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Siwetz M, Widni-Pajank H, Hammer N, Bruneder S, Wree A, Antipova V. Course and Relation of the Facial Vessels-An Anatomical Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:805. [PMID: 38792988 PMCID: PMC11123074 DOI: 10.3390/medicina60050805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: Facial vascular anatomy plays a pivotal role in both physiological context and in surgical intervention. While data exist on the individual course of the facial artery and vein, to date, the spatial relationship of the vasculature has been ill studied. The aim of this study was to assess the course of facial arteries, veins and branches one relative to another. Materials and Methods: In a total of 90 halved viscerocrania, the facial vessels were injected with colored latex. Dissection was carried out, the relation of the facial vessels was studied, and the distance at the lower margin of the mandible was measured. Furthermore, branches including the labial and angular vessels were assessed. Results: At the base of the mandible, the facial artery was located anterior to the facial vein in all cases at a mean distance of 6.2 mm (range 0-15 mm), with three cases of both vessels adjacent. An angular vein was present in all cases, while an angular artery was only present in 34.4% of cases. Conclusions: The main trunk of the facial artery and vein yields a rather independent course, with the facial artery always located anterior to the vein, while their branches, especially the labial vessels, demonstrate a closer relationship.
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Affiliation(s)
- Martin Siwetz
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria; (M.S.); (H.W.-P.)
| | - Hannes Widni-Pajank
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria; (M.S.); (H.W.-P.)
- Department of Oral and Maxillofacial Surgery, Klagenfurt Am Wörthersee Clinic, Feschnigstraße 11, A-9020 Klagenfurt am Wörthersee, Austria
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria; (M.S.); (H.W.-P.)
- Department of Orthopedic and Trauma Surgery, University of Leipzig, D-04103 Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, D-09126 Dresden, Germany
| | - Simon Bruneder
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria;
| | - Andreas Wree
- Institute of Anatomy, Rostock University Medical Center, Gertrudenstr. 9, D-18057 Rostock, Germany;
| | - Veronica Antipova
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria; (M.S.); (H.W.-P.)
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Honda K, Omori K, Kishimoto Y. Anatomical variations in the superficial venous system of the neck: an image-based study using contrast-enhanced computed tomography. Surg Radiol Anat 2024; 46:669-677. [PMID: 38536426 DOI: 10.1007/s00276-024-03326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The superficial venous system (SVS) of the neck receives blood from the face and oral cavity. The SVS comprises the anterior jugular vein (AJV), external jugular vein (EJV), and facial vein (FV). Comprehensive knowledge of the normal anatomy and potential variations in the venous system is valuable in surgical and radiological procedures. This study aimed to update the anatomic knowledge of the SVS using a radiographic approach, which is a beneficial data source in clinical practice. METHODS Contrast-enhanced computed tomography images of the neck of patients with head and neck cancer treated between 2017 and 2020 were retrospectively evaluated. Each side of the neck was counted separately. A total of 302 necks of 151 patients were enrolled in this study. RESULTS The medial AJV was absent in 49.7% (75/151) of the patients on the left side, which was significantly greater than the 19.2% (29/151) on the right (p < 0.001). The left AJV drained into the right venous system in 6.6% (10/151) of the necks. In 48.3% (146/302) of the necks, the FV did not flow into the internal jugular vein but rather into the EJV or AJV; these findings were significantly more frequent than those reported in previous studies. The diameters of the veins were significantly larger when they received blood from the FV than when they were not connected to the FV. CONCLUSION These findings indicate that the AJV has a rightward preference during its course. The course of the FV is diverse and affects the diameter of connected veins.
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Affiliation(s)
- Keigo Honda
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Sakyo-Ku, Shogoin Kawahara-Cho 54, Kyoto, Kyoto, Japan.
| | - Koichi Omori
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Sakyo-Ku, Shogoin Kawahara-Cho 54, Kyoto, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Sakyo-Ku, Shogoin Kawahara-Cho 54, Kyoto, Kyoto, Japan
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Guo Y, Wen L, Wang X, Zou H, Liang W, Wang J, Zhu X. Analysis of Age-Related Changes in Lower Facial Fat Compartments and of the Course of Blood Vessels Using Computed Tomography. Plast Reconstr Surg 2024; 153:539e-548e. [PMID: 37010462 DOI: 10.1097/prs.0000000000010506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND According to the volume restoration theory, lower facial fat compartments tend to selectively atrophy or hypertrophy with age. The aim of this study was to demonstrate age-related changes in lower facial fat compartments using computed tomography, with strict control of the body mass index and underlying diseases. METHODS This study included 60 adult women in three age-based categories. The thicknesses of the jowl, labiomandibular, and chin fat compartments were measured using computed tomographic images. The distribution and arrangement of facial blood vessels were further analyzed to provide evidence of the safety of rejuvenation strategies based on the facial volumetric theory. RESULTS The inferior part of the superficial jowl fat compartment and deep jowl fat compartment thickened with age. The deep layer of the labiomandibular fat compartment thinned with age, and the superficial layer thickened with age. The deep and superficial layers of the chin compartments thickened with age. The facial vein passes through the lower mandibular border at the anterior edge of the masseter muscle and moves upward, perpendicular to the lower mandibular border. The high-risk area of the facial artery had an angle of approximately 45 degrees to the lower mandibular border. CONCLUSIONS This study suggests that with age, selective thickening or thinning occurs in different lower facial fat compartments. The mandible and masseter muscle were used as reference markers to analyze the courses of the facial artery and facial vein, which can help clinicians to reduce vascular injury.
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Affiliation(s)
- Yixuan Guo
- From the Department of Plastic and Cosmetic Surgery, First People's Hospital of Foshan
- Departments of Plastic Surgery
| | - Lihong Wen
- Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Xianlong Wang
- Radiology, Second School of Clinical Medicine, Southern Medical University
| | - Huan Zou
- Radiology, Second School of Clinical Medicine, Southern Medical University
| | - Weiqiang Liang
- Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | | | - Xiongxiang Zhu
- Department of Plastic and Burn Surgery, Third School of Clinical Medicine, Southern Medical University
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Bernardini FP, Skippen B. Expanding Treatment Indications Beyond the Tear Trough Defect: The G-Point Lift Technique to Address the Entire Eyelid-Cheek Junction. Dermatol Clin 2024; 42:89-95. [PMID: 37977689 DOI: 10.1016/j.det.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Knowledge of the anatomy of the infraorbital region is key to understanding the full extent of clinically visible infraorbital defects and the underlying structures involved to achieve optimal aesthetic results. The authors have developed a more anatomic approach to the infraorbital region, which has led to recognition of a specific anatomic area, defined previously as the aesthetic G-point. Shifting attention away from the tear trough itself and applying a surgical approach to aesthetic medicine can lead to more natural and complete results while at the same time minimizing the risk of undesired side effects and complications.
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Affiliation(s)
- Francesco P Bernardini
- Oculoplastica Bernardini, Villa Montallegro, Via Monte Zovetto, 27, 16145 Geneova, Italy
| | - Brent Skippen
- Wagga Wagga NSW 2650, Australia; UNSW Medical School.
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Pistoia F, Camerino PL, Ioppi A, Picasso R, Zaottini F, Caprioli S, Mocellin D, Ascoli A, Pansecchi M, Carobbio ALC, Parrinello G, Marchi F, Peretti G, Martinoli C. High-resolution US of the facial vessels with new facial vein landmarks for reconstructive surgery and dermal injection. Eur Radiol Exp 2023; 7:49. [PMID: 37691033 PMCID: PMC10493206 DOI: 10.1186/s41747-023-00363-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/12/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Accurate knowledge of vessel anatomy is essential in facial reconstructive surgery. The technological advances of ultrasound (US) equipment with the introduction of new high-resolution probes improved the evaluation of facial anatomical structures. Our study had these objectives: the primary objective was to identify new surgical landmarks for the facial vein and to verify their precision with US, the secondary objective was to evaluate the potential of high-resolution US examination in the study of both the facial artery and vein. METHODS Two radiologists examined a prospective series of adult volunteers with a 22-8 MHz hockey-stick probe. Two predictive lines of the facial artery and vein with respective measurement points were defined. The distance between the facial vein and its predictive line (named mandibular-orbital line) was determined at each measurement point. The distance from the skin and the area of the two vessels were assessed at every established measurement point. RESULTS Forty-one volunteers were examined. The median distance of the facial vein from its predictive line did not exceed 2 mm. The facial vein was visible at every measurement point in all volunteers on the right side, and in 40 volunteers on the left. The facial artery was visible at every measurement point in all volunteers on the right and in 37 volunteers on the left. CONCLUSIONS The facial vein demonstrated a constant course concerning the mandibular-orbital line, which seems a promising clinical and imaging-based method for its identification. High-resolution US is valuable in studying the facial artery and vein. RELEVANCE STATEMENT High-resolution US is valuable for examining facial vessels and can be a useful tool for pre-operative assessment, especially when combined with the mandibular-orbital line, a new promising imaging and clinical technique to identify the facial vein. KEY POINTS • High-resolution US is valuable in studying the facial artery and vein. • The facial vein demonstrated a constant course concerning its predictive mandibular-orbital line. • The clinical application of the mandibular-orbital line could help reduce facial surgical and cosmetic procedure complications.
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Affiliation(s)
- Federico Pistoia
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy.
| | - Paola Lovino Camerino
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Alessandro Ioppi
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Riccardo Picasso
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Federico Zaottini
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Simone Caprioli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Davide Mocellin
- Department of Otorhinolaryngology, Ospedale S. Paolo, Savona, Italy
| | - Alessandro Ascoli
- Department of Otorhinolaryngology, Ospedale Giovanni Borea, Sanremo, Italy
| | - Michelle Pansecchi
- Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore 1, Genoa, Italy
| | - Andrea Luigi Camillo Carobbio
- Department of Neurosciences, Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua "Azienda Ospedaliera Di Padova", 35128, Padua, Italy
| | | | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, Italy
- Department of Health Sciences (DISSAL), Radiology Section, University of Genova, Via Pastore 1, Genoa, Italy
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Siwetz M, Widni-Pajank H, Hammer N, Pilsl U, Bruneder S, Wree A, Antipova V. The Course and Variation of the Facial Vein in the Face-Known and Unknown Facts: An Anatomical Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1479. [PMID: 37629769 PMCID: PMC10456631 DOI: 10.3390/medicina59081479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
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.
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Affiliation(s)
- Martin Siwetz
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - Hannes Widni-Pajank
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
- Department of Oral and Maxillofacial Surgery, Klagenfurt Am Wörthersee Clinic, Feschnigstraße 11, A-9020 Klagenfurt am Wörthersee, Austria
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, D-04103 Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, D-09126 Dresden, Germany
| | - Ulrike Pilsl
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - Simon Bruneder
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria
| | - Andreas Wree
- Institute of Anatomy, Rostock University Medical Center, Gertrudenstr. 9, D-18057 Rostock, Germany
| | - Veronica Antipova
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
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Wilde CL, Gupta A, Lee S, Ezra DG. Tear Trough Filler Using the Three-point Tangent Technique: Lessons from 1452 Tear Trough Applications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5060. [PMID: 37305194 PMCID: PMC10256367 DOI: 10.1097/gox.0000000000005060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/29/2023] [Indexed: 06/13/2023]
Abstract
This study describes a novel three-point tangent technique for tear trough filler and the results from the largest series to date. Methods A retrospective case review was performed for all patients treated between 2016 and 2020. Patient demographics, filler details and complications were recorded. The injection technique involves using a blunt cannula to deliver filler along three linear tangents bespoke to each patient. Results A total of 1452 applications of filler to the orbits of 583 patients were recorded. The median patient age was 41 years (range 19-77), and 84% were women. The mean volume of applied filler at the first appointment was 0.34 mL to each orbit (range 0.1--1.5); 82% reported no complication, 10% reported swelling with a median duration of 4 weeks (range 1-52), 4.3% experienced bruising, 4.6% reported contour irregularities, and 3.3% experienced a Tyndall effect. Retrobulbar hemorrhage occurred in one patient (0.17%), which was managed immediately with no lasting visual compromise. Volume of filler injected was significantly associated with a risk of edema (P < 0.00001) and contour irregularities (P = 0.012). In total, 50% of cases of edema resolved spontaneously after 4 weeks. Filler was dissolved in 1.9% of orbits. Patients with a history of dissolving were significantly more likely to require dissolving after subsequent reinjection (P = 0.043). Conclusions The three-point tangent technique is a safe and effective method. Increasing volume of filler administered is associated with complications of edema and contour irregularities. Edema is the most common complication and resolves spontaneously in half of patients by 4 weeks.
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Affiliation(s)
- Caroline L. Wilde
- From the Moorfields Eye Hospital NHS Trust, London, United Kingdom
- The Ezra Clinic, London, United Kingdom
| | - Ankur Gupta
- From the Moorfields Eye Hospital NHS Trust, London, United Kingdom
| | - Sieun Lee
- Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Daniel G. Ezra
- From the Moorfields Eye Hospital NHS Trust, London, United Kingdom
- The Ezra Clinic, London, United Kingdom
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Abstract
BACKGROUND Hyaluronic acid soft-tissue augmentation fillers are commonly injected into multiple areas of the face, including the tear trough. Despite well-documented risks, there is no standardized, evidence-based approach to inject filler in this area, be it using a hypodermic needle or a microcannula. The authors, therefore, sought to establish a preference between the two methods to facilitate progression toward standardization and prevention of adverse events. METHODS This is a systematic review of articles discussing hyaluronic acid tear trough injection techniques performed in vivo and related outcomes. Searches were conducted across The Cochrane Library, PubMed, Scopus, Web of Science, and Embase to yield relevant articles published before February of 2020. All selected articles incorporated discrete patient cases and were analyzed by a variety of variables assessing evidence strength, outcomes, technique, and patient safety. RESULTS After appraisal, 42 articles met eligibility criteria: 20 using needles, 12 using cannulas, and 10 focusing on adverse events. Level III was the most commonly awarded evidence grade, corresponding to retrospective, nonexperimental descriptive studies. There were no statistically significant differences in reported aesthetic results, patient satisfaction, or incidence of adverse events across the needle-based and cannula-based articles. Some technique trends, such as targeted anatomical plane and needle position, emerged in subsequent articles. CONCLUSION Given that there were no statistically significant differences in patient safety or outcomes, an evidence-based preference for needle or cannula injection into the tear trough cannot be made at this time. Current inconsistencies make tear trough injection procedures difficult to replicate, making standardization based on avoidance of adverse events not feasible.
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Calomeni M, Alfertshofer MG, Frank K, Moellhoff N, Dennison R, Bravo B, Schelke L, Velthuis P, Green JB, Cotofana S. Real-Time Ultrasound Imaging of the Tear Trough: Lessons Learned From Functional Anatomy. Aesthet Surg J 2022; 42:518-526. [PMID: 34610093 DOI: 10.1093/asj/sjab351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying facial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments. OBJECTIVES The authors sought to evaluate the location and function of the angular vein in the tear trough in 3 different facial expressions: repose, smiling, and max. orbicularis oculi contraction. METHODS Twenty study participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m2 were investigated via functional ultrasound imaging. The diameter of the angular vein and the velocity and direction of venous blood flow were analyzed in repose, smiling, and during max. orbicularis oculi contraction. RESULTS The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle (intra-muscular course) within the tear trough, whereas the angular artery was not identified in this location. The distance between the angular vein and the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/s and was 7.3 cm/s at max. orbicularis oculi muscle contraction; however, no blood flow was detectable during smiling. CONCLUSIONS The diameter and the venous blood flow of the angular vein varied between the 3 tested facial expressions. Based on these anatomical findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein.
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Affiliation(s)
| | - Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | | | | | - Leonie Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
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Wang D, Xiong S, Zeng N, Wu Y. Facial Arterial Variations in Asians: A Study on Computed Tomographic Angiography. Aesthet Surg J 2022; 42:527-534. [PMID: 34724046 DOI: 10.1093/asj/sjab380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A consensus on facial artery anatomy has not been established due to the discrepancies in previous studies. OBJECTIVES The authors sought to assess the branches, course, and location of the facial artery in Asians by utilizing computed tomographic angiography. METHODS The computed tomographic angiography images of 300 facial arteries from 150 Asian patients were evaluated. The FA was classified as follows: type 1, facial artery terminates superior labial or inferior labial artery; type 2, facial artery terminates lateral nasal or inferior alar artery; type 3, facial artery terminates medial canthal artery; or type 4, facial artery is divided into duplex branches with dominant medial canthal artery laterally. The relationship between nasolabial fold and FA was evaluated, and the distances from anatomical landmarks to FA were measured to position the course. RESULTS Seventy (23.3%), 163 (54.3%), 49 (16.3%), and the other 18 arteries (6.0%) were classified as type 1, 2, 3, and 4, respectively. A total 72.3% of facial arteries were located medially to the nasolabial fold, and only 14.7% of arteries were lateral to the nasolabial fold. The vertical distance between the facial artery and the inner canthus or the midpoint of the inferior orbital rim decreased from type 1 to type 4 facial artery (P < 0.0001). The 4 types did not significantly differ in distance between the mandibular angle (P = 0.1226) or oral commissure (P = 0.1030) and the facial artery at inferior of mandible. CONCLUSIONS Detailed findings of the facial artery will provide a valuable reference for filler injection in cosmetic procedures and flap design in reconstructive surgery.
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Affiliation(s)
- Dawei Wang
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shixuan Xiong
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Ning Zeng
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yiping Wu
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Wang D, Xiong S, Zeng N, Wu Y. The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection. Aesthet Surg J 2022; 42:NP319-NP326. [PMID: 36413200 DOI: 10.1093/asj/sjab391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Knowledge of the anatomy of the facial vein is essential for plastic surgery and filler injection. OBJECTIVES The authors sought to investigate the variation and 3-dimensional (3D) course of the facial vein utilizing computed tomographic angiography. METHODS The computed tomographic angiography images of 300 facial veins from 150 Asian patients were included in this study. The distance between each anatomical landmark and the facial vein was measured to position the course. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum were measured at 5 anatomical planes. RESULTS The facial vein showed a relatively constant course with a frequency of 7.0% variation. The vertical distance between the medial canthus, midpoint of inferior orbital rim, or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar, or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between the mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm or 53.04 ± 6.56 mm. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum varied from the plane of the medial canthus to the plane of the mandible. CONCLUSIONS This study revealed the 3D course of the facial vein with reference to anatomical landmarks. Detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.
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Affiliation(s)
- Dawei Wang
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Shixuan Xiong
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Ning Zeng
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yiping Wu
- Department of Plastic Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Gréant E, Haesendonck GV, Faris C. A Buccal Space Approach for Midface Free Flap Reconstruction. Facial Plast Surg 2022; 38:214-217. [PMID: 35114712 DOI: 10.1055/s-0041-1742133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This article describes a transbuccal approach to reach the facial vessels. The anatomy of this intraoral approach is predictable, minimizing the risk of facial nerve dysfunction. This technique provides the possibility of free flap midface reconstruction with short pedicles and avoids the need to use vein grafts. Moreover, it is esthetically preferable. Through cadaver dissection and anatomical drawings, we describe extensively the different surgical steps. Using the combination of the previous knowledge and recent anatomical understandings, we can provide a reliable step-by-step approach to find the facial artery and vein through a transbuccal approach for microvascular midface free flap repair.
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Affiliation(s)
- Elisabeth Gréant
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Gilles Van Haesendonck
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Callum Faris
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Recognize facial muscle contraction direction and muscle morphology based on skin surface movements and facial rhytides. 2. Classify different muscle contraction patterns and target respectively with the recommended dosage and injection technique. 3. Apply the presented injection techniques to the patients' individual anatomy with greater precision and without affecting adjacent muscles or causing other adverse events. SUMMARY Facial muscular anatomy has recently gained increased attention, with new investigative methodologies and new injection techniques arising on the market. These recent advancements have increased our understanding about the functional anatomy of facial muscles and have changed the way health care professionals see and understand their interplay during various facial expressions and in determining facial shape. This new anatomical understanding of facial muscles and their interaction has resulted in superior neuromodulator treatment outcomes with fewer side effects and with increased precision. The latter is of greatest importance, as all facial muscles act as a unit and connect with each other. It is therefore paramount to target during neuromodulator treatments only the muscle responsible for the aesthetic effect desired and not other adjacent muscles, which can have different or even antagonistic effects. Conventional anatomy was previously limited to two-dimensional explanations of muscle locations without incorporating their detailed action or their three-dimensional location of extent. The "new" anatomy incorporates those novel concepts and, once understood, will help health care providers to understand better and to "read" the underlying muscular anatomy based on the wrinkle status and based on the change in skin surface landmarks based on the actions of the underlying musculature. The following article summarizes tips and tricks, pearls and pitfalls, and dos and don'ts during facial neuromodulator injections along with a guide toward adverse event management and patient outcome assessment with special focus on the underlying anatomy.
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Patel C, Abdel-Rahman A, Gahir D. Potential of the common facial vein as a recipient vein in free flap reconstruction. Clin Anat 2021; 34:1208-1214. [PMID: 34448241 DOI: 10.1002/ca.23778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/05/2022]
Abstract
Recipient vessel selection for free flap reconstruction depends on numerous factors and may be limited due to previous treatment. Currently, little evidence is available regarding the anatomy and reconstructive potential of the common facial vein (CFV), a tributary of the internal jugular vein (IJV). The aim of this project was to determine the diameter of the CFV at various points along its course and identify suitable landmarks to locate the CFV, to consider the vessel as a potential recipient vein in free flap reconstruction. A cadaveric study was conducted by dissecting 17 embalmed neck hemi-sections in the Keele University Medical School Anatomy Suite. Our intent was to describe the gross anatomy of the CFV in terms of diameter and relation to surrounding structures. We found the mean diameter of the CFV to be 5.9 (± 1.8) mm at its termination into the IJV. We also found the mean distance of the CFV termination into the IJV from the level of the hyoid bone was 8.0 (± 4.0) mm. The diameter of the CFV could accommodate for end-to-end anastomoses to be formed with the IJV system. The diameter also suggests the vein to be appropriate for microvascular anastomosis with commonly used free flaps. The results propose that the CFV can be found within 12 mm of the level of the hyoid bone, knowledge of which could reduce operative time and site morbidity. These findings support the CFV as a potential recipient vein in free flap reconstruction of the head and neck.
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Affiliation(s)
- Chantal Patel
- Keele Medical School Anatomy Department, Keele University, Keele, Staffordshire, UK
| | - Ahmed Abdel-Rahman
- Department of Oral and Maxillo-Facial Surgery, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Daya Gahir
- Keele Medical School Anatomy Department, Keele University, Keele, Staffordshire, UK.,Department of Oral and Maxillo-Facial Surgery, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
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Schelke L, Velthuis PJ, Lowry N, Rohrich RJ, Swift A, Gotkin RH, Moellhoff N, Frank K, Dumbrava M, Cotofana S. The mobility of the superficial and deep midfacial fat compartments: An ultrasound-based investigation. J Cosmet Dermatol 2021; 20:3849-3856. [PMID: 34365716 DOI: 10.1111/jocd.14374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the mobility of the midface and the separate contributions of the superficial and deep fat compartments is essential for natural esthetic outcomes following soft tissue filler or fat grafting procedures. A study was designed that used ultrasound imaging to demonstrate in vivo visualization and quantification of distances and movements in the midface. METHODS A total of 48 midfaces of 24 healthy Caucasian volunteers, all naïve of esthetic procedures, (22 females; 46.85 (9.8) years; 22.83 (3.1) kg/m2 ) were scanned using 18 MHz ultrasound imaging. Distances between bony landmarks (inferior orbital rim, infraorbital foramen) were used as markers to measure the cranial movement of the superficial (superficial nasolabial and superficial medial cheek fat compartment) and the deep (deep pyriform space, deep medial check fat compartment, deep lateral cheek fat compartment) midfacial fat compartments between resting and smiling facial position. RESULTS The superficial midfacial fat compartment moved, on average, 3.7 mm (p < 0.001) cranially, whereas the deep midfacial fat compartments moved, on average, 0.1 mm (p > 0.05) during smiling. No gender differences in mobility were identified (p > 0.05). CONCLUSION The results obtained are in line with previous cadaveric investigations and revealed, in a highly statistically significant fashion, that the superficial midfacial fat compartments move in cranial direction whereas the deep fat compartment did not display similar positional changes. These results help to guide facial injectable treatments and to understand why, in the midface, a deep supraperiosteal approach should be favored when augmenting the deep midfacial fat compartments.
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Affiliation(s)
- Leonie Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands.,Private Practice, Amsterdam, The Netherlands
| | - Peter J Velthuis
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Natalia Lowry
- Division of Anatomy, Department of Medical Education, Albany Medical College, Albany, NY, USA
| | | | - Arthur Swift
- Westmount Institute of Plastic Surgery, Montreal, Quebec, Canada
| | | | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Mihai Dumbrava
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Gombolevskiy V, Gelezhe P, Morozov S, Melnikov DV, Vorontsov A, Kulberg N, Frank K, Gotkin RH, Lachman N, Cotofana S. The Course of the Angular Artery in the Midface: Implications for Surgical and Minimally Invasive Procedures. Aesthet Surg J 2021; 41:805-813. [PMID: 32593170 DOI: 10.1093/asj/sjaa176] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous anatomic studies have provided valuable information on the 2-dimensional course of the angular segment of the facial artery in the midface and its arterial connections. The third dimension (ie, the depth of the artery) is less well characterized. OBJECTIVES The objective of the present study was to describe the 3-dimensional pathway of the angular segment of the facial artery and its relationship to the muscles of facial expression. METHODS The bilateral location and the depth of the midfacial segment of the facial artery was measured utilizing multi-planar computed tomographic image analyses obtained from contrast agent-enhanced cranial computed tomographic scans of 156 Caucasians aged a of 45.19 ± 18.7 years and with a mean body mass index of 25.05 ± 4.9 kg/m2. RESULTS At the nasal ala, the mean depth of the main arterial trunk was 13.7 ± 3.7 mm (range, 2.7-25.0 mm), whereas at the medial canthus it was 1.02 ± 0.62 mm (range, 1.0-3.0 mm). This was reflected by the arteries' relationship to the midfacial muscles: at the nasal ala superficial to levator anguli oris in 62.0% but deep to the levator labii superioris alaeque nasi in 53.6%; at the medial canthus superficial to the levator labii superioris alaeque nasi in 83.1% and superficial to the orbicularis oculi in 82.7%. CONCLUSIONS The results presented herein confirm the high variability in the course of the angular segment of the facial artery. Various arterial pathways have been identified providing evidence that, in the midface, there is no guaranteed safe location for minimally invasive procedures.
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Affiliation(s)
- Victor Gombolevskiy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Pavel Gelezhe
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Sergey Morozov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Dmitry V Melnikov
- Plastic Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Nikolay Kulberg
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russia
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | | | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Urdiales-Gálvez F, Farollch-Prats L. Management of Tear Trough with Hyaluronic Acid Fillers: A Clinical-Practice Dual Approach. Clin Cosmet Investig Dermatol 2021; 14:467-483. [PMID: 34012281 PMCID: PMC8127324 DOI: 10.2147/ccid.s301117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022]
Abstract
Introduction Tear trough deformity (TTD) is currently a major concern for many individuals that seek periorbital rejuvenation. Among the different options currently available for treating TTD, hyaluronic acid (HA) filler injections have become increasingly popular. Purpose To provide a dual approach, direct and indirect strategies for treating TTD with HA fillers according to patient facial structure. Methods The current paper combined the authors’ experience with the currently available scientific evidence. Results The current study presents the authors clinical experience regarding TTD treatment and serves as a guide on the best therapeutic approach with HA fillers. For achieving good aesthetic outcomes, especially in TTD, it is crucial to have a detailed understanding of both facial anatomy and the individual characteristics of the HA fillers. Proper management of full-face facial rejuvenation should have into consideration three main pillars: structure, contour, and refinement. Conclusion Treatment of TTD should be addressed from a comprehensive perspective, including potential lack of structural support, as well as interventions on the dynamic processes involved in the problem. Additionally, HA fillers can be used to modulate mechanically muscle movement by either facilitating their action or decreasing contractility by reducing their movement. Clinicians can benefit from ongoing guidance on the use of these products in order to tailor and optimize treatments to patient’s requirements. Although HA filler injections have low rates of side effects, TTD was listed as the most challenging area to treat with HA. Therefore, TTD treatment should be performed only by well-trained and experienced specialists.
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A Safe and Effective Lip Augmentation Method: The Step-by-Step Φ (Phi) Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3332. [PMID: 33680634 PMCID: PMC7928943 DOI: 10.1097/gox.0000000000003332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
The shape and fullness of the lips are essential in facial aesthetics. We describe a safe injection technique of hyaluronic acid (HA), based on the well-known golden number Φ (phi), for lip augmentation.
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19
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Anatomical Evaluation of Zygomaticus Major Muscle With Relation to Orbicularis Oculi Muscle and Parotid Duct. J Craniofac Surg 2020; 31:1844-1847. [DOI: 10.1097/scs.0000000000006396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Superficial and Deep Facial Anatomy and Its Implications for Rhytidectomy. Facial Plast Surg Clin North Am 2020; 28:243-251. [PMID: 32503712 DOI: 10.1016/j.fsc.2020.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The relationship of the skin, the superficial and deep fat compartments, and the ligaments that connect these structures is key to performing any rhytidectomy. In order to successfully mobilize, elevate, and reposition the facial soft tissues, a detailed understanding of facial anatomy is required. This article details the anatomy of the midface and neck that is essential to understanding and performing the face-lift operation.
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The Superior Ophthalmic Vein: Anatomical Perspective for Transvenous Access to the Cavernous Sinus. J Craniofac Surg 2020; 31:1153-1156. [PMID: 32149970 DOI: 10.1097/scs.0000000000006303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The anatomical characteristics of the superior ophthalmic vein (SOV), which is crucial when performing craniofacial surgeries and transvenous access to the cavernous sinus, have not been documented. The present study aimed to explore them using magnetic resonance angiography (MRA). A volumetric, phase-contrast MRA was performed in 74 outpatients not bearing vascular or tumorous pathologies in the face, orbit, and cavernous sinus. The entire course of the SOV was delineated in 46 patients (62%), for 76% on the right side and 83% on the left. These SOVs consistently showed a characteristic morphology with a laterally coursing proximal segment and a medially coursing distal segment. The latter segment was connected to the angular, supraorbital, supratrochlear, facial, and external nasal veins that were inconsistently delineated. The angular vein was tortuous in 51% of the patients on the right and 53% on the left. The morphology of the proximal part of the SOV was also variable and involved a tortuous segment in 11% of the patients on the right and in 7% on the left. Furthermore, in 4 patients (8.7%), a fenestration was found in the right SOVs. Inconsistent tributaries of the SOV, tortuous angular vein, and possible tortuous segment and fenestration of the SOV can make orbital transvenous access to the cavernous sinus difficult.
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Hanick A, Ciolek P, Fritz M. Angular Vessels for Free‐Tissue Transfer in Head and Neck Reconstruction: Clinical Outcomes. Laryngoscope 2020; 130:2589-2592. [DOI: 10.1002/lary.28540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Andrea Hanick
- Head and Neck Institute, Cleveland Clinic Foundation Cleveland Ohio
| | - Peter Ciolek
- Head and Neck Institute, Cleveland Clinic Foundation Cleveland Ohio
| | - Michael Fritz
- Section Head Facial Plastic and Microvascular Surgery, Head and Neck Institute, Cleveland Clinic Foundation Cleveland Ohio U.S.A
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Casabona G, Bernardini FP, Skippen B, Rosamilia G, Hamade H, Frank K, Freytag DL, Sykes J, Onishi EC, Cotofana S. How to best utilize the line of ligaments and the surface volume coefficient in facial soft tissue filler injections. J Cosmet Dermatol 2019; 19:303-311. [DOI: 10.1111/jocd.13245] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023]
Affiliation(s)
| | | | | | - Gianna Rosamilia
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
| | - Hassan Hamade
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery Ludwig–Maximilians University Munich Munich Germany
| | - David L. Freytag
- Department for Hand, Plastic and Aesthetic Surgery Ludwig–Maximilians University Munich Munich Germany
| | - Jonathan Sykes
- Facial Plastic and Reconstructive Surgery UC Davis Medical Center Sacramento CA USA
| | | | - Sebastian Cotofana
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
- Division of Plastic Surgery Department of Surgery Albany Medical Center Albany NY USA
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Cotofana S, Lowry N, Devineni A, Rosamilia G, Schenck TL, Frank K, Bautista SA, Green JB, Hamade H, Gotkin RH. Can smiling influence the blood flow in the facial vein?—An experimental study. J Cosmet Dermatol 2019; 19:321-327. [DOI: 10.1111/jocd.13247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Sebastian Cotofana
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
- Division of Plastic Surgery Department of Surgery Albany Medical Centre Albany NY USA
| | - Natalia Lowry
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
| | - Aditya Devineni
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
| | - Gianna Rosamilia
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
| | - Thilo L. Schenck
- Department for Hand, Plastic and Aesthetic Surgery Ludwig–Maximilian University Munich Munich Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery Ludwig–Maximilian University Munich Munich Germany
| | | | | | - Hassan Hamade
- Division of Anatomy Department of Medical Education Albany Medical College Albany NY USA
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Facial Transplantation for an Irreparable Central and Lower Face Injury: A Modernized Approach to a Classic Challenge. Plast Reconstr Surg 2019; 144:264e-283e. [PMID: 31348362 DOI: 10.1097/prs.0000000000005885] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Facial transplantation introduced a paradigm shift in the reconstruction of extensive facial defects. Although the feasibility of the procedure is well established, new challenges face the field in its second decade. METHODS The authors' team has successfully treated patients with extensive thermal and ballistic facial injuries with allotransplantation. The authors further validate facial transplantation as a reconstructive solution for irreparable facial injuries. Following informed consent and institutional review board approval, a partial face and double jaw transplantation was performed in a 25-year-old man who sustained ballistic facial trauma. Extensive team preparations, thorough patient evaluation, preoperative diagnostic imaging, three-dimensional printing technology, intraoperative surgical navigation, and the use of dual induction immunosuppression contributed to the success of the procedure. RESULTS The procedure was performed on January 5 and 6, 2018, and lasted nearly 25 hours. The patient underwent hyoid and genioglossus advancement for floor-of-mouth dehiscence, and palate wound dehiscence repair on postoperative day 11. Open reduction and internal fixation of left mandibular nonunion were performed on postoperative day 108. Nearly 1 year postoperatively, the patient demonstrates excellent aesthetic outcomes, intelligible speech, and is tolerating an oral diet. He remains free from acute rejection. CONCLUSIONS The authors validate facial transplantation as the modern answer to the classic reconstructive challenge imposed by extensive facial defects resulting from ballistic injury. Relying on a multidisciplinary collaborative approach, coupled with innovative emerging technologies and immunosuppression protocols, can overcome significant challenges in facial transplantation and reinforce its position as the highest rung on the reconstructive ladder. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Influence of Age, Sex, and Body Mass Index on the Depth of the Superficial Fascia in the Face and Neck. Dermatol Surg 2019; 45:1365-1373. [DOI: 10.1097/dss.0000000000001909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Koziej M, Trybus M, Hołda M, Polak J, Wnuk J, Brzegowy P, Popiela T, Walocha J, Chrapusta A. Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic Procedures. Aesthet Surg J 2019; 39:1151-1162. [PMID: 30721996 DOI: 10.1093/asj/sjz028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The facial artery (FA) is the main blood vessel supplying the anterior face and an understanding of its anatomy is crucial in facial reconstruction and aesthetic procedures. OBJECTIVES The aim of this study was to assess the many anatomical features of the FA utilizing a multidimensional approach. METHODS Head and neck computed tomographic angiographies of 131 patients (255 FAs) with good image quality were evaluated. The FA was classified according to its termination pattern, course, and location with reference to soft tissue/bone surrounding structures. RESULTS In total, each branch was present as follows: the submental artery (44.8%), the inferior labial artery (60%), the superior labial artery (82.2%), the lateral nasal artery (25.1%), and the angular artery (42.5%). The most common FA course was the classic course, situated medially to the nasolabial fold (27.1%). In total 65.5% of the arteries were located medially to the nasolabial fold, and only 12.3% of them were totally situated lateral to the nasolabial fold. The median distance (with quartiles) from the inferior orbital rim reached the FA after the superior labial artery branched off in 50.2% of cases and was 36.6 mm (33.4; 43.3). The angle between the FA and the inferior border of the mandible was 49.8o (31.9; 72.4). The horizontal distances between the oral commissure and naris to the FA were 8.5 ± 4.0 mm and 12.1 ± 6.7 mm, respectively. CONCLUSIONS An anatomical map summarizing the major measurements and geometry of the FA was generated. The detailed anatomy and relative positioning of the FA should be considered to avoid any unexpected complications in plastic surgery.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, The Ludwik Rydygier Hospital, Krakow, Poland
- The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
| | - Marek Trybus
- Second Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Hołda
- Department of Anatomy, Jagiellonian University Medical College
| | - Jakub Polak
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jakub Wnuk
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Paweł Brzegowy
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Tadeusz Popiela
- Head of the Department of Radiology, Department of Rescue Medicine and Multiorgan Trauma, University Hospital, Krakow, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College
| | - Anna Chrapusta
- Head of The Malopolska Center for Burns and Plastic Surgery, The Ludwik Rydygier Hospital, Krakow, Poland
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Kantar RS, Ceradini DJ, Rodriguez ED. Unique Venous Anatomy in a Face Donor. JAMA FACIAL PLAST SU 2019; 21:462-463. [DOI: 10.1001/jamafacial.2019.0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rami S. Kantar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York
| | - Daniel J. Ceradini
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York
| | - Eduardo D. Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York
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Cotofana S, Lachman N. Anatomie der Fettkompartimente des Gesichts und ihre Bedeutung für die ästhetische Chirurgie. J Dtsch Dermatol Ges 2019; 17:399-415. [PMID: 30958928 DOI: 10.1111/ddg.13737_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Sebastian Cotofana
- Department of Medical Education, Albany Medical College, Albany, New York, USA
| | - Nirusha Lachman
- Department of Anatomy and Department of Surgery, Division of Plastic Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
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External and Internal Diameters of the Facial Artery Relevant to Intravascular Filler Injection. Plast Reconstr Surg 2019; 143:1031-1037. [DOI: 10.1097/prs.0000000000005428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Iwanaga J, Kikuta S, Tubbs RS. Breathing Life into the Cadaver: Introducing Air Dissection As a New Teaching and Dissecting Method for the Venous System. Clin Anat 2019; 32:566-572. [PMID: 30773730 DOI: 10.1002/ca.23354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/13/2019] [Indexed: 12/31/2022]
Abstract
Air insufflation has been used for various surgical procedures such as during laparoscopy. We hypothesized that the use of pressurized air might enable cadaveric dissection to differentiate smaller veins better than traditional dissection techniques. In three fresh-frozen cadavers, the inferior vena cava (IVC) and right or left femoral veins were exposed just distal to the inguinal ligament and a needle placed into one of them. Pressurized air was then placed into the cannulated femoral vein using an air compressor. In all specimens, the IVC and most of its tributaries, both left and right sides, were clearly insufflated. When the IVC was traced superiorly by resecting the diaphragm through the caval foramen, the right atrium and ventricle were also found to be dilated. Additionally, venous variants that would have not been obvious without dilatation of the IVC were identified. Air dissection of the venous system in fresh-frozen cadavers aids in anatomical dissection. Such a model might also serve as a surgical training model and teaching tool as it better mimics life-like anatomy and physiology. We term this technique "cadaveric air dissection." Clin. Anat. 32:566-572, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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Arteries of the Face and Their Relevance for Minimally Invasive Facial Procedures. Plast Reconstr Surg 2019; 143:416-426. [DOI: 10.1097/prs.0000000000005201] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Cotofana S, Lachman N. Anatomy of the Facial Fat Compartments and their Relevance in Aesthetic Surgery. J Dtsch Dermatol Ges 2019; 17:399-413. [DOI: 10.1111/ddg.13737] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Sebastian Cotofana
- Department of Medical EducationAlbany Medical College Albany New York USA
| | - Nirusha Lachman
- Department of Anatomy and Department of SurgeryDivision of Plastic SurgeryMayo Clinic College of Medicine and ScienceMayo Clinic Rochester Minnesota USA
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Schenck TL, Koban KC, Schlattau A, Frank K, Sclafani AP, Giunta RE, Roth MZ, Gaggl A, Gotkin RH, Cotofana S. Updated anatomy of the buccal space and its implications for plastic, reconstructive and aesthetic procedures. J Plast Reconstr Aesthet Surg 2018; 71:162-170. [DOI: 10.1016/j.bjps.2017.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/10/2017] [Accepted: 11/07/2017] [Indexed: 11/26/2022]
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Mojallal A, Cotofana S. Anatomy of lower eyelid and eyelid-cheek junction. ANN CHIR PLAST ESTH 2017; 62:365-374. [PMID: 29033216 DOI: 10.1016/j.anplas.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Understanding the anatomy of the lower eyelid and the lid-cheek junction is important for surgical and non-surgical approaches. It is important to understand the correlation between the clinical presentation and the individual anatomy to direct an adequate treatment. METHODS A review of the literature based on the authors experience combined with anatomical dissections was conducted to reveal the current concepts of the surgical and non-surgical anatomy. The various anatomical structures important for the understanding of the symptoms and the proposed treatment are described in this article. RESULTS The anatomy of the lower eyelid and the lid-cheek junction has to be understood as a unit. Structures are continuous from the eyelid to the cheek influencing each other during aging. The concept of superficial, i.e. superficial to the orbicularis oculi muscle and deep facial fat compartments, i.e. deep to the orbicularis oculi muscle has to be applied in order to understand the relevant anatomy regarding the ligaments, fat compartments, muscular and tarsal structures and the vascularization. CONCLUSION The understanding of the layered arrangement of the lower eyelid and eyelid-cheek junction anatomy enables practitioners to perform safe and effective surgical and non-surgical procedures.
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Affiliation(s)
- A Mojallal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Croix-Rousse Hospital, hospices civils de Lyon (HCL), University of Lyon Claude-Bernard 1, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
| | - S Cotofana
- Department of Medical Education, Albany Medical College, 47 New Scotland avenue MC-135, 12208 Albany, NY, USA
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