic facial procedures exposes many more
to review not only nerve injuries but also the people to potential facial peripheral nerve
anatomic locations of the most susceptible injury than ever before.
nerve regions and analyze dissection tech New, minimally invasive facial rejuvena
niques to avoid injuries. tion techniques, such as fat grafting, endo
Because I have board certification in scopic procedures, and filler and neurotoxin
neurology as well as plastic surgery, it is not injections, although reducing the size of vis
unusual that I am asked by my plastic sur ible external scars, have also increased the
gery colleagues to evaluate patients when number of blind interventions into the face.
facial nerve injury occurs in the course of These new techniques are done without the
rhytidectomy surgery. benefit and safety of traditional and carefully
Although much has changed in plastic learned surgical exposure of the Facial
surgery since the publication of the first Danger Zones, where extra caution is re
edition of Facial Danger Zones 15 years ago, quired to avoid nerve injury. Performing
the peripheral nerve anatomy of the face, such blind interventions in such a highly in
and the devastating consequences of surgical nervated area without proper knowledge of
Vl1
Preface
continuecC
the underlying neural anatomy and potential against using photographs of patients with
for significantly debilitating injury is, in the facial nerve injuries. Anne Greene's drawings
time-tested phrase, "a prescription for depict the clinical findings in such detail that
disaster." one can easily diagnose a clinical injury from
The knowledge of how to avoid injuring the illustrations reproduced in the book.
the peripheral nerves of the face during sur It is my sincere hope that all who intend
gical or minimally invasive and injection to assume responsibility for performing
procedures is available in the pages of this these procedures on the patients entrusted
short, well illustrated book. to them will take the time to become famil
I have organized the book by assigning iar with this very basic, well delineated, and
numbers in the order in which I enter the important anatomy.
various danger zones in the course of face To my many colleagues whose interest in
lift surgery; that is to say, the first danger this book has led to its continued success, I
zone I see during dissection is danger zone express my sincere gratitude. My hope is
one followed by two, three, four, five, six, that Facial Danger Zones will continue to
and seven. help prevent nerve injury during all facial
Out of respect for the privacy of the pa procedures, and thus benefit our patients
tients and their referring physicians, I decided who we are all most privileged to serve.
BrookeR. Seckel, M.D.
Vlll