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Deep Pyriform Space: Anatomical Clarifications and Clinical Implications

Surek, Christopher K., D.O.; Vargo, James, M.D.; Lamb, Jerome, M.D.


In the July 2016 article by Surek et al. entitled “Deep Pyriform Space: Anatomical Clarifications and Clinical Implications” ( Plast Reconstr Surg . 2016;138:59–64), the first author’s middle initial is given incorrectly. The author’s name should appear as “Christopher C. Surek, D.O.” ( correction in italics ). The publisher regrets this error.

Plastic and Reconstructive Surgery. 138(2):536, August 2016.

Plastic and Reconstructive Surgery: July 2016 - Volume 138 - Issue 1 - p 59-64
doi: 10.1097/PRS.0000000000002262
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Background: The purpose of this study was to define the anatomical boundaries, transformation in the aging face, and clinical implications of the Ristow space. The authors propose a title of deep pyriform space for anatomical continuity.

Methods: The deep pyriform space was dissected in 12 hemifacial fresh cadaver dissections. Specimens were divided into three separate groups. For group 1, dimensions were measured and plaster molds were fashioned to evaluate shape and contour. For group 2, the space was injected percutaneously with dyed hyaluronic acid to examine proximity relationships to adjacent structures. For group 3, the space was pneumatized to evaluate its cephalic extension.

Results: The average dimensions of the deep pyriform space are 1.1 × 0.9 cm. It is bounded medially by the depressor septi nasi and cradled laterally and superficially in a “half-moon” shape by the deep medial cheek fat and lip elevators. The angular artery courses on the roof of the space within a septum between the space and deep medial cheek fat. Pneumatization of the space traverses cephalic to the level of the tear trough ligament in a plane deep to the premaxillary space.

Conclusions: The deep pyriform space is a midface cavity cradled by the pyriform aperture and deep medial cheek compartment. Bony recession of the maxilla with age predisposes this space for use as a potential area of deep volumization to support overlying cheek fat and draping lip elevators. The position of the angular artery in the roof of the space allows safe injection on the bone without concern for vascular injury.

This and Related “Classic” Articles Appear on for Journal Club Discussions.

Kansas City, Kan.; and Independence, Mo.

From the Department of Plastic Surgery, University of Kansas Medical Center; and private practice.

Received for publication September 3, 2015; accepted February 17, 2016.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Christopher Surek, D.O., Department of Plastic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kan. 66160,

Copyright © 2016 by the American Society of Plastic Surgeons