Anatomy for Plastic Surgery of the Face, Head and Neck

Book Preface

This book was planned as a head and neck surgical anatomy book for plast ic surgeons, head and neck surgeons, and surgeons who practice in related elds. Unfortunately, few surgical textbooks emphasize anatomy, especially textbooks in the eld of plastic surgery. In most surgical textbooks, the procedures are described only in minute det ail. Conversely, t radit ional anatomical textbooks do not provide adequate informat ion on the regional anatomy, preventing surgeons from obtaining the knowledge necessary to expertly perform various surgical procedures. One reason for this is that although the basic anatomy of the human body was almost completely described more than 100 years ago, the anatomy in the head and neck region, especially that applicable to plastic surgery, is still developing. Additionally, anatomical textbooks often do not provide the most up-to-date information. Therefore, we have at tempted to include the latest anatomical understanding of the head and neck anatomy from a plastic surgeon’s perspective.

In writing this preface, I (KW) discussed head and neck anatomy with my mentors in two specialt ies: gross anatomy and plastic surgery. This allowed me to consider anatomy from two di erent viewpoints.

First , my mentor in gross anatomy made the following observat ions: The anatomy of the head and neck is ext remely complicated and the details di er among individuals and during di erent stages of life. These di erences include the thickness of the tissues, their changes in response to aging, and even anatomical variations in vessels, nerves, and muscles. Each organ in the head and neck region has a very dist inct funct ion. Consequently, pathologies involving the head that require surgery will be operated on by surgeons specializing in neurosurgery, otorhinopharyngolaryngology, ophthalmology, dental medicine, and plastic surgery. While in-depth knowledge in the anatomical area of specializat ion is extremely important in treat ing patients, the surgeon as well as the medical sta must also be highly familiar with not just related regions of the body but also with unrelated regions. In medical education, unfortunately, the importance of anatomical education has been downplayed globally in recent years. This may be because nowadays medical students have less time to study anatomy, given the many new elds of medicine that they are expected to be familiar with. Apparently, some medical schools no longer o er anatomical dissection. Thus, not surprisingly, the number of anatomists, especially gross anatomists, is decreasing. This tendency has crit ical, negat ive implicat ions for surgery. Gross anatomy is the basis of knowledge for every surgeon. Surgeons must be experts in gross anatomy if they hope to acquire the surgical skills to become experts in surgery.

My second mentor, a specialist in plast ic surgery, o ered the following: The most important aspect of performing plastic surgery is knowledge of three-dimensional regional anatomy. For example, each nerve and blood vessel takes up space three dimensionally. It is important to recognize how these structures t ravel on the surface plane, but it is more important for the success of the actual surgery to know which t issue layers these st ructures run through. Anatomical atlases and textbooks provide detailed images of these st ructures, but the knowledge gained from them is two-dimensional. Novice surgeons typically memorize the two-dimensional image of their surgical eld. Because of this, surgical results are sometimes unsatisfactory, or unexpected surgical complications may occur. To perform surgeries with a high degree of di cult y, a surgeon has to be able to vividly visualize the three-dimensional regional anatomy of the surgical eld. Plastic surgery residents have to study the regional anatomy in anatomical atlases and textbooks, and con rm their anatomical knowledge in pract ical operat ions. By repeating this pat tern many times, a resident is able to establish and practice three-dimensional anatomical knowledge. By having surgical training based on accurate anatomical knowledge, a surgeon will be bet ter equipped to perform high-degree operations.

We hope that our textbook will not only help to improve the surgical skill of individual surgeons, but will also promote the development of head and neck surgery. I would like to thank Dr. Koh-ichi Yamaki, Professor of Anatomy, and Dr. Kensuke Kiyokawa, Professor of Plastic Surgery, for kindly contributing the above comments to the preface.