Fetal anatomy of the fascial-cellular spaces of the lateral face region

Abstract

In order to comprehend the etiopathogenesis of surgical pathology and traumatic injuries of the maxillofacial region and possible ways of inflammatory processes spreading, thorough knowledge of the age-related variant anatomy of the fascial-cellular formations of the facial region of the head is of particular importance.

Аim - to clarify the peculiarities of morphogenesis and formation of the topography of fascial-cellular spaces of the lateral face region in human fetuses, taking into account the forms of their anatomical variability, in order to develop new methods of diagnosis, prognosis and treatment of congenital and acquired pathology of organs and structures of the maxillofacial region..

Materials and methods. The study was conducted on head preparations of 38 human fetuses with a parieto-coccygeal length of 81.0-375.0 mm using macromicroscopic preparation, vascular injection, and morphometry.

Results. Starting from 6 months of fetal development, subcutaneous adipose tissue, especially in the buccal, parotid-masticatory and deep lateral areas of the face, is relatively well expressed. Different density of the parotid fascia has been observed, in particular, its thinning or absence in the areas of the superior surface of the gland and the internal surface of the pharyngeal process. This suggests that the fiber surrounding the parotid gland may have a connection with the fiber of the peripharyngeal space. The fascia on the external surface of the parotid gland was found to be loose. In fetuses of 9-10 months, in the area between the maxilla and the anterior edge of the ramus of the mandible, the buccal fat pad tightly adheres to the tissue of the upper part of the pterygo-maxillary space, as well as to the tissue of the pterygo-palatine fossa. Therefore, at the stages of postnatal human ontogenesis, this may contribute to the spread of purulent-inflammatory processes from the buccal fat pad into the temporal and infratemporal fossae, pterygo-maxillary space, etc. The lateral pterygoid muscle and loose tissue are located in the posterior part of the infratemporal fossa, which in fetuses of 8-10 months form single clusters -  on the external surface of the muscle - the temporal-pterygoid fissure; on the internal surface of the muscle - the extrapterygoid space; on the superior surface of the lateral pterygoid muscle - the epipterygoid bone-fascial space. These structures appear as narrow slits. In human fetuses, the pterygoid venous plexus, which is located on the external surface of the lateral pterygoid muscle, topographically corresponds to the temporal-pterygoid cellular space.

Conclusions. In human fetuses, a connection between the shape of the infratemporal fossa and the length of the fascial-cellular spaces of the deep facial region was found. Considering that the loose tissue of the infraorbital region is connected to the tissue of the buccal region, it can be assumed that abscesses that arise in the postnatal period can be located not only in the canine fossa region, but also extend superiorly and medially.

The study was conducted in accordance with international and national bioethical standards, which was confirmed by the conclusion of the Biomedical Ethics Commission of the Bukovinian State Medical University.

The authors declare no conflict of interest.