Frequency of the prominent transverse nasal root vein in children

BACKGROUND

The presence of a vascular, blue linear discoloration on the nasal root of infants and young children is a frequent incidental feature, rarely reported in the medical literature. It is related to the trajectory of the transverse nasal root vein (TNRV).

OBJECTIVE

To study the frequency and clinical characteristics of the vascular discoloration of the nasal root in children.

METHODS

A prospective study was performed to address the presence or absence of vascular discoloration of the nasal root in all children under 6 years of age attending a pediatric dermatology clinic from November 2022 to November 2023. Data on age and skin phototype (Fitzpatrick classification I-VI) were also collected.

RESULTS

Of 701 patients examined, 345 (49.2%) presented with a vascular discoloration of the nasal root. This was present in 97 of 193 (50.3%), 127 of 261 (48.7%), and 121 of 247 (49.0%) patients for the age groups 0-1, 1-3, and 3-6 years, respectively. The presence of vascular discoloration of the nasal root was more frequent in patients with lighter Fitzpatrick skin phototypes: 49 of 69 (71.0%) phototype II, 157 of 290 (54.1%) phototype III, and 137 of 337 (40.7%) phototype IV.

CONCLUSIONS

A vascular discoloration of the nasal root is a frequent skin feature in infants and children, persisting at least until the age of 6. It does not constitute any medical problem aside from cosmetic concern and parents can be reassured of its benign nature. We propose the medical term "prominent TNRV" to describe this condition.

The Course and Variation of the Facial Vein in the Face-Known and Unknown Facts: An Anatomical Study

Background and Objectives: The facial vein is the main collector of venous blood from the face. It plays an important role in physiological as well as pathological context. However, to date, only limited data on the course and tributaries of the facial vein are present in contemporary literature. The aim of this study was to provide detail on the course and the tributaries of the facial vein. Materials and Methods: In 96 sides of 53 body donors, latex was injected into the facial vein. Dissection was carried out and the facial vein and its tributaries (angular vein, ophthalmic vein, nasal veins, labial veins, palpebral veins, buccal and masseteric veins) were assessed. Results: The facial vein presented a textbook-like course in all cases and crossed the margin of the mandible anterior to the masseter in 6.8% of cases, while being located deep to the zygomaticus major muscle in all cases and deep to the zygomaticus minor in 94.6% of cases. Conclusions: This work offers detailed information on the course of the facial vein in relation to neighboring structures, which shows a relatively consistent pattern, as well as on its tributaries, which show a high variability.

Reconstruction of the Exenterated Orbit with an Island Pericranial Flap: A New Surgical Approach

Reconstruction of the bony socket after orbital exenteration is a matter of much debate. Prompt defect closure with a microvascular flap is desirable but involves a major surgical procedure and hence, places considerable burden on the patient. The new surgical technique presented here permits a technically simpler wound closure with fewer complications after orbital exenteration.

Methods

Between May 2014 and June 2022 in the ENT department of Regensburg University, nine patients underwent exenteration and reconstruction with a pericranial flap. The flap was raised via a broken line incision in the forehead or endoscopically, incised in a roughly croissant-like shape, then introduced into the orbit through a tunnel in the eyebrow. A retrospective analysis of the patients and considerations about determining the size, shape, and vascular supply of the flap are presented.

Results

Flap healing was uncomplicated in all cases. Only 6 weeks after surgery, the flap was stable, making it possible to start adjuvant therapy and prosthetic rehabilitation swiftly. The flap is adapted to the near cone-shape of the orbit. The mean (± standard deviation) surface area of the measured orbits is (39.58 ± 3.32) cm². The territory of the angular artery provides the periosteal flap arterial blood supply. Venous drainage is via venous networks surrounding the artery.

Conclusions

Use of the pericranial flap makes it possible to close the orbital cavity promptly with minimal donor site defect and a short operating time, thereby minimizing the surgical risk and speeding up physical and psychological recovery.

New Insights into the Communications of the Facial Vein with the Dural Venous Sinuses

Background and Objectives: Anastomoses of the extracranial and intracranial venous system have been described in the literature. The presence of such anastomoses may facilitate a possible spread of infection into the dural venous sinuses. However, the frequency and relevance of such anastomoses is highly debated. The aim of this study was to quantify frequencies of anastomoses between the facial vein and the dural venous sinuses. Materials and Methods: In 32 sides of 16 specimens, latex was injected into the facial vein. Dissection was carried out to follow and described these anastomoses, yielding the presence of latex in the intracranial venous system. Results: In 97% of cases, a dispersal of latex into the cavernous sinus as well as anastomoses was observed. A further dispersal of latex into other dural venous sinuses was found at rates ranging between 34% (transverse sinus)-88% (superior petrosal sinus), respectively. Conclusions: The presence of anastomoses between the extracranial and intracranial venous system in a majority of cases needs to be considered when dealing with pathologies as well as procedures in the facial region.

Endovenous Thermal Ablation of Prominent Central Forehead Veins (Supratrochlear Veins)

BACKGROUND

Many patients complain of prominent vertical veins in the center of their forehead, worse when smiling, wrinkling the forehead in bright light, leaning forward, and when vasodilated in heat, when exercising, or with alcohol. Previous attempts to treat these with external laser, sclerotherapy, and phlebectomy have not been successful.

OBJECTIVE

To describe a new method of treating prominent vertical forehead veins and to report the early results.

MATERIALS AND METHODS

We used endovenous laser ablation with a 1470 nm diode laser in 15 patients (F:M 12:3; mean age 38.4 years range 24-69). A bare fiber was used once and a 400-μm single ring radial fiber (Biolitec, Vienna, Austria) in all other cases. Tumescence was placed around the vein and a power of 2 to 3 W with a pullback of 7 to 10 seconds per centimeter.

RESULTS

Twelve of the 15 patients (80%) ended up with a good cosmetic result and were satisfied, although 2 needed redo treatment. One patient had minor skin tethering, and 2 (13%) suffered burns-one was the only bare fiber case and the other, the only one where 4 W was used.

CONCLUSION

We present a novel technique to treat prominent vertical forehead veins, with apparently good early results.

The Arteries of the Central Forehead: Implications for Facial Plastic Surgery

BACKGROUND

The forehead has substantial importance as an aesthetic unit. The central and supraorbital parts of this area are supplied by the supratrochlear (ST) and supraorbital (SO) arteries as well as the recently defined paracentral (PA) and central arteries.

OBJECTIVES

The authors aimed to assess the morphometry of the vessels of the forehead in the context of plastic surgery and minimally invasive cosmetic procedures.

METHODS

This research included 40 cadavers directed for forensic autopsy and subjected to postmortem computed tomography angiography. In total, 75 hemifaces were examined for the course and location of arteries relative to the bones and surrounding structures.

RESULTS

The arteries were observed as follows: ST in 97.3%, SO in 89.3%, and PA in 44.0%. The PA can be expected in the 13-mm-wide zone starting 2 mm laterally from the midline. The ST should be expected in the 10-mm-wide area extended laterally from the tenth millimeter from the midline, and the SO should be expected in the slightly wider (11 mm) area extending laterally from the 20th millimeter from the midline. For the proximal main trunks of the ST and SO arteries, we observed no overlap between the zones of occurrence, whereas the zones for the PA and ST main proximal trunks did overlap. No distinctive central artery was observed in the midline region of the forehead, but instead a network of small vessels in the midline region was visible.

CONCLUSIONS

The ST is the main and most conservative artery of this region and the PA is the most variable. A unique and detailed anatomical map was created to better understand the vasculature of the forehead area.

Ultrasonographic and Three-Dimensional Analyses at the Glabella and Radix of the Nose for Botulinum Neurotoxin Injection Procedures into the Procerus Muscle

Botulinum neurotoxin (BoNT) injections are widely used for facial rejuvenation procedures, and the procerus muscle is a major target in cases of glabellar transverse lines or rhytids. Although there have been many cadaveric studies of the procerus, its depth and thickness have not been investigated thoroughly. The aim of this study was to measure the depth and thickness of the procerus and identify the location of the intercanthal vein using ultrasonographic (US) imaging and the three-dimensional scanning method, which is needed to know to avoid side effects during BoNT injections. The morphology of the procerus was classified into two types based on the US images obtained at the glabella. The procerus was located deeper below the skin surface at the glabella than the sellion (3.8 ± 0.7 mm versus 2.7 ± 0.6 mm). The width of the procerus in US images increased from the sellion (10.9 ± 0.2 mm) to the glabella (14.5 ± 4.6 mm), whereas its thickness decreased (from 1.6 ± 0.6 mm to 1.1 ± 0.5 mm). The intercanthal vein was located 5.1 ± 4.0 mm superior to the sellion and 3.0 ± 0.6 mm below the skin’s surface. The present findings provide anatomical knowledge as well as the reference location information for use when injecting BoNT into the procerus.

High-Risk Basal Cell Carcinomas of the Head and Neck: Selected Successful Surgical Approach in Three Bulgarian Patients!

BACKGROUND

Regarding localisation, basal cell carcinomas are classified in three risk groups, designated as H for high-, M as medium-, and L as low-risk area. In patients with high-risk basal cell carcinomas (BCCs), as a first-line of treatment are mentioned, different types of surgical approaches and radiotherapy. Depending on the location of the tumour, the choice of surgical technique should vary and be consistent with the patient's will for a most aesthetically acceptable result.

CASE REPORT

Three cases of patients with BCCs defined as high-risk about two different indicators-localisation and relapse after radiation therapy are presented. For the recovery of the occurred defects, three different types of surgical approaches (primary closure/undermining surgical approach, island flap and advancement flap) were used, tailored to the high-risk factors in each patient, which at the same time provided a perfect clinical outcome.

CONCLUSIONS

High-risk BCCs are a challenge for every dermatosurgeon and require serious training and knowledge both in terms of anatomy and in terms of the possibilities for reconstruction of the defects that occurred. Operations usually run in three phases, namely: 1) removal of tumour tissue, 2) intraoperative plan for reconstruction according to the size of the defect and the condition of the surrounding tissues as well as phase 3) undermining of surrounding tissues and adaptation of the wound edges.

A New Approach to an Old Flap: A Technique to Augment Venous Drainage from the Paramedian Forehead Flap

The paramedian forehead flap is commonly used in nasal reconstruction, and survival of the distal part of the flap is usually essential for a good cosmetic outcome. Venous congestion leading to tissue necrosis is a recognized complication with this flap. The standard paramedian forehead flap is designed with a number of aims. These are to include the supratrochlear artery, to maximize mobility of the flap pedicle, to maximize the reach of the flap, and to minimize cosmetic implications at the donor site. The supratrochlear artery does not possess sizable venae comitantes; thus, the main pathway for venous drainage of the paramedian forehead flap is through superficial veins. The pattern and location of the superficial veins varies and therefore a standard skin pedicle design cannot be expected to always include sufficient veins to prevent venous congestion and subsequent flap necrosis. This article demonstrates the superficial venous anatomy of the forehead using computed tomographic venography, clinical demonstration, and cadaveric dissection, and describes a technique that can be carried out to augment flap venous drainage by performing careful dissection to identify additional superficial veins at the margins of the flap skin pedicle. One or more veins can then be mobilized and included with the flap pedicle to augment its venous drainage. Use of this technique should lead to a lower incidence of flap necrosis secondary to venous congestion.

Description of a novel anatomic venous structure in the nasoglabellar area

Injectable dermal fillers are frequently used to reduce the appearance of various facial creases and rhytids. However, venous complications can develop while injecting dermal filler, especially in the nasoglabellar area. The aims of this study were to determine the anatomic patterns of the veins in the nasoglabellar area and to elucidate their detailed location with reference to various facial landmarks. Forty-one heads from Korean and Thai cadavers were dissected. When the anastomosing vein between the bilateral angular veins (AVs) was located in the nasoglabellar area, it was designated the intercanthal vein (ICV). The bilateral AVs continued as the facial vein without any communicating branches in 12 cases (29.3%). At the radix of the nose, the AV communicated with the ICV, connecting them bilaterally. The ICV was found above (type IIA) and below (type IIB) the intercanthal line in 26 (63.4%) and 3 (7.3%) cases, respectively. The ICV can be regarded as a candidate causative site for the frequent complications associated with dermal filler injection in the nasoglabellar area, and utmost care should be taken when injecting in this area, such as when performing radix augmentation and softening wrinkles in the glabellar area.