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The first 25 slides, exactly as they appear. The full deck has 99 content slides.
Maxillofacial Surgery
Submental-Cervical Region
Built from Facial Aesthetics — Concepts and Clinical Diagnosis
What’s inside
13 sections · 99 slides
Overview
- What this covers
Why this region matters
A small area that changes the whole lower face
- What the submental-cervical region is
- Why it is never judged alone
Anatomy
What lies between the skin of the neck and the floor of the mouth
- Where the neck begins
- The layers under the chin
- Submental anatomy and its muscle attachments
- From skin down to the mouth
- The platysma
- The sternocleidomastoid
Terminology
Agree the landmarks before quoting any number
- Why the words confuse everyone
- Cervical point, or C-point
- The submental plane
- The cervical plane
- Submental plane, cervical plane and cervical point
- Building the analysis, one landmark at a time
- The word roots, decoded
- The cervicomental angle trap
What creates a poor contour
Skin, fat, muscle, gland, jaw and hyoid - any of them can be the culprit
- The parameters that decide the shape
- Why a submental-cervical contour goes wrong
- Excess skin and excess fat
- Muscle and gland
- Jaw position: deficiency
- Jaw position: rotation
Clinical evaluation
What to look at, what to feel, and in what head position
- Start in natural head position
- The evaluation checklist
- Skeletal pattern: look, then posture
- Class II jaw relationship with an increased submental-cervical angle
- Reading the posturing test
- Posturing the mandible forward stretches the submental tissues
- When surgery makes it worse
- The skin laxity test
- Skin laxity test
- Platysma tone and the midline
- The platysma view
- Contracting the platysma to reveal its borders
- Platysmal bands in an ageing neck
- Submental adiposity
- Fat accumulation under the chin
- The submental pinch test
- Where does the submental fat sit?
- The inferior border of the mandible
- The hourglass in frontal view
- Hourglass transition from neck to jawline
- Submandibular gland position
- Treating submandibular fullness
- Six visual criteria for a youthful neck: 1 to 3
- Six visual criteria for a youthful neck: 4 to 6
- Visual criteria for a youthful neck, seen in profile
The submental-facial angle
Six ways to measure it, and six different normal values
- One angle, several definitions
- Submental-facial angles: methods of evaluation
- Submental-facial angles: further methods of evaluation
- Submental plane to facial plane
- The lower face-throat angle
- Chin tangent and lower lip versions
- E-line and subnasale vertical versions
- The 'ideal' measurement
- Submental plane against true vertical and true horizontal
- Submental plane close to true horizontal
- Submental plane inclined away from true horizontal
Submental length
How long the floor under the chin should be
- What submental length is
- Reduced and increased submental length
- Normal values, and why they differ
- Proportions instead of millimetres
- Submental length matched to orbital depth and lower lip-chin height
- The lower vertical height-depth ratio
- Lower vertical height-depth ratio
- Submental length and jaw surgery
- What raters thought of varying lengths
- When raters would suggest surgery
The submental-neck angle
The single most quoted number in this region
- What the submental-neck angle describes
- The published numbers
- How raters judged the angle
- Thresholds for wanting surgery
- The submental-sternomastoid angle
Deep parameters
Soft tissue thickness and the position of the hyoid bone
- Measuring submental soft tissue thickness
- Normative submental soft tissue thickness
- Where submental soft tissue thickness is measured
- Why the hyoid bone matters
- Hyoid anatomy at the bedside
- Above and below the hyoid
- Judging hyoid position: vertical
- Judging hyoid position: sagittal
- Hyoid bone position in a normal attractive neck
- What holds the hyoid where it is
- When the hyoid is the cause
Management
Match the operation to the factor that is actually at fault
- The usual picture
- When the hyoid is the problem
- Submental suprahyoid myotomy
- Suprahyoid myotomy relocates the hyoid bone
- Obtuse angle from a low, forward hyoid
- After suprahyoid myotomy
The region in context
How the neck changes the way the rest of the profile is read
- Five interrelated facial prominences
Take-home points
What to carry out of this topic
- Landmarks and words
- The numbers worth keeping
- In clinic
- References
- References (continued)
- References (continued)
- Facial Aesthetics: Concepts and Clinical Diagnosis, 2nd Edition