It was pointed out in the review process by Dr. Knize that Figure 2 in our original article represents a dissection that might never be performed in surgery, so it was subsequently omitted from the article. Part of Dr. Knize’s reasoning was that we had infiltrated the tissue layer with normal saline prior to dissection, and so the layer appeared more substantial than it would intraoperatively. The purpose of this figure, however, is to show that this layer in the upper temporal compartment is a tissue layer of substance rather than merely a dissection plane. Injecting the loose areolar tissue of the scalp over the vertex does not result in a similar tissue layer.
Dr. Knize also comments that layer 4 in the upper temporal compartment does not warrant a specific name. We were careful not to rename any structure that had already been named in the literature, preferring to suggest an existing name that we felt to be the most appropriate. In the case of layer 4 in the upper temporal compartment, we believe that it does deserve a name. This layer is vascularized and can be used as a flap (Fig. 3). It was accurately described by de la Plaza et al.3
Our dissections were performed on fresh cadavers, which conferred the advantage of dissection that cannot be performed during an operation. Dr. Knize makes the observation that some of our dissections may not accurately reflect the structures as they are seen intraoperatively. The point of these dissections was to show the true nature of the structures anatomically, and hence to improve understanding of the limited anatomy seen when operating on patients. Dr. Knize is concerned that the appearance of certain structures had been altered, “stretched and elongated,” to demonstrate our anatomic concepts. We agree that these structures have been displayed in such a way as to demonstrate our concepts, but we would also like to add that no structures were altered in any way other than to separate tissue layers in order to display the true and “unseen in surgery” nature of the septa.
The question of “surgical relevance” of certain structures in this region has been raised by Dr. Knize. We believe that any anatomical structures that can be consistently identified during dissection add to our knowledge of the region and provide landmarks for orientation of the surgeon. The sentinel vein is a good example of this point, having little surgical importance to the surgeon other than orientation. Naming such structures confers the advantage of both brevity and clarity when discussing dissection technique.
In attempting to standardize the terminology used, it was recognized that parts of the anatomy needed to be clarified, and once that was achieved, a consensus needed to be reached. We have suggested a nomenclature system that we believe is comprehensive and based on anatomical principles and contemporary use. We believe that “favoritism” would be a poor foundation for such a system, and we remain open to further collaboration.
The authors have no financial interest to declare in relation to the content of this communication or of the associated article.
Justin X. O’Brien, B.M.B.S., P.G.Dip.Surg.Anat.
Mark W. Ashton, F.R.A.C.S.
Warren M. Rozen, M.D.B.S., Ph.D.
Richard Ross, B.M.B.S., P.G.Dip.Surg.Anat.
Bryan C. Mendelson, F.R.C.S.E., F.R.A.C.S., F.A.C.S.
G. I. Taylor Laboratory
Department of Anatomy and Neuroscience
University of Melbourne
Parkville, Victoria, Australia
1. Knize DM. Discussion: New perspectives on the surgical anatomy and nomenclature of the temporal region: Literature review and dissection study Plast Reconstr Surg. 2013;131:523–525
2. O’Brien J, Ashton MW, Rozen WM, Ross R, Mendelson BC. New perspectives on the surgical anatomy and nomenclature of the temporal region: Literature review and dissection study Plast Reconstr Surg. 2013;131:510–522
3. de la Plaza R, Valiente E, Arroyo JM. Supraperiosteal lifting of the upper two-thirds of the face. Br J Plast Surg. 1991;44:325–332
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.
Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.
Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/.
We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.
The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.©2013American Society of Plastic Surgeons