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CERVICOPLASTIAMAURICIO RODRIGUEZ URREA
Cirugía Plástica, Reconstructiva y estética
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CONTENIDO1. Objetivos
2. Introducción.
3. Anatomía funcional
4. Examen físico
5. Técnica Quirúrgica
6. Complicaciones.
7. Conclusiones.
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OBJETIVOS
Conocer las estructuras que modifican
el contorno del cuello y como
corregirlas a través de una
cervicoplastia
Conocer los planos anatómicos para
evitar lesionar el nervio facial
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INTRODUCCIÓN
Ángulo mentocervical
Contorno suave
Ritidoplastia asociada
CHAPTER 20 – Deep plane procedures in the neck
Adam Bryce Weinfeld, Foad Nahai. Section 4 – The neck.
Aesthetic Plastic Surgery. Aston.2009
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ANATOMÍA QUIRÚRGICASMAS Y NERVIO FACIAL
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LIGAMENTOS Y PLANOS
QUIRÚRGICOS
Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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SMAS
fassdFascia
temporo
parietal
Cori A. Agarwal, M.D. Shaun D. Mendenhall, III, M.S The Course of the Frontal Branch of the Facial Nerve in Relation to Fascial Planes:
An Anatomic Study Plast. Reconstr. Surg. 125: 532, 2010
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SMASFASCIA
TEMPOROPARIETAL
Cori A. Agarwal, M.D. Shaun D. Mendenhall, III, M.S The Course of the Frontal Branch of the Facial Nerve in Relation to Fascial Planes:
An Anatomic Study Plast. Reconstr. Surg. 125: 532, 2010
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PLATISMA
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FASCIA PAROTIDA MASETERINA
Cori A. Agarwal, M.D. Shaun D. Mendenhall, III, M.S The Course of the Frontal Branch of the Facial Nerve in Relation to Fascial Planes:
An Anatomic Study Plast. Reconstr. Surg. 125: 532, 2010
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FASCIA CERVICAL PROFUNDA
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DONDE ESTA EL NERVIO FACIAL?
RAMA FRONTAL:
Fascia parotidea- periostio a. Cigomático- fascia
temporoparietal
RAMAS: CIGOMÁTICA, BUCAL
Fascia parotidomaseterina
RAMA MARGINAL Y CERVICAL
Fascia cervical profunda.
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NERVIO OCCIPITAL MENOR
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N. AURICULAR MAYOR
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N. CERVICAL TRANSVERSO
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ANATOMÍA QUIRÚRGICACERVICAL
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PLANOS
Nahai F. The Art of Aesthetic Surgery Principles and Techniques: Applied Anatomy of the Face and Neck. Vol II; Pag 827-896.
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PLANOS
Nahai F. The Art of Aesthetic Surgery Principles and Techniques: Applied Anatomy of the Face and Neck. Vol II; Pag 827-896.
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PLANOS
Nahai F. The Art of Aesthetic Surgery Principles and Techniques: Applied Anatomy of the Face and Neck. Vol II; Pag 827-896.
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PLATISMA
I: 75%, interdigitación 1-2cm sínfisis
II: 15% sínfisis hasta tiroides
III: 10% No interdigitación
Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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M. DIGÁSTRICO
Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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Cara Posterior: Art y vena
Facial.
Cara superior: N. Marginal
mandibular.
Cara medial Prof: N.
Lingual, N. hipogloso.
Resección intracapsular.
Hipertrofia.
CHAPTER 20 – Deep plane procedures in the neck
Adam Bryce Weinfeld, Foad Nahai. Section 4 – The neck.
Aesthetic Plastic Surgery. Aston.2009
GLÁNDULA SUBMANDIBULAR
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EXAMEN FÍSICO
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• Ángulo de 90 a 100°
• Borde mandibular definido
• Depresión subtiroidea
• Cartílago tiroides visible
• Borde anterior del ECM visible
Stephen Prendiville, MD; Mimi S. Kokoska, MD; Christopher S. Hollenbeak, PhD; A Comparative Study of Surgical Techniques
on the Cervicomental Angle in Human Cadavers Arch Facial Plast Surg. 2002;4:236-242
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Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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Triangulo submandibular.
Balotéo de la glándula
CHAPTER 20 – Deep plane procedures in the neck
Adam Bryce Weinfeld, Foad Nahai. Section 4 – The neck.
Aesthetic Plastic Surgery. Aston.2009
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CLASIFICACIÓN DE DEDO
Dedo DD. “How I do it”—plastic surgery: practical suggestions on facial plastic surgery: a preoperative classification of the
neck for cervicofacial rhytidectomy. Laryngoscope. 1980;90:1894-1896
CLASE I: BUENA DEFINICIÓN
CLASE II: PIEL LAXA, MÚSCULO FIRME
I II
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CLASE II
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CLASIFICACIÓN DE DEDO
CLASE III: GRASA SUBCUTANEA. PIEL Y MÚSCULO
ADECUADO
CLASE IV: DEHISCENCIA PLATISMA, BANDAS
III IV
Dedo DD. “How I do it”—plastic surgery: practical suggestions on facial plastic surgery: a preoperative classification of the
neck for cervicofacial rhytidectomy. Laryngoscope. 1980;90:1894-1896
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CLASE III
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CLASE IV
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CLASIFICACIÓN DE DEDO
Dedo DD. “How I do it”—plastic surgery: practical suggestions on facial plastic surgery: a preoperative classification of the
neck for cervicofacial rhytidectomy. Laryngoscope. 1980;90:1894-1896
V
CLASE V: RETROGNATIA
CLASE VI: POSICION ANORMAL DE HIOIDES (COMPROMETE
RESULTADO)
VI
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CLASE V
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PROCEDIMIENTOS
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SUBMENTOPLASTIA DIRECTA
John B. Bitner, MD; Oren Friedman, MD; Richard T. Farrior, MD Direct Submentoplasty for Neck
Rejuvenation Arch Facial Plast Surg. 2007;9:194-200
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SUBMENTOPLASTIA DIRECTA
John B. Bitner, MD; Oren Friedman, MD; Richard T. Farrior, MD Direct Submentoplasty for Neck
Rejuvenation Arch Facial Plast Surg. 2007;9:194-200
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DESVENTAJAS:
Modificación pequeña
Cicatriz central
No ritidoplastia
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SUSPENSIÓN DE MÚSCULO PLATISMA
Corrección anatómica
Mejor resultado en combinación con ritidoplastia
Plano de disección subplatisma (subSMAS)
Riesgo de lesión neurovascular?
Abordaje retroauricular.
Fijar a periostio de mastoides
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SUSPENSIÓN DE MÚSCULO PLATISMA
Liposucción de tejido adiposo preplastimal con
definición del borde mandibular
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Warren R, Aston S, Mendelson B. Face Lift. Plastic and Reconstructive Surgery. 2011; 128: 147-764.
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Warren R, Aston S, Mendelson B. Face Lift. Plastic and Reconstructive Surgery. 2011; 128: 147-764.
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Warren R, Aston S, Mendelson B. Face Lift. Plastic and Reconstructive Surgery. 2011; 128: 147-764.
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Warren R, Aston S, Mendelson B. Face Lift. Plastic and Reconstructive Surgery. 2011; 128: 147-764.
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Warren R, Aston S, Mendelson B. Face Lift. Plastic and Reconstructive Surgery. 2011; 128: 147-764.
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Rohrich R, Stuzin J,. Five-step neck lift: intergrating Anatomy with Clinical Practice to Optimize Results Plast. Reconst.
Surg. Aug. 2013
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CERVICOPLASTIA PROFUNDA
1. Infiltración subcutánea.
2. Incisión transversa submental 3 a 5 cm
1. Colgajo piel grueso.
2. Cartílago tiroides.
3. Ligamentos retención mandibular.
3. Resección grasa preplatismal
Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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CERVICOPLASTIA PROFUNDA
Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas
S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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CERVICOPLASTIA PROFUNDA
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CERVICOPLASTIA PROFUNDA
GLÁNDULA SUBMANDIBULAR
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CERVICOPLASTIA PROFUNDA
GLÁNDULA SUBMANDIBULAR
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CERVICOPLASTIA PROFUNDA
PLICATURAS
Rohrich R, Stuzin J,. Five-step neck lift: intergrating Anatomy with Clinical Practice to Optimize Results Plast. Reconst.
Surg. Aug. 2013
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CERVICOPLASTIA PROFUNDA
Disminuye recurrencia de bandas
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CUIDADOS POP
Observación pop inmediato
Vendaje de 2 a 5 días retiro de drenes
Sólo noche 10 días
Cuello levemente extendido
Flexión aumenta edema. (obstrucción
venas)
Rohrich R, Stuzin J,. Five-step neck lift: intergrating Anatomy with Clinical Practice to Optimize Results Plast. Reconst.
Surg. Aug. 2013
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COMPLICACIONES AGUDAS
Hematoma
3%.
Drenaje con jeringa.
Agudos de expansión
Emergencia.
Obstrucción vía aérea.
Necrosis piel.
Seroma
Post-edema.
Aspiración regular.
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COMPLICACIONES AGUDAS
Sialoma (ant. Resección)
Aumento con las comidas
Dren
Antisialogogos
Lesión de rama marginal mandibular
Depresor anguli oris y mentalis (1 a 90 días)
Caída de labio inf.
Comisura labial.
Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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COMPLICACIONES CRÓNICAS
Irregularidad de contorno
Exceso de resección
Adherencias
Deformidad dinámica
Falta de resección
Digástrico
Plano profundo
Aesthetic Plastic Surgery. Sherrell J. Aston, Douglas S. Steinbrech, Jennifer L. Walden, Elsevier 2009
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ALGORITMO
NO TRATAMIENTO
CLASE I:
BUENA DEFINICIÓN
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ALGORITMO
LIPOSUCCIÓN +
RITIDOPLASTIA
CLASE II
PIEL LAXA, MÚSCULO FIRME
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ALGORITMO
LIPOSUCCIÓN
CERVICOPLASTIA PROFUNDA
CLASE III:
GRASA SUBCUTANEA.
PIEL Y MÚSCULO ADECUADO
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ALGORITMO
LIPOSUCCIÓN+ LIPOSUCCIÓN+
CERVICOPLASTIA PROFUNDA SUSPENSIÓN DE PLATISMA
RITIDOPLASTIA RITIDOPLASTIA
CLASE IV:
DEHISCENCIA PLATISMA
BANDAS
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ALGORITMO
CIRUGÍA ORTOGNATICA Y/O MENTOPLASTIA
CLASE V:
RETROGNATIA
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CONCLUSIONES
El conocimiento de la anatomía permite realizar
técnicas con bajo riesgo de complicaciones y
optimiza resultados con apariencia natural.
La mejor herramienta para la elecci’on de un
procedimiento quirúrgico, es un buen diagnóstico,
individualizando necesidades
Se recomienda no realizar ritidoplastia sin
cervicoplastia y viceversa
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BIBLIOGRAFÍA
Aesthetic Plastic Surgery. Sherrell J. Aston,
Douglas S. Steinbrech, Jennifer L. Walden, Elsevier
2009
Rohrich R, Stuzin J,. Five-step neck lift:
intergrating Anatomy with Clinical Practice to
Optimize Results Plast. Reconst. Surg. Aug. 2013
Warren R, Aston S, Mendelson B. Face Lift. Plastic
and Reconstructive Surgery. 2011; 128: 147-764.
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BIBLIOGRAFÍA
John B. Bitner, MD; Oren Friedman, MD; Richard T. Farrior, MD
Direct Submentoplasty for Neck Rejuvenation Arch Facial
Plast Surg. 2007;9:194-200
Stephen Prendiville, MD; Mimi S. Kokoska, MD; Christopher S.
Hollenbeak, PhD; A Comparative Study of Surgical Techniques
on the Cervicomental Angle in Human Cadavers Arch Facial
Plast Surg. 2002;4:236-242
Dedo DD. “How I do it”—plastic surgery: practical suggestions
on facial plastic surgery: a preoperative classification of the
neck for cervicofacial rhytidectomy. Laryngoscope.
1980;90:1894-1896
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BIBLIOGRAFÍA
Adam Bryce Weinfeld, Foad Nahai, CHAPTER 20 –
Deep plane procedures in the neck. Section 4 –
The neck. Aesthetic Plastic Surgery. Aston.2009
Cori A. Agarwal, M.D. Shaun D. Mendenhall, III, M.S
The Course of the Frontal Branch of the Facial
Nerve in Relation to Fascial Planes: An Anatomic
Study Plast. Reconstr. Surg. 125: 532, 2010
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GRACIAS!