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Characterization of Neck Ligaments
Gehaan D'Souza
Andrew Cho
Edoardo Dalapozzo
James Zins
Cleveland Clinic
2017-02-19
Presenter: Gehaan D'Souza
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: James Zins
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
Background
Although fascial ligaments have been both well defined and described, neck ligaments have not. Understanding the variable location and consistency of these structures is important with regard to surgical execution.
There are two approaches to surgical neck rejuvenation. There are those who prefer the anterior approach to the necklift with dissection of skin from the platysma coupled with a midline platysmaplasty. There are also those that prefer the posterior approach without medial maniuplation. In order to understand the pros and cons of the anterior and posterior neck approaches one must understand the ligamentous anatomy of the neck and its variability.
Methods
7 cadaveric necks were dissected. The platysma mandibular ligament, ear lobe ligament, cervical retaining ligaments, submental ligament, and medial platysma filiaments were dissected.
Results
The ligaments varied considerably in terms laxity. Laxity (height of ligament from bone to skin) of the platysma mandibular ligament varied from 2 mm to 6 mm. The medial platysma cutaneous filament varied from 3mm to 12 mm.
Conclusions
There is a great deal of variability in the ligamentous structure of necks. Some necks have strong adherent ligaments others have ligaments that are lax. The configuration of the medial platysma filiaments, platysma mandibular ligaments, and submental ligaments differed considerably. Without adequate anterior release of all ligaments with dissection of skin from platysma and a submental approach for further medial tightening there is no way for adequate re-draping and platysma tightening. Our dissection advocates the anterior neck approach with release of all neck ligaments and medial platysma tightening.
