ULTRASOUND ANATOMY OF

THE FACIAL DANGER ZONES

ROBERT BARD, MD

DIRECTOR, THE BIOFOUNDATION FOR

ANGIOGENESIS RESEARCH, NY

J. POZNER, MD & L. BASS, MD

PLASTIC SURGERY CENTER, NY

XIMENA WORTSMAN, MD

RADIOLOGIST SANTIAGO, CHILE

IMAGING PARAMETERS

LINEAR ARRAY 14-18 MHZ

3D ARRAY 15-17 MHZ WITH

SURFACE RENDERING DISPLAY

LINEAR ELECTRONIC ARRAY 20-40 MHZ

DOPPLER

COLOR, POWER, SPECTRAL WITH

VESSEL DENSITY HISTOGRAM ANALYSIS

FACIAL NERVE IMAGING

SUPERFICIAL FACIAL NERVES ARE

DIFFICULT TO IMAGE IN STANDARD

CROSS SECTIONS

3D REPRESENTATION OF A SUSPECTED

NERVE WILL VERIFY THE FINDING IF

THE REGION SHOWS CONTINUITY

WITH THE PLANE OF THE NERVE

FIBERS AND FACIAL ARTERIES

IMAGING LANDMARKS

The boney landmarks permit identification of overlying superficial

structures. For example, the zygomatic arch is the upper limit of

the parotid gland, the orbital rims mark the path of the

infra/supraorbital nerves and the mastoid process reveals the

emergence of the facial nerve. Similarly, the foramen imaged as

boney notches afford a window to the orbital and mental nerves

and arteries which run in the subcutaneous tissues.

The SMAS (superficial musculoaponeurotic system) interconnects

the facial and neck musculature. This is divided into two parts: the

superficial SMAS with the arterial supply and the deep SMAS

wherein lie most of the nerves.

3-D VS 2-D SONOGRAM

(#1 has depth of 0.2 mm)

EURO 3D IMAGE

2D CROSS SECTION

LEAD PENCIL TIP SUBCUT

2D

3D

2-D 3-D

nerve

artery

nerve

artery

STERNOCLEIDOMASTOID

Ext Jugular

Vein

greater auricular nerve

MANDIBLE nerve

nerve

CORRUGATOR

FAT

SMAS

nerve

nerve

nerve

MULTIPLE CHOICE QUESTIONS

(ANSWERS NEXT SLIDE)

QUESTION 1

FACIAL NERVE IMAGING IS MOST IMPORTANT TO

a) Neurologist

b) Plastic surgeon

c) Dermatologist

QUESTION 2

FACIAL NERVES ARE FOUND IN

a) Subcutaneous tissues

b) Superficial SMAS

c) Deep SMAS

QUESTION 3

SUPERFICIAL IMAGING IS BEST PERFORMED WITH

a) Curved probe

b) Linear array probe

c) Endfire probe

ANSWERS

Q.1 Plastic surgeon to avoid nerve trauma

Q. 2 Nerves lie in the deep SMAS

Q. 3 Linear array probe, followed by 3D imaging