Öz
Aim: Modiolus is a dense, mobile fibromuscular structure lateral to the mouth corner. It is of great importance in aesthetic and reconstructive surgery. The aim of this study was to enlighten the structural changes in modiolus with demographic variables such as age and gender in living individuals.
Methods: This retrospective cohort study was conducted on MR images of healthy individuals. Age and sex-related changes in modiolus level and volume were retrospectively analyzed in 64 patients [37M; 27F; mean age 48.2(16.3)] who underwent head and neck magnetic resonance imaging. ROC analysis was performed to determine the cut off values for age of modiolus. Correlation analysis (Pearson and point biserial correlation) was used to determine whether there was a significant correlation between age and volume. Significance of the differences between the volumes of right and left modiolus of the same individual were evaluated by dependent t tests.
Results: The mean volume of the modiolus was calculated as 0.51(0.26) mm3. The volumes of right and left modioli decreased by aging. Ninety-one percent of the patients with modioli located inferior to horizontal line were over 49 years old. Right and left modioli relocated inferior to horizontal line with age. Modiolus volume was prominently less in women and the downward displacement of modiolus in women was 3.3 times higher than in men. Gender and age had significant effects on modiolus level. The right and left modiolus volumes were similar (P=0.975).
Conclusion: Surgeon’s knowledge on modiolus and its relations will provide benefit, not only for the procedures such as face lifting and botulinum toxin injection, but also for the surgeries of facial paralysis and trauma patients.
Anahtar Kelimeler
Modiolus Magnetic resonance imaging Radiologic anatomy Senile changes Aging
Kaynakça
- 1. Kim HS, Pae C, Bae JH, Hu KS, Chang BM, Tansatit T, et al. An anatomical study of the risorius in Asians and its insertion at the modiolus. Surg Radiol Anat. 2015;37(2):147-51.
- 2. Yu SK, Lee MH, Kim HS, Park JT, Kim HJ, Kim HJ. Histomorphologic approach for the modiolus with reference to reconstructive and aesthetic surgery. J Craniofac Surg. 2013;24(4):1414-7.
- 3. Zufferey JA. Importance of the modiolus in plastic surgery. Plast Reconstr Surg. 2002;110(1):331-4.
- 4. Al-Hoqail RA, Abdel Meguid EM. An anatomical and analytical study of the modiolus: enlightening its relevance to plastic surgery. Aesthetic Plast Surg. 2009;33(2):147-52.
- 5. Onderoğlu S. Topographical relations of the facial artery in the region of the modiolus anguli oris. Okajimas Folia Anat Jpn. 1999;76(2-3):141-7.
- 6. Ahn HJ, Ho-Jung Cho HJ, Nam YS, Han SH, Chung IH, Kim IB. The Location of the Modiolus in Living Korean. Korean J Phys Anthropol. 2009;26(4):141-6.
- 7. Zufferey JA. Modiolus: dynamic angular stone of the nasolabial fold. Eur J Plast Surg. 2003;25:352–6.
- 8. Marinetti CJ. The lower muscular balance of the face used to lift labial commissures. Plast Reconstr Surg. 1999;104(4):1153-62.
- 9. Demiryurek D, Bayramoglu A, Erbil KM. Three-dimensional structure of the modiolus. A computerized reconstruction study. Saudi Med J. 2003;24:846-9.
- 10. Standring S. Gray’s anatomy: the anatomical basis of clinical practice, Churchill Livingstone Spain: Elsevier;2008. p.495-498.
- 11. Choi YJ, Kim JS, Gil YC, Phetudom T, Kim HJ, Tansatit T, et al. Anatomical considerations regarding the location and boundary of the depressor anguli oris muscle with reference to toxin injection. Plast Reconstr Surg. 2014;134(5):917-21.
- 12. Brandt F, Bassichis B, Bassichis M, O'Connell C, Lin X. Safety and effectiveness of small and large gel-particle hyaluronic acid in the correction of perioral wrinkles. J Drugs Dermatol. 2011;10(9):982-7.
- 13. Kwak HH, Hu KS, Youn KH, Jin GC, Shim KS, Fontaine C, et al. Topographic relationship between the muscle bands of the zygomaticus major muscle and the facial artery. Surg Radiol Anat. 2006;28:477-80.
- 14. Otero_Rivas MM, Alonso-Alonso T, Perez-Bustillo A, Rodriguez-Prieto MA. Reconstruction of Surgical Defects of the Labial Commissure. Actas Dermosifiliogr. 2015;106(9):49-54.
- 15. Robotti E, Righi B, Carminati M, Ortelli L, Bonfirraro PP, Devalle L, et al. Oral commissure reconstruction with orbicularis oris elastic musculomucosal flaps. J Plast Reconstr Aesthet Surg. 2010;63:431-9.
Öz
Amaç: Modiolus, ağız köşesinin lateralinde yoğun, hareketli, fibromüsküler bir yapıdır. Estetik ve rekonstrüktif cerrahide büyük öneme sahiptir. Çalışmanın amacı; yaş ve cinsiyet gibi demografik değişkenlere bağlı olarak modiolusta oluşan yapısal değişikleri göstermektir.
Yöntemler: Bu çalışma sağlıklı bireylerin MR görüntülerinden retrospektif kohort çalışması olarak tasarlanmıştır. Modiolus düzeyinde ve hacminde yaş ve cinsiyete bağlı oluşan değişiklikler, baş ve boyun manyetik rezonans görüntülemesi yapılan 64 hastada [37E; 27K; ort. yaş 48,2(16,3)] retrospektif olarak incelendi. Yaşta cut off değerini belirlemek için ROC analizi yapıldı. Yaş ve hacim arasında anlamlı bir korelasyon olup olmadığı korelasyon analizi (Pearson ve point biserial korelasyon) ile değerlendirildi. Aynı bireyin sağ ve sol modiolus hacimleri arasındaki önemli farklar dependent t testi ile yapıldı.
Bulgular: Modiolusun ortalama hacmi 0,51(0,26) mm3 bulundu. Sağ ve sol modiolus hacimleri yaş ile azalmıştır. Modiolus seviyesi horizontal hattın altında olan hastaların %91’i 49 yaşın üzerindeydi. Sağ ve sol modiolus, yaşlanma ile birlikte horizontal çizginin altına yer değiştirdi. Kadınlarda modiolus hacmi belirgin olarak daha azdı ve kadınlarda modiolusun aşağı doğru yer değiştirmesi, erkeklerden 3,3 kat daha yüksekti. Cinsiyet ve yaşın modiolus seviyesi üzerinde önemli etkisi vardı. Sağ ve sol hacim ölçümleri arasında istatistiksel fark bulunamadı (P=0,975).
Sonuç: Cerrahın modiolus ve komşulukları hakkındaki bilgisi sadece yüz germe ve botulinum toksin enjeksiyonu gibi prosedürler için değil ayrıca facial paralizi ve travma hastalarının ameliyatları için de fayda sağlayacaktır.
Anahtar Kelimeler
Modiolus Manyetik rezonans görüntüleme Radyolojik anatomi Yaşlılık değişiklikleri Yaşlanma
Kaynakça
- 1. Kim HS, Pae C, Bae JH, Hu KS, Chang BM, Tansatit T, et al. An anatomical study of the risorius in Asians and its insertion at the modiolus. Surg Radiol Anat. 2015;37(2):147-51.
- 2. Yu SK, Lee MH, Kim HS, Park JT, Kim HJ, Kim HJ. Histomorphologic approach for the modiolus with reference to reconstructive and aesthetic surgery. J Craniofac Surg. 2013;24(4):1414-7.
- 3. Zufferey JA. Importance of the modiolus in plastic surgery. Plast Reconstr Surg. 2002;110(1):331-4.
- 4. Al-Hoqail RA, Abdel Meguid EM. An anatomical and analytical study of the modiolus: enlightening its relevance to plastic surgery. Aesthetic Plast Surg. 2009;33(2):147-52.
- 5. Onderoğlu S. Topographical relations of the facial artery in the region of the modiolus anguli oris. Okajimas Folia Anat Jpn. 1999;76(2-3):141-7.
- 6. Ahn HJ, Ho-Jung Cho HJ, Nam YS, Han SH, Chung IH, Kim IB. The Location of the Modiolus in Living Korean. Korean J Phys Anthropol. 2009;26(4):141-6.
- 7. Zufferey JA. Modiolus: dynamic angular stone of the nasolabial fold. Eur J Plast Surg. 2003;25:352–6.
- 8. Marinetti CJ. The lower muscular balance of the face used to lift labial commissures. Plast Reconstr Surg. 1999;104(4):1153-62.
- 9. Demiryurek D, Bayramoglu A, Erbil KM. Three-dimensional structure of the modiolus. A computerized reconstruction study. Saudi Med J. 2003;24:846-9.
- 10. Standring S. Gray’s anatomy: the anatomical basis of clinical practice, Churchill Livingstone Spain: Elsevier;2008. p.495-498.
- 11. Choi YJ, Kim JS, Gil YC, Phetudom T, Kim HJ, Tansatit T, et al. Anatomical considerations regarding the location and boundary of the depressor anguli oris muscle with reference to toxin injection. Plast Reconstr Surg. 2014;134(5):917-21.
- 12. Brandt F, Bassichis B, Bassichis M, O'Connell C, Lin X. Safety and effectiveness of small and large gel-particle hyaluronic acid in the correction of perioral wrinkles. J Drugs Dermatol. 2011;10(9):982-7.
- 13. Kwak HH, Hu KS, Youn KH, Jin GC, Shim KS, Fontaine C, et al. Topographic relationship between the muscle bands of the zygomaticus major muscle and the facial artery. Surg Radiol Anat. 2006;28:477-80.
- 14. Otero_Rivas MM, Alonso-Alonso T, Perez-Bustillo A, Rodriguez-Prieto MA. Reconstruction of Surgical Defects of the Labial Commissure. Actas Dermosifiliogr. 2015;106(9):49-54.
- 15. Robotti E, Righi B, Carminati M, Ortelli L, Bonfirraro PP, Devalle L, et al. Oral commissure reconstruction with orbicularis oris elastic musculomucosal flaps. J Plast Reconstr Aesthet Surg. 2010;63:431-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anatomi |
| Bölüm | Araştırma makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 3 Sayı: 9 |
