1
|
McKinnon VE, Riaz S, Stubbs E, McRae MH, McRae MC. Identification of the anatomy of the deep temporal vein using computed tomography imaging: A retrospective cross-sectional review of patient imaging. Microsurgery 2022; 42:757-765. [PMID: 36082800 DOI: 10.1002/micr.30956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/19/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The deep temporal vein (DTV) can be used in free flap procedures when the superficial temporal vein is inadequate. Despite its potential utility, its branching patterns have only been examined in one small anatomic study. The purpose of this study was to examine computed tomography angiography (CTA) images to determine DTV location, variation, and suitability as a microvascular recipient, to provide surgeons with a guide for its use in head and neck defects. METHODS A retrospective chart review identified 152 patient CTA images (76 female; 76 male) in a single academic center imaging database, selected consecutively from January 2017 to April 2020. Patients under 19 years were excluded; ages ranged from 19 to 80 years (average 51.6 years). Reason for imaging, DTV caliber, laterality, distance to zygomatic arch (ZA [coronal and sagittal]), distance to lateral orbital rim (LOR), and branching pattern were recorded. RESULTS The predominant reason for imaging was to rule out cerebrovascular accident (96.2%). Average caliber was 3.46 ± 1.29 mm (95% confidence interval [CI] [3.32, 3.61]; range, 1.00-10.8). Bilateral DTVs were observed in 98.7% of patients. Average distance to landmarks were as follows: ZA (coronal), 13.8 ± 5.85 mm (95% CI [13.2, 14.5]; range, 2.7-33.8); ZA (sagittal), 15.1 ± 6.12 mm (95% CI [14.1, 16.1]; range, 2.8-47.2); LOR, 47.1 ± 9.09 mm (95% CI [46.0, 48.1]; range, 10.8-62.9). Seven branching patterns were identified, including a posterior vertical variant that bypasses the superficial temporal fat pad. CONCLUSIONS The DTV is a "lifeboat" option for head and neck reconstruction. Its average caliber is sufficient for use in microsurgery. Knowledge of both its typical and aberrant courses allow for efficient preoperative planning and surgical dissection. CTA is a useful adjunct when planning to use the DTV for free tissue transfer.
Collapse
Affiliation(s)
- Victoria E McKinnon
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shaista Riaz
- Department of Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Euan Stubbs
- Department of Diagnostic Imaging, McMaster University, Hamilton, Ontario, Canada
| | - Mark H McRae
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Matthew C McRae
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
4
|
Huang RL, Xie Y, Wang W, Herrler T, Zhou J, Zhao P, Pu LLQ, Li Q. Anatomical Study of Temporal Fat Compartments and its Clinical Application for Temporal Fat Grafting. Aesthet Surg J 2017; 37:855-862. [PMID: 28520850 PMCID: PMC5846703 DOI: 10.1093/asj/sjw257] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Low satisfaction rates and severe complications are two major limitations for temporal hollowing augmentation using autologous fat grafting. Despite fat compartments in temporal region have been reported, its clinical applied anatomy for fat grafting have not been the subject of studies that show its benefits objectively and statistically. OBJECTIVES To investigate temporal fat compartments and relative neurovascular structures in cadavers, developing a safe and effective fat grafting technique for temporal hollowing augmentation. METHODS The study was conducted on 8 cadavers (16 temples). The tissue layers, fat compartments, ligaments, and neurovascular structures in the temporal region were analysed. The variables were the number and location of sentinel veins, perforator vessels of the middle temporal vein. Measurements were taken with a digital calliper. RESULTS Two separate fat compartments, the lateral temporal-cheek fat compartment and lateral orbital fat compartment, were found in the subcutaneous layer, and two separate septum compartments, the upper and lower temporal compartment, were found in the loose areolar tissue layer. One sentinel vein and 1 to 6 perforator vessels were found to travel through the subcutaneous tissue layer, traverse the overlapping tissue layers in the lower temporal septum region, and finally join in the middle temporal vein. CONCLUSIONS The four fat compartments in the temporal region are ideal receipt sites for fat grafting. The medial border of the junction of the hairline and temporal line is a safe and effective cannula entry site for temporal fat grafting. The anterior half of the lower temporal compartment is a "zone of caution" for temporal fat grafting.
Collapse
Affiliation(s)
- Ru-Lin Huang
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Yun Xie
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Wenjin Wang
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Tanja Herrler
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Jia Zhou
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Peijuan Zhao
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Lee LQ Pu
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Qingfeng Li
- Drs Huang, Xie, Wang, Zhou, and Zhao are Plastic Surgeons, and Dr Li is a Professor, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Dr Herrler is an Attending Surgeon, Plastic Surgery and Burn Center, Trauma Center Murnau, Murnau, Germany. Dr Pu is a Professor of Plastic Surgery, Division of Plastic Surgery, University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
5
|
Pessa JE, Kenkel JM, Heldermon CD. Periorbital and Temporal Anatomy, "Targeted Fat Grafting," and How a Novel Circulatory System in Human Peripheral Nerves and Brain May Help Avoid Nerve Injury and Blindness During Routine Facial Augmentation. Aesthet Surg J 2017; 37:969-973. [PMID: 28595323 PMCID: PMC5846697 DOI: 10.1093/asj/sjx089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joel E Pessa
- Dr Pessa is an Associate Clinical Professor and Dr Kenkel is the Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is also the Associate Editor of Aesthetic Surgery Journal. Dr Heldermon is an Assistant Professor of Medicine, Division of Hematology and Oncology, The University of Florida College of Medicine, Gainesville, FL
| | - Jeffrey M Kenkel
- Dr Pessa is an Associate Clinical Professor and Dr Kenkel is the Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is also the Associate Editor of Aesthetic Surgery Journal. Dr Heldermon is an Assistant Professor of Medicine, Division of Hematology and Oncology, The University of Florida College of Medicine, Gainesville, FL
| | - Coy D Heldermon
- Dr Pessa is an Associate Clinical Professor and Dr Kenkel is the Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is also the Associate Editor of Aesthetic Surgery Journal. Dr Heldermon is an Assistant Professor of Medicine, Division of Hematology and Oncology, The University of Florida College of Medicine, Gainesville, FL
| |
Collapse
|