Hak Seung Lee

Deep fat of the face revisited

The midfacial deep fatty tissue has been divided into the buccal and parapharyngeal fat pads although the former carries several extensions in adults. Using histological sections of 15 large human fetuses, we demonstrated that the parapharyngeal fat pad corresponds to the major content of the prestyloid compartment of the parapharyngeal space or, simply, the prestyloid fat. The buccal and prestyloid fatty tissues were separated by the medial and lateral pterygoid muscles. In these tissues, superficial parts, corresponding to the lower body and the masseteric extension of the adult buccal fat pad, were well encapsulated and showed the most advanced stage of histogenesis. As the sphenoid bone was not fully developed even in the largest specimens, the temporal, infratemporal, and pterygopalatine fossae joined to provide a large space for a single, large upper extension of the buccal fat pad. In the intermediate part of the extension course, the larger specimens carried a narrower part between the maxilla and the temporalis muscle. The single, upper extension appeared to divide into several extensions, as seen in adults. The periocular fat was clearly separated from the upper extension of the buccal fat pad by the sheet‐like orbitalis muscle. A communication between the prestyloid fat and the buccal fat pad likely occurred through a potential space along the lingual nerve immediately superior to the deep part of the submandibular gland. At this site, therefore, the prestyloid fat may be injured or infected when the buccal fat pad is treated surgically. Clin. Anat., 2013.

Status of treatment for dementia patients who visited hospital as the first visit

We are approaching a period of population ageing in which the number of dementia patients will increase rapidly and become a significant social problem. There are many study guides for treatment of dementia, but there are limited numbers of studies and limited amounts of data available for evaluating the treatment used on dementia patients as related to their hospital for the first time. A study was performed using information gathered from 50 domestic hospitals to ensure that the treatment status data was representative of the actual field of clinical dementia. We observed retrospectively the medical records of 4282 patients who visited the hospital and were finally judged to have dementia from January, 2009 to December, 2010. Among the types of dementia, Alzheimers disease (AD) had the greatest occurrence at 66.57%, with vascular dementia (VD) at 17.63%, AD with CVD at 10.18%, and Parkinson related dementia at 4.25%. The drug primarily used for initial therapy is the same drug primarily used for patients who have undergone long term dementia treatment, namely donepezil (75.22%). Among all 4282 patients, there was addition or transition of drugs used for 389 of the patients. Ineffectiveness of the initial drug treatment was the reason for the addition of drugs or transition to other drugs in almost all cases. In this study, the clinical characteristics observed for dementia treatment is compared as drugs changing, which will be helpful in the preparation of a treatment guide for dementia in the future.