Study of Branching Pattern of External Carotid Artery

Background: Anatomical information of vasculature is of need for the surgeons and radiologists. Carotid artery and its branches supply most of head, neck, and brain. Injuries to the external carotid artery and its branches is often complex and results in high mortality. Knowledge of types and frequencies of vascular variations of external carotid artery is of help for invasive diagnostic and interventional procedures. Materials and methods: 50 external carotid arteries were dissected to study the branching pattern of external carotid artery. Results: Conventional branching pattern was seen in 58% specimens. Superior thyroid artery originated from common carotid artery in 12% specimens. Linguofacial trunk was observed in 16%. Occipital artery and ascending pharyngeal artery rose from a single trunk in 12%. Origin of facial artery from maxillary artery was observed in one specimen. Conclusion: Study of variations in the branching pattern of the external carotid artery adds to the existing anatomical knowledge. Variations in the branching pattern is of definite help for interventional radiologists, vascular, craniofacial and neck surgeons.

Post-traumatic Pseudoaneurysm of a Branch of Facial Artery

@#Pseudoaneurysm which is also known as a false aneurysm is caused by extravasation of blood from the injured vessel wall which is contained by the surrounding soft tissue. It does not contain any layer of the vessel wall and can expand as more and more blood collects. We are reporting a case of an 18-year-old Indian gentleman who presented with complaint of left neck swelling after being involved in a motor vehicle accident. Examination showed a softly pulsating swelling at the angle of the left mandible. CT angiogram revealed a pseudoaneurysm of a branch of the left facial artery. The pseudoaneurysm was embolized by using histoacryl glue. Pseudoaneurysm should be considered as a differential diagnosis in patients with a pulsatile mass after trauma.

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.

Unusual branching pattern and termination of facial artery and its clinical implications for facial operations / Padrão anômalo de ramificação e terminação da artéria facial e implicações clínicas para cirurgias da face

The facial artery is the main artery of the face and variations in its origin and its branching pattern have been documented. We report herein multiple facial artery branch variations in the face. A large posterior (premasseteric) branch originated from the left facial artery and coursed upwards behind the main trunk of the facial artery. This artery presented with a straight course and was closely related to the anterior border of the masseter. The branch then terminated by supplying the adjacent connective tissue below the parotid duct. It was also observed that the facial artery was very thick and tortuous and terminated as the superior labial artery. Knowledge of this variation is of great clinical significance in facial operations, especially for maxillofacial surgeons and plastic surgeons, because it forms the anatomical basis for the facial artery musculo-mucosal flap

A artéria facial é a principal artéria da face, e variações da sua origem e padrão de ramificação têm sido documentadas. Este artigo descreve múltiplas variações de ramificações da artéria facial. Um ramo posterior grande (pré-massetérico) teve origem na artéria facial esquerda e cursou para cima por trás do tronco principal da artéria facial. Essa artéria apresentou um curso reto e intimamente relacionado com a borda anterior do masseter. O ramo terminou suprindo o tecido conjuntivo adjacente abaixo do ducto parotídeo. Também se observou que a artéria facial tinha grande calibre, era tortuosa e terminava na artéria labial superior. Conhecer essa variação é de grande significância clínica em cirurgias da face, principalmente para cirurgiões maxilofaciais e plásticos, tendo em vista que ela forma a base anatômica para o retalho músculo-mucoso da artéria facial

Individualized design of facial artery perforator flap for reconstruction of soft tissue defects in the midface / 中华医学美学美容杂志

Objective@#To explore the clinical application of individualized design of facial artery perforator flap for the repair of midfacial defect caused by tumor resection.@*Methods@#From January 2015 to January 2018, a total of 36 cases of midfacial defect were repaired by individualized designed facial artery. Flaps were designed and harvested according to the location and size of the midfacial defect resulted from tumor resection, including propeller flaps, droplet flaps and swallowtail-shape flaps. Flap size was between 1.3 cm × 1.6 cm and 2.0 cm × 4.2 cm with the donor site being sutured in the first stage.@*Results@#During the 6 months to 3 years of postoperative follow-up, no tumor recurred. All the 36 cases of individualized designed facial artery perforator flaps survived well. Furthermore, flaps being designed according to the wound defect had a good appearance, the flaps matched the color and texture of the surrounding skin and had a favorable appearance. Besides, flaps had a certain degree of sensory recovery while there was no obvious scarring presented in the donor area.@*Conclusions@#Individualized design of facial artery perforator flap has great advantages of simple and flexible, easy manipulation, reliable flap blood flow and minimal donor injury, which render it valuable for clinical application.

Facial artery perforator flaps in reconstructing nasal defects: the evolution and challenges / 中华整形外科杂志

The facial artery perforator flap has the advantages of minimal donor site morbidity, acceptable appearance and function at recipent area, which brings its wide application in reconstruction of facial small and medium-sized defects. Nasal defects, as the most important aesthetic unit at face, require three-dimennsional and precise reconstruction. The article reviewed the anatomic study and the current status of the clinical applications of this technique in reconstruction of nasal defects, as well as the existing questions. The prospective application of SPY system in localization of facial artery perforator was also analyzed.

A Study On Course And Variations Of Facial Artery On The Face

Introduction: Face is mainly supplied by the Facial artery supplemented by transverse facial artery. Variations inthe course and branching pattern of facial artery are commonly seen. The understanding of these variations offacial artery plays a very important role in facio-maxillary surgeries. It is also of immense importance toradiologists in interpreting facial artery angiography.Materials and Methods: The present study was conducted in the Department of Anatomy, Subbaiah Institute ofMedical Sciences on 50 formalin fixed adult hemi-faces irrespective of sex. The branching pattern, terminationsand variations of facial artery on the face were studied.The facial artery predominantly terminated as angular artery in 28 (56%) hemi-faces, as superior labial arteryin 15 (30%) hemi-faces and as lateral nasal artery in 6 (12%) hemi-faces.Results: An inconstant posterior (pre-masseteric) branch of facial artery was observed in 3 (6%) hemi-faces. Inone of the hemi-face we found a deviation in the usual course of facial artery, where the artery deviated towardsthe infra-orbital foramen then continued and terminated as the lateral nasal artery. An unusual termination offacial artery was observed in one of the hemi-faces where the artery terminated by giving 4 branches in the lowerbuccal region.Conclusion: Knowledge of these variations and anomalous branching pattern is of great academic and clinicalsignificance in general practice, Otorhinology, Traumatology, Plastic and Maxillofacial surgeries and Radiology

Bilateral thyrolinguofacial trunk: unusual and rare branching pattern of external carotid artery / 대한해부학회지

Prior knowledge of arterial supply to the head and neck is of substantial importance for well-planned surgeries involving the concerned region. We are reporting an unusual and rare variation in the branching pattern of external carotid artery in a 60-year-old female cadaver. A common trunk known as thyrolinguofacial trunk, originating from the anterior surface of the external carotid artery (right and left) giving of superior thyroid artery and a linguofacial trunk during a routine neck dissection. The linguofacial trunk then divided into a lingual and a facial artery. Vascular abnormalities are usually detected either on the dissection table or by the radiologists during imaging or accidently during surgeries leading to serious consequences.

V-Y advanced flap with facial artery perforator for repairing the upper lip defect / 中华整形外科杂志

Objective@#To evaluate the feasibility and clinical effect of V-Y advanced flap with facial artery perforator for repairing the upper lip defect.@*Methods@#Between January 2014 and March 2017, 29 cases with the upper lip tumor or additional scar resulted from trauma. The lesions size ranged from 0.8 cm×2.0 cm-1.9 cm×3.0 cm in diameter. V-Y advanced flap with facial artery perforator was designed according to the size, shape and the location of the wound, and the donor site was closed directly.@*Results@#All the 29 flaps survived completely, including four cases appeared vein congestion at the distal region of the flap, and recovered after active conservative treatment. All the patients were followed up for 3 to 15 months (on average 8 months), with no tumor recurrence, inconspicuous scar. All the patients were satisfied with their function and appearance.@*Conclusions@#V-Y advanced flap with facial artery perforator, which could achieve good cosmetic and functional effect, with little influence to the donor site, is an optimal choice to reconstruct the defect of the upper lip.

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.

Propeller facial artery perforator flap for repairing defect after resection of skin malignant tumor at upper lip / 中国修复重建外科杂志

Objective: To explore the effectiveness of propeller facial artery perforator flap to repair the defect after resection of skin malignant tumor at upper lip.

The use of facial artery musculomucosal (FAMM) readvancement flap in closure of recurrent oronasal fistula

High failure rate for recurrent palatal fistulas closure pose agreat challenge to plastic surgeons. Tongue and facial arterymusculomucosal (FAMM) flaps are the more commonly usedflaps for closure of these recurrent fistulas. We report a caseof a formerly inset FAMM flap to effectively close apreviously repaired oronasal fistula.

A Case of Abrupt Termination of the Facial Artery with Unusual Multiple Arterial Anastomoses: Clinical Implications in the Head and Neck.

Having up-to-date knowledge of the variability in facial artery topography is an essential starting point in performing certain surgical and radiological procedures on the head and neck (e.g. oromucosal reconstruction flaps, transarterial embolization). We report a unique case with: (1) the left facial artery truncating as an atypical inferior labial artery, (2) the left anterolateral face being perfused by unusual arterial collaterals derived from the right superior labial, left infraorbital and left dorsal nasal arteries, (3) the transverse facial artery not being one of the perfusing collaterals, and (4) the right submental artery piercing the mylohyoid muscle and entering the oral cavity. The embryologic basis of this atypical vascular pattern is discussed. Discovery of a highly atypical facial artery highlights the importance of performing a thorough pre-operative vascular evaluation to prevent iatrogenic injuries and complications before any surgical or therapeutic procedure.

A Study on Facial Artery Variation and its Clinical Implication for Facial Surgeries.

Introduction: Accurate knowledge of the normal and variant arterial anatomy of the facial artery is important for vascular radiology and will provide an anatomical basis to assist surgeons in performing maxillo-facial surgeries successfully. Materials and Methods: Formalin-fixed faces of unknown sex adult cadavers were dissected following the Cunningham’s manual of practical anatomy, volume 3. The age of the cadavers was not noted. Results: The variations in the facial artery were grouped under three categories following the classification of Bayramet.al, 2010. Type I category – Facial artery terminated as angular artery ; Type II category – facial artery terminated as superior labial ; Type III – Facial artery terminated as inferior labial .In present study (type-II) is seen. Premasseteric branch was observed. Discussion: Niranjan NS (1988) observed the variations of facial artery in 50 hemi-faces. According to him, facial artery terminated as angular artery in 68 % of hemi-faces, lateral nasal artery in 26% of hemi-faces, Superior labial artery in 4% of hemi-faces and 2% terminated at the alar base 12. In present study facial artery terminates as superior labial artery. A study conducted by Magden et.al (2009) , on the premasseteric branch, suggested that in 3% cases the diameter of premasseteric branch was larger than the facial artery. Conclusion: This study shows that the variation in the branching pattern of facial artery variations, which help in avoiding the mishaps during certain surgical procedures.

Variation In the Branching Pattern of Facial Artery: Premasseteric Artery.

Arterial variations are uncommon. In the present case, the arterial variation observed was an additional branch of the facial artery arising from the main trunkwhile it crosses the base of themandible. It ascended on the masseter and terminated into three branches. Knowledge of vascular variations will enhance the surgical precision, avoid misdiagnosis and prevent iatrogenic complications during surgical procedures of the face.

Anatomical observation on oral part of the facial artery and facial vein and its clinical application / 局解手术学杂志

Objective To observe the oral part of the facial artery and facial vein and to provide anatomical data for clinical applica-tion. Methods The origin, branches, course, diameter, position of oral part of facial artery and facial vein were observed on 32 fixed cada-ves (64 sides). Results The position relation between the facial artery and facial vein is non-constant. Measure the distance from inferior border of mandible to corner of the mouth, angulus mandibulae, mental protuberance midpoint. It is (5. 49 ± 0. 63) cm, (2. 50 ± 0. 89) cm and (6. 20 ± 1. 68) cm in the left side respectively, and (5. 69 ± 0. 72) cm, (2. 56 ± 1. 08) cm and (6. 85 ± 1. 86) cm in the right side re-spectively. The diameter of facial artery in inferior border of mandible is (0. 33 ± 0. 08) cm in the left side and (0. 38 ± 0. 07) cm in the right side;while the diameter of facial vein is (0. 40 ± 0. 12) cm in the left side and (0. 42 ± 0. 18) cm in the right side. The facial artery and facial vein are not concomitant and they are not asymmetry also. The position of superior labial artery arteries is constant, but the position of inferior labial artery arteries have more variations. Conclusion The branches, course, diameter and position of oral part of facial artery and facial vein have a number of variations. The superior labial artery arteries could be positioned more easily than inferior labial artery arter-ies. Being familiar with their distribution is of great importance for clinical application.

Preservation of the Facial Artery during Submandibular Gland Resection: Preoperative Sonographic Assessment of Facial Artery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The traditional surgical method for submandibular gland resection includes ligation of facial artery. In this study, we used ultrasound preoperatively and tried to preserve the facial artery if facial artery passed on an extra-glandular course with a glandular branch. SUBJECTS AND METHOD: Patients undergoing submandibular gland resection either because of submandibular gland tumor or submandibular gland stone were prospectively included. Preoperative sonographic assessment was done to evaluate the intra-glandular or extra-glandular course of facial artery. For the cases with extra-glandular course with a glandular branch of facial artery, we tried to preserve facial artery by ligation of the glandular branch. RESULTS: A total of 34 cases were included in this study. Among them, 6 cases (17%) hadfacial artery passing on an extraglandular course with glandular branching. For these 6 cases, we easily could find the facial artery and glandular branch in the operative field and were able to preserve the facial artery. For the remaining 28 cases, however, the facial artery penetrated through the submandibular gland, thus we opted for the ligation of facial artery rather than preserving it to minimize bleeding or trauma during the surgery. There were no statistic difference between two groups with respect to clinical and surgical variables. CONCLUSION: Extra-glandular course of facial artery was easily assessed by preoperative ultrasound. In those cases, we could preserve facial artery easily without bleeding or trauma to the submandibular gland by ligation of glandular branch. As facial artery is animportant vessel for reconstruction and facial rejuvenation, it is preferable to preserve this artery if the course of this artery makes it possible to preserve.

Relationship Between the Facial Artery and Sub Mandibular Salivary Gland.

Knowledge of relationship between the facial artery and submandibular salivary gland is essential for the surgeon operating in the submandibular region. This study has been under taken to have the knowledge of this relationship. Submandibular region has been dissected on 20 male cadavers in the Department of Anatomy, Sree Narayana Institute of Medical Sciences, Kerala. The course of the facial artery and its relationship to submandibular salivary gland has been followed carefully. The standard description of ascent of the facial artery along the entire length of posterior border of the submandibular salivary gland was seen in 15 out of the 20 sides studied. In 4 out of 20 sides dissected the facial artery reached only the upper part of the posterior border of the gland. The facial artery arose high on the external carotid artery near the angle of the mandible in one specimen. It reached the gland only at its postero-superior angle, pierced through the gland and emerged on the upper part of the lateral surface of the gland. Our study shows that only 1/5 of instances facial artery courses along the posterior border of the gland. In 4/5 of instances it reaches only the upper part of the posterior border.

Bilateral Anatomical Variation in the Arterial Supply of Face Involving the Facial and Transverse Facial Artery.

We present a case-report whereby a bilateral variation in the arterial supply of face was seen. The facial artery which is the main artery of face was seen terminating in the lower part of the face, as the inferior labial artery and few other branches; the transverse facial artery, which supplements the facial artery normally, was seen to enlarge and take over the course of facial artery, giving the superior labial and lateral nasal branches. The small pre-masseteric branch arising from facial artery was seen only on right side of face. It was absent on left side. Accurate knowledge of the normal and variant arterial anatomy of the facial artery is important for vascular radiology and will provide an anatomical basis to assist surgeons in performing maxillo-facial surgeries successfully. The details of this variation and its clinical significance are discussed herein.

Morphometric Analysis of the Facial Artery in Perioral Region / 체질인류학회지

The facial artery is the largest and main arterial supply of the face, and the inferior and superior labial arteries supply blood to the lower and upper lips and intersect on the opposite site. The aim of this study was to provide quantitative data on the course of facial artery and the distribution of inferior and superior labial artery in perioral region. The location, distance, course, and diameter of the facial artery, inferior labial artery, and superior labial artery were measured directly on 50 hemifacial cadavers of Koreans and statistically analyzed using oneway ANOVA. The facial artery was located 18.50 mm lateral to the mouth corners (Cheilions). The inferior labial artery at its origin was located 15.11 mm inferior and 19.63 mm lateral to the Cheilions. The superior labial artery at its origin was located 5.83 mm superior and 11.28 mm lateral to the Cheilions. The diameter of facial artery, inferior labial artery, and superior labial artery was 2.19, 1.56, and 1.48 mm, respectively. The courses of the facial artery and it's branches showed no significant differences on laterality except for the diameter of the superior labial artery (p=0.026). The buccal branch of facial artery was showed in 44% of the cases in the deep layer of perioral region. In conclusion, this study provides that the data will be useful in predicting the courses of the facial artery and helpful for reconstructive surgery in perioral region.