- Fetal anatomy of the fascial-cellular spaces of the lateral face region
Fetal anatomy of the fascial-cellular spaces of the lateral face region
Modern Pediatrics. Ukraine. (2025).4(148): 53-61. doi: 10.15574/SP.2025.4(148).5361
Soltys R. M., Khmara T. V., Slobodian O. M., Lavriv L. P., Zamorskii І. І., Stoliar D. B.
Bukovinian State Medical University, Chernivtsi, Ukraine
For citation: Soltys RM, Khmara TV, Slobodian OM, Lavriv LP, Zamorskii ІІ, Stoliar DB. (2025). Fetal anatomy of the fascial-cellular spaces of the lateral face region. Modern Pediatrics. Ukraine. 4(148): 53-61. doi: 10.15574/SP.2025.4(148).5361.
Article received: Feb 07, 2025. Accepted for publication: Jun 10, 2025.
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.
Keywords: deep facial region, parotid-masticatory region, buccal fat pad, fascial-cellular spaces, masticatory muscles, infratemporal fossa, lateral skull norm, fetus.
REFERENCES
1. Allen E, Minutello K, Murcek BW. (2023). Anatomy, Head and Neck, Larynx Recurrent Laryngeal Nerve. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. PMID: 29261997.
2. Craig JR, Hopkins C. (2024). Sinus Pathophysiology of Odontogenic Sinusitis. Otolaryngol Clin North Am. 57(6): 1007-1018. https://doi.org/10.1016/j.otc.2024.06.006; PMid:39428205
3. Craig JR, Saibene AM, Felisati G. (2024). Sinusitis Management in Odontogenic Sinusitis. Otolaryngol Clin North Am. 57(6): 1157-1171. https://doi.org/10.1016/j.otc.2024.06.012; PMid:39428206
4. Craig JR. (2022). Odontogenic sinusitis: A state-of-the-art review. World J Otorhinolaryngol Head Neck Surg. 8(1): 8-15. https://doi.org/10.1002/wjo2.9; PMid:35619928 PMCid:PMC9126162
5. De Kersaint-Gilly A, Leroy G, Legent F, Lavenant F, Lajat Y et al. (1982). The pterygo-maxillary region (fossa infra-temporalis). A clinical, radioanatomical and pathological study. J Neuroradiol. 9(4): 271-83. PMID: 6298380.
6. Feigl G, Hammer GP, Litz R, Kachlik D. (2020). The intercarotid or alar fascia, other cervical fascias, and their adjacent spaces – a plea for clarification of cervical fascia and spaces terminology. J Anat. 237(1): 197-207. https://doi.org/10.1111/joa.13175; PMid:32080853 PMCid:PMC7309289
7. Ghali S, Katti G, Shahbaz S, Chitroda PK, Anukriti V, Divakar DD et al. (2021). Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging. World J Clin Cases. 9(3): 573-580. https://doi.org/10.12998/wjcc.v9.i3.573; PMid:33553395 PMCid:PMC7829733
8. Guidera AK, Dawes PJ, Fong A, Stringer MD. (2014). Head and neck fascia and compartments: no space for spaces. Head Neck. 36(7): 1058-68. https://doi.org/10.1002/hed.23442; PMid:23913739
9. Ji T, Hou K, Li C, Yu J. (2021). Imaging features of internal maxillary artery and extracranial middle meningeal artery and their relationships on head CTA. Neuroradiol J. 34(6): 629-641. https://doi.org/10.1177/19714009211019380; PMid:34042531 PMCid:PMC8649192
10. Karkas A, Zimmer LA, Theodosopoulos PV, Keller JT, Prades JM. (2021). Endonasal endoscopic approach to the pterygopalatine and infratemporal fossae. European processes and their course. Herald of problems of biology and medicine Annals of Otorhinolaryngology, Head and Neck Diseases. 138(5): 391-395. https://doi.org/10.1016/j.anorl.2020.12.009; PMid:33384280
11. Khoury J, Mihailidis S, Ghabriel M, Townsend G. (2010). Anatomical relationships within the human pterygomandibular space: Relevance to local anesthesia. Clin Anat. 23(8): 936-44. https://doi.org/10.1002/ca.21047; PMid:20949494
12. Khoury JN, Mihailidis S, Ghabriel M, Townsend G. (2011). Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks. Aust Dent J. 56(2): 112-21. https://doi.org/10.1111/j.1834-7819.2011.01312.x; PMid:21623801
13. Komune N, Matsuo S, Nakagawa T. (2019). The Fascial Layers Attached to the Skull Base: A Cadaveric Study. World Neurosurg. 126: e500-e509. https://doi.org/10.1016/j.wneu.2019.02.078; PMid:30825625
14. Kushta AO, Shuvalov SM. (2024). Peculiarities of the topographical and anatomical structure of the pterygoid-palatine fossa, which affect the spread of pathological. 2(173): 29-32. https://doi.org/10.29254/2523-4110-2024-2-173/addition-29-32
15. Maini K, Dua A. (2023). Temporomandibular Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. PMID: 31869076.
16. Marcuzzo AV, Šuran-Brunelli AN, Dal Cin E, Rigo S, Piccinato A, Boscolo Nata F, Tofanelli M, Boscolo-Rizzo P, Grill V, Di Lenarda R, Tirelli G. (2020). Surgical Anatomy of the Marginal Mandibular Nerve: A Systematic Review and Meta-Analysis. Clin Anat. 33(5): 739-750. https://doi.org/10.1002/ca.23497; PMid:31591743
17. Mochalov I, Kryvtsova M, Chobey A, Kulynych M. (2023). Identification of Pathogenic Microflora and Its Sensitivity to Antibiotics in Cases of the Odontogenic Purulent Periostitis and Abscesses in the Oral Cavity. Prague Med Rep. 124(1): 16-32. https://doi.org/10.14712/23362936.2023.2; PMid:36763828
18. Noguchi T, Odaka K, Fukuda KI. (2023). Clinical Application of Inferior Alveolar Nerve Block Device for Safe and Secure IANB by Any Operator. Pain Res Manag. 2023: 1021918. https://doi.org/10.1155/2023/1021918; PMid:37719895 PMCid:PMC10504047
19. Ottone NE, Sandoval C, Cid-Gutierrez P, Vásquez-Balboa ML, Tubbs RS, Fuentes R. (2021). Systematic review and meta-analysis of the anatomy of the maxillary artery using the Anatomical Quality Assurance (AQUA) checklist. Surg Radiol Anat. 43(11): 1875-1886. https://doi.org/10.1007/s00276-021-02825-3; PMid:34480213
20. Pannkuk TF, Craig JR, Tušas P, Simuntis R. (2024). Management of Endodontic Disease for Odontogenic Sinusitis. Otolaryngol Clin North Am. 57(6): 1119-1138. https://doi.org/10.1016/j.otc.2024.07.002; PMid:39214736
21. Pierucci F, Rubini B, Chassagne JF. (1985). L'apport de la scanographie dans l'exploration radiologique de la fosse ptérygo-maxillaire [Role of computed tomography in the radiologic exploration of the pterygomaxillary fossa]. Rev Stomatol Chir Maxillofac. 86(6): 418-24. PMID: 3868808.
22. Poweski L, Drum M, Reader A, Nusstein J, Beck M, Chaudhry J. (2014). Role of ultrasonography in differentiating facial swellings of odontogenic origin. J Endod. 40(4): 495-8. https://doi.org/10.1016/j.joen.2014.01.002; PMid:24666898
23. Rusu MC, Vrapciu AD, Popescu ŞA. (2022). Fenestrated Maxillary Artery. J Craniofac Surg. 33(8): e861-e863. https://doi.org/10.1097/SCS.0000000000008788; PMid:35882049
24. Sakamoto Y. (2022). Characterization of the pterygomeningeal artery based on branching pattern and muscular distribution. Surg Radiol Anat. 44(4): 543-550. https://doi.org/10.1007/s00276-022-02911-0; PMid:35244749
25. Schachtel MJC, Gandhi M, Midwinter MJ, Panizza BJ. (2023). Fascial layers encountered in the lateral skull base region: A cadaveric and radiological analysis. Head Neck. 45(5): 1272-1280. https://doi.org/10.1002/hed.27342; PMid:36929039
26. Shumway CL, Motlagh M, Wade M. (2023). Anatomy, Head and Neck, Orbit Bones. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. PMID: 30285385.
27. Snosek M, Macchi V, Stecco C, Tubbs RS, De Caro R, Loukas M. (2021). Anatomical and histological study of the alar fascia. Clin Anat. 34(4): 609-616. https://doi.org/10.1002/ca.23644; PMid:32628306
28. Somayaji SK, Acharya SR, Mohandas KG, Venkataramana V. (2012). Anatomy and clinical applications of the mandibular nerve. Bratisl Lek Listy. 113(7): 431-40. https://doi.org/10.4149/BLL_2012_097; PMid:22794519
29. Vieira L. (2020). Embryology of the Fascial System. Cureus. 12(8):e10134. https://doi.org/10.7759/cureus.10134
30. Xue K, Wang L, Zheng S, Zhang H, Liu Q, Gu Y, Li W, Song X, Sun X, Yu H. (2024). Research progress in the anatomy and surgical approach of the parapharyngeal space. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 38(6): 534-540. Chinese. doi: 10.13201/j.issn.2096-7993.2024.06.015