An anatomical study of the facial artery / Un estudio anatómico de la arteria facial

The facial artery (a branch of the external carotid artery) is the main artery of the face. It gives rise to seven branches viz. inferior labial, superior labial, inferior alar, superior alar, lateral nasal and angular arteries, which are variable. This study included a dissection of twenty embalmed adult cadaveric head and neck specimens. The parameters of origin, branching patterns, termination and variations were analysed and compared with sex and laterality. The facial artery followed the standard anatomical description of origin in 84.62 % of the sample. Variations: (i) origin as a linguofacial trunk in 12.82 % and (ii) high origin in 2.56 % was observed. Male specimens displayed a higher number of linguofacial trunk origins (7.69 %). The branching patterns of the facial artery was classified into six types, with subtypes for Types 1 and 2. Subtype 1-A (standard anatomical description with early termination) occurred in most of the sample (46.15 %). Males were found to have more variations in branching patterns than females (48.72 % and 41.03 % respectively). Termination of the facial artery was as follows: inferior labial artery (5.13 %), superior labial artery (10.26 %), inferior alar artery (10.26 %), superior alar artery (46.15 %), lateral nasal artery (5.13 %), and angular artery (20.51 %). A single case (2.56 %) of an abortive artery was noted. Statistical analysis showed that sex was independent of each parameter observed in this study. Anatomical knowledge of the facial artery is of importance to clinicians and surgeons during procedures such as musculomucosal, island flaps and aesthetic dermatology.

La arteria facial (una rama de la arteria carótida externa) es la arteria principal de la cara. Da lugar a siete ramas: labial inferior, labial superior, alar inferior, alar superior, arterias nasales y angulares laterales, además de ramas pequeñas variables. Este estudio incluyó una disección de veinte muestras de cabeza y cuello de cadáveres adultos fijados. Los parámetros de origen, patrones de ramificación, terminación y variaciones fueron analizados y comparados con el sexo y la lateralidad. La arteria facial se originó de manera normal en el 84,62 % de la muestra. Variaciones: (i) origen como tronco linguofacial en 12.82 % y (ii) se observó un origen alto en 2,56 %. Las muestras en los hombres mostraron un mayor número de orígenes del tronco linguofacial (7,69 %). Los patrones de ramificación de la arteria facial se clasificaron en seis tipos, con subtipos para los Tipos 1 y 2. El subtipo 1-A (descripción anatómica normal con terminación temprana) se observó en (46,15 %) de la muestra. Las muestras de varones tenían una mayor variación en los patrones de ramificación que las muestras de mujeres, 48,72 % y 41,03 % respectivamente. La terminación de la arteria facial fue la siguiente: arteria labial inferior (5,13 %), arteria labial superior (10,26 %), arteria alar inferior (10,26 %), arteria alar superior (46,15 %), arteria nasal lateral (5,13 %) y arteria angular (20,51 %). Se observó un solo caso (2,56 %) de una arteria abortiva. El análisis estadístico mostró que el sexo era independiente de cada parámetro observado en este estudio. El conocimiento anatómico de la arteria facial es importante para los médicos y cirujanos durante procedimientos como colgajos musculomucosal y en la dermatología estética.

Efficacy of nasolabial flap in repairing inferior nasal defect / 中华医学美学美容杂志

Objective To investigate the clinical effect of retrograde nasolabial fold flap pedicled with angular artery in the repair of inferior nasal defect .Methods According to the location and size of inferior nasal defect ,the reverse island flap or axial flap pedicled with the inner canthus artery was de-signed to repair the defect at the nasolabial fold of the affected side .Results Eighteen patients were followed up for 6-36 months ,of which 2 cases had partial necrosis at the distal part of the flap ,healed by dressing change ,and the rest of the flaps survived .The flaps were not bulky and the color and tex-ture were similar to those of the surrounding skin .All patients were satisfied with the appearance im -provement .Conclusions The blood supply of the retrograde nasolabial fold flap pedicled with the in-ner canthus artery is reliable ,using flaps from the nasolabial sulcus is surgically convenient ,flexible in design and covert in donor site .It is one of the ideal methods for the repair of inferior nasal defects .It is worthy of clinical application .

Application of horn shaped flap pedicled with the angular artery perforator for midface reconstruction / 中华整形外科杂志

Objective@#To evaluate the effect of the horn shaped flap pedicled with the angular artery perforator for midface reconstruction.@*Methods@#From March 2014 to April 2017, twenty patients underwent operations for the reconstruction of midface defect, defect due to trauma, tumors, moles, scar and other soft tissue defects after resection. Various horn shaped flap pedicled with the angular artery perforator, perforator flap was rotated and pushed to repair the defect area.The maximum width of the perforator flap was equal to the width of the defect, and the length is about 2.5 to 3.0 times the length of the defect.@*Results@#All flaps survived.After 1 month to 1 year follow up on 20 cases, the flap is significantly improved in color、shape and function.The patients were satisfied with the final aesthetic and functional results.@*Conclusions@#The flap has flexibility and simply with reliable blood supply.The donor sites could be closed directly without skin graft.it is a simple and fast method for the reconstruction of midface defect.

Topographic anatomy of facial artery and medial canthus artery / 中华医学美学美容杂志

Objective To explore the layers of the facial and angular arteries between the orbital notch and the antegonial notch.Methods Anatomical studies were performed on 5 cases of adult cadavers (10 sides).Parallel lines were drawn on each cadaver through the position of the orbital incise,inner canthus,above of wing nose,nasal wing point,mouth angle,anterior incise.When the region of the arterial level changes,the parallel lines could be temporarily divided.The levels of the arteries that appeared on every horizontal line were recorded.Results The surface artery between the orbital notch (including the supraorbital notch) and the inner canthus (including the inner cantholes) was mainly in the orbicularis muscle layer.In the middle of the inner canthus and the highest point of the nasal wing,1/3 of the arteries were mainly walking in the orbicularis orbicularis muscular layer,and the next 1/3 were mainly located in the superficial layer or subcutaneous fat layer of the orbicularis oculi muscle.The highest point of the nose wing was found in the middle of the subcutaneous fat.The main line between the top of the nose and the lower part of the nose was deep in the subcutaneous fat.At the bottom of the nose,the main line was located in the fat layer of the zygomaticus,the zygomaticus maximus.In the middle and upper part of the nose and the middle of the mouth,a third of the main lines were walking in the lower fat layer (from shallow to deep) under the zygomaticus,and the next 1/3 segment was found in the subcutaneous fat deep.On the outside of the corner of the mouth,the main line was walking the subcutaneous fat layer or the lower fat layer of the platysma.Conclusions This study preliminarily clarifies the walking level of the facial artery from the upper orbital notch and the anterior notch of the angle.Bearing in mind the depth and the location of the vasculature within each zone,clinical practitioners can tailor their injection techniques to prevent vessel injury and avoid cannulation.

Topography of Superficial Arteries on the Face / 체질인류학회지

The facial artery (FA) and superficial temporal artery (STA) from the external carotid artery and the supraorbital, supra- and infratrochlear arteries from the internal carotid artery are the superficial arteries distributing to the face. It was broadly known that the FA winds on the antegonial notch, ascends superomedially and finally reaches to the medial canthus area as forming the angular artery (AA). However many previous studies reported that the AA was only observed in 4~68% in their studies. The superior labial artery (SLA) from the FA issues the superficial and deep septal artery proceeding superiorly toward the nasal septum. It was reported that the nasal branches were ramified from the FA, after the bifurcation of the SLA in most Korean cadavers, and it seems that the lateral nasal and dorsal nasal arteries are crucial vasculature of the external nose. The branches of the ophthalmic artery distribute the glabellar and forehead, and they form anastomoses each other or are communicated to the AA. The topography of the superficial arteries of face is very important in the reconstructive surgery and non-invasive treatment such as the botulinum neurotoxin type A or dermal filler injection.

The Vascular System of the Angular Artery: Anatomical Study and Clinical Application

PURPOSE: Although there are many ways to perform midface reconstruction, several difficulties exist for selecting the appropriate method, because of its anatomical and functional complexities, donor site morbidities, and poor aesthetic results. Various flaps based on the angular artery can overcome these limitations of the traditional reconstruction methods. The purpose of this study is to suggest an alternative reconstructive method for the midface using various flaps based on the angular artery. METHODS: We investigated the relationship between the angular artery and its surrounding structures through cadaveric studies and then applied the findings clinically. As a result, we were able to perform reconstruction with a retroangular flap for defects of the lower half of the nose and the lower eyelid. In addition, defects of the upper half of the nose and the medial canthal area were reconstructed by using island composite glabellar flap. RESULTS: The angular artery was reliable as a pedicle, whether it was used antegrade or retrograde. All the wounds were successfully closed, with the exception of minor complications such as partial skin necrosis and flap bulkiness. The aesthetic outcomes for the donor and recipient sites were satisfactory. CONCLUSION: The angular artery has diverse relationships with its surrounding structures according to its course of travel, and if a surgeon has a precise understanding of its anatomical location, we believe that retroangular flap and island composite glabellar flap may improve the treatment of midface defects.

Effectiveness of Vascular Network Including Angular Artery in Inner Canthal Region for Mid-facial Reconstruction

Angular artery as a terminal branch of facial artery ends at inner canthal region and anastomoses with adjacent arteries to form the vascular network in this region. Flaps using this network have been widely used to reconstruct the mid-facial defects. This study was designed to investigate the anatomical basis of theses arteries, especially angular artery which is known to have variable courses, and to demonstrate safety and effectiveness of flaps using this network. The authors reviewed several textbooks of anatomy and reported literatures through MEDLINE search about anatomy of angular artery and its anastomosis. To document clinical application, the authors also analyzed clinical experiences of 19 patients for recent 6 years who were undergone the reconstructive flap surgeries for mid-facial defects using forehead, dorsal nasal and retroangular flaps based on anastomosed vascular network in inner canthal region. As a result of review, the authors could not get an exact conclusion, although there were numerous opinions about anatomical variations of facial and angular artery. However, robust network composed of anastomotic arteries in inner canthal region seems to give high viability to flaps due to rich blood supply regardless of variation. Clinical experiences also showed excellent flap viability without any complication and satisfactory results functionally and cosmetically. In conclusion, flaps using vascular network in inner canthal region should be suggested as safe and effective methods for mid-facial reconstruction.