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Surgical Anatomy Of The Ligamentous Attachments In Neck: A Cadaver Study
Cagri Cakmakoglu, M.D1, Gehaan D'Souza, MD2, James Zins, MD,FACS1.
1Cleveland Clinic Foundation, Cleveland, OH, USA, 2Iconic Plastic Surgery Clinic, Carlsbad, CA, USA.


Background Release of the retaining ligaments of the upper, middle, and lower face play an integral part in facial rejuvenation procedures. While neck ligaments have received little attention in the literature, they may play a similar role.
This study aimed to identify the variability in location, number, and dimensions of the neck retaining ligaments. Such identification might then assure more consistent release during surgery.
Methods Twenty cadaveric hemi-necks dissections were performed to identify the retaining ligaments in the neck in the supra and subplatysmal planes.
The length and width of each ligament were recorded using Frankfort's horizontal, the tragus, and the thyroid cartilage.
Results. Fourteen distinct neck ligaments were identified. The most commonly found ligaments were the mandibular ligaments (100%), platysma mandibular ligament (100%), and the lateral sternomastoid-cutaneous ligaments (82%). The least commonly found ligaments were the mastoid-cutaneous ligaments (33%) and the submental ligaments (36%).
The width of ligaments varied from 0.2 mm to 4.2 mm. Although some hemi-faces had few weak ligaments, others had dense and thick ones in multiple rows. The thickest ligament was the clavicular-cutaneous ligaments (1.640.81mm), and the thinnest ligaments was the paramedian platysma retaining ligament (0.490.33mm).
The number of ligaments, their location, and density varied significantly. However, ligaments were consistent from cadaver side to side.
Conclusions A topographical map and contour plot describing location and ligament density was developed. This may aid in identification and ligament release during facial surgery.


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