Pilot Study: Endoscopic Anatomical Study of the Lower Premasseter Space and Buccal Space for Sub-superficial Musculo-aponeurotic System Face Lift: Observations Based on Live Dissections.

BACKGROUND

Sub-superficial musculo-aponeurotic system dissections of the lower premasseteric space (LPMS) and buccal space (BS) performed under direct visualization are challenging because of the close relationship between neurovascular bundles and the fascioligamentous system, making these structures prone to injury. This pilot study aims to document the endoscopic anatomy of these spaces through intraoperative visualization, enabling clearer identification and description of key structures.

METHODS

Five representative cases were selected from a series of 80 sub-superficial musculo-aponeurotic system face lift dissections for this observational, descriptive pilot study. Inclusion was based on high-quality intraoperative imaging and preservation of anatomical integrity. Endoscopic dissections were performed using a 4-mm, 30-degree endoscope. Photographic and video documentation of the LPMS and BS were obtained and reviewed qualitatively. No objective measurements or interobserver validation were performed.

RESULTS

Endoscopic visualization revealed the detailed anatomy of both spaces. The LPMS was identified as a rhomboidal cavity bordered by the buccinator, masseteric fascia, parotid gland, and the BS. The BS appeared as a wedge-shaped cavity containing the buccal fat pad and traversed by the facial vessels and buccal nerve branches. High-definition photographs demonstrated differentiation among ligamentous, vascular, and neural structures.

CONCLUSIONS

Within the limitations of this pilot study, the LPMS and BS appeared to be natural optical cavities of the face that may be suitable for endoscopic exploration. Endoscopic visualization may allow precise identification of their contents and support safer release of fascial and ligamentous structures. These preliminary observations require validation through controlled comparative studies to confirm any potential reduction in neurovascular injury risk.