Revisiting the first patient: review of craniofacial anatomy and its role in dermatological practice (536.3)

Dermatology is a branch of medicine that focuses on diagnosis of over 3,000 skin diseases and disorders. The unique nature of this medical discipline requires the physician to be proficient in delicate surgical procedures, pathology, and pharmacologic practice, thus dermatologists are highly skilled specialists. An anatomical workshop for residents of the department of dermatology was held at SUNY Downstate to review and augment foundational knowledge of underlying craniofacial anatomy with the goal of facilitating and translating basic principles of cutaneous surgical procedures. Intimate spatial relationships of dermal, subcutaneous and fascial layers, muscle, nerves, and bone were “brought to life” for residents rarely afforded the opportunity to perform human dissection. Important concepts reviewed included significance of the mid‐pupillary reference line, utilized in location of supraorbital, infraorbital and mental foramina for safe injection of Onabotulinum toxinA (Otx), a potent neuromuscular inhibitor. Review of muscular anatomy with particular attention to the overlapping zygomaticus minor (Zm) and orbicularis occuli (Oo) demonstrated the manner in which inadvertent delivery of Otx to the Zm can induce “relaxation” (paralysis) of Oo when injected beyond the ‘safe‐zone’ (2 mm lateral to mid‐pupillary line). Mastery of craniofacial anatomy remains indispensable for proper and safe cutaneous and cosmetic procedures.