all right the next area of evaluation is a temple it's my favorite area because it's a very complex Anatomy there's several different layers so the way I like to evaluate the temple is not quite horizontal and not quite vertical it's sort of in an oblique fashion so it's paralleling the orbital rim and I like to do it this way remember when you hold the ultrasound make sure that part of your hand is actually touching the patient allows you to make fine movements so let's go through the anatomy here so the very deepest aspect is your bone that's down here the next layer is going to be your temporalis keep in mind that there is no periosteum on the tempo bone so here is your muscle this is the temporalis the next layer is going to be your deep layer of your deep temporal fascia that's right there so the Deep temporal fascia actually is one layer that splits into two layers it splits into a superficial layer the D temporal fasia and a deep layer of the deep tempal fascia and in between those layers there's a couple names for this fat pad I like to call it the intermediate temporal fat pad but it's also called the superficial temporal fat pad and that's right here and then this layer here is going to be your superficial layer of your deep tempal fascia which is right there now you see a little black area just above that fasia that's called the interfascial plane and that's right here and then superficial to that is going to be your superficial temporal fcia or your temporal parietal fascia or your smaz layer so that's right here and then superficial to that it's going to be subcutaneous tissue subcutaneous fat and skin right here and then skin above here so let's see the t- mode in this area let's see how accurate I was so here we go so let's look at the t- mode um images so deeply you see the bone then you see the muscle then you see the fasal layer then you see the fat then you see a superficial layer the det tempal fascia and then you see a purple layer which is the interfacial plane so the t-o is really good to help you navigate the anatomy of the temple so let's look at the vascular structures of the temple let's go back into your B mode here and then power doppler and so there's basically superficial vessels and deep vessels so let's look at the superficial vessels so there the anterior branch of the superficial temporal artery is usually in the inferior temporal septum and the inferior temporal septum runs from the superior orbital rim to the root of the Helix so it's not always but usually in a line like this so therefore I like to place it somewhere in that area oh what do we find doing doing this search I came across that deep temporal artery so here we go so that's the Deep temporal artery right there so the Deep temporal artery this is the anterior Branch there's two branches there's a anterior and a posterior the anterior branch is going to be right near the orbital Rim it runs along the temporal bone and that's actually at risk when you're doing those deep injections so I highly recommend doing vascular mapping before you do the Deep injections in the temple to look for this deep temporal artery and in this patient it was very close to the injection point that you like to use for this one up one over technique in that deep area so while I was doing this examination the patient did remind me that she had surgery because she had a pseudo aneurysm of her superficial temporal artery from a trauma case so I'm not going to find that superficial temporal artery on this side so we can take a look at this side so interesting I was able to get both of the arteries in one screen and let me show you that [Music] so right here so this is the Deep temporal artery anterior Branch right here and this is the superficial temporal artery more superficially that superficial temporal artery lies in the sads layer or the temporal prial fascia or the superficial temporal fats so those are all the same so we found all the necessary vasular structure of the temple that deep temporal artery and that superficial temporal artery that concludes the evaluation of the Temple
