Anatomy of the temporal region to guide filler injections.

Hollow temples are not typically considered aesthetically pleasing, and hollowness worsens with the aging process. When filling this region with fillers, there are several anatomical considerations, with injection techniques varying depending on the layer targeted. Specifically, injections between the superficial temporal fascia and the superficial layer of the deep temporal fascia are performed using a cannula, while periosteal layer injections involve the use of a needle to reach the bone before inserting fillers. Detailed anatomical insights encompass the boundaries of the temporal fossa and cautionary notes regarding blood vessels, supported by specific studies on veins and arteries in the temporal region. Complications, including vessel injuries, are discussed alongside an exploration of various injection techniques. This review provides a comprehensive exploration of anatomical considerations and the specific methodologies employed in temple augmentation with fillers.

Middle temporal vein access for transvenous embolization of Cavernous sinus dural arteriovenous fistula: A case report and review of literature.

Transvenous endovascular treatment is the first choice for treating most cavernous sinus dural arteriovenous fistulas (CDAVFs). Among several available venous routes, the inferior petrosal sinus is the most commonly used. We report a case of CDAVF treated with endovascular treatment via the middle temporal vein (MTV). A 65-year-old man presented with unilateral chemosis and exophthalmos for approximately two months. Digital subtraction angiography showed a right CDAVF with predominant venous drainage toward the right superior ophthalmic vein. The superior ophthalmic vein primarily drained into the dilated MTV. Both sides of the inferior petrosal sinus were occluded; therefore, transvenous embolization was performed via the MTV route. The fistula was completely obliterated. The patient's symptoms improved and the postoperative course was uneventful. The transfemoral approach via the MTV to treat CDAVF provides a crucial alternative when other venous routes are difficult or impossible to navigate with a catheter.

Superficial middle temporal vein as a pivotal route to embolize dural carotid-cavernous fistulas.

Dural carotid-cavernous fistulas (DCCF) are located in the cavernous sinus wall involving the arterial feeders from the external and internal carotid arteries. The venous route usually passes through the internal jugular vein and inferior petrosal sinus (IPS) up to the pathologic shunts of the cavernous sinus. In cases of a thrombosed IPS, catheterization is not always possible because of the obstruction. Here, we report eight cases of DCCF treated with endovascular transvenous embolization via the superficial middle temporal vein (SMTV). A retrospective study involving eight patients with DCCF treated with transvenous embolization via SMTV was performed. In six patients, IPS was thrombosed. In one patient, IPS was patent, but we could not catheterize the internal jugular vein. In the other patient, because of the compartmentalization of the cavernous sinus, we could not access the anterior part of the cavernous sinus via IPS. Therefore, we performed the embolization via SMTV to occlude the shunts of the anterior part of the cavernous sinus. In all eight cases, navigating through the tortuous junction of the angular vein and superior ophthalmic vein (SOV) was possible. After transvenous catheterization of the cavernous sinus via SMTV, placement of coils resulted in complete occlusion of DCCF with clinical improvement in all eight patients. In the endovascular treatment of DCCF, the transfemoral approach via SMTV provides a pivotal route alternative to other transvenous routes. In patients with dilated SOV, catheterization of the cavernous sinus via SMTV is usually successful.

A Systematic Literature Review of the Middle Temporal Vein Anatomy: 'Venous Danger Zone' in Temporal Fossa for Filler Injections.

BACKGROUND: Treatment of a sunken appearance of the temporal region using injectable fillers is a popular procedure. The temporal fossa has very complex anatomy due to multiple vessels running in the different tissue layers. A severe complication in the form of non-thrombotic pulmonary embolism (NTPE) can occur as a result of an inadvertent injection in the middle temporal vein (MTV) while performing temporal fossa filler procedures. Therefore, in-depth knowledge and understanding of the MTV anatomy are essential for successful and safer injectable procedures of the temporal fossa. OBJECTIVES: While there have been many studies to describe the arteries in this region, there is limited information about the location and course of the middle temporal vein. This literature review is aimed at providing detailed information about the course, depth, and size of the MTV to help aesthetic practitioners in performing safer temporal fossa filler injections. This information is imperative to delineate the 'venous danger zone' in the temple region. METHODS: The preferred reporting items for systematic reviews and meta-analyses guidelines were used for this review. A literature search was performed to find the articles providing details about the MTV anatomy and the measurements related to its course and size. RESULTS: A review of the literature showed that the MTV displays a consistent course and depth in the temporal region, with high variability in its diameter. The middle temporal vein width varied between 0.5 and 9.1 mm in various studies. The middle temporal vein receives many subfascial tributaries from the surface of the temporalis muscle, and for most of its course runs in the fat pad enclosed between superficial and deep layers of the deep temporal fascia. A 'venous danger zone,' in the interfascial planes of the temporal fossa, which contain the main part of the MTV and its tributaries, has been proposed in this paper. CONCLUSIONS: The temporal fossa filler procedures need great caution, and knowledge of the depth and course of the MTV is essential for avoiding NTPE. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sentinel vein and middle temporal vein in Chinese: an anatomic study / 中华医学美学美容杂志

Objective@#To study the characteristics of sentinel vein (SV) and middle temporal vein (MTV) and influence in surgery of periorbital and temporal areas.@*Methods@#From January 2018 to August 2019, 20 donated fresh/frozen head specimens (12 males and 8 females) were collected in various regions of China, with an average age of 47.2 (21 to 88) years. Temporal region of 29 hemi-facial area was dissected in layers, and the occurrence rate, route, geometric parameters, branchesand correlation of SV and MTV were observed and measured.@*Results@#Occurrence rate of SV was 96.6% (28/29), the subcutaneous subordinate branches of SV were 2.5±1.0 in average, with both joining together in 6 kinds of mode. The horizontal section length was (5.8±3.8) mm, and outside diameter was (1.0±0.1) mm. The vertical section length was (8.2±4.3) mm, and outside diameter was (1.2±0.4) mm, steering vertically to the deep through the superficial temporal fascia, middle temporal fascia (MTF) and superficial layer of deep temporal fascia (SDTF), continuing to the MTV. The minimal average distance between the SV and TFN was (6.0±2.7) mm. Occurrence rate of MTV was 96.6% (28/29). The first half of MTV was parallel to the zygomatic arch and ran across the superficial temporal fat pad, then turned down near the upper pole of the external ear wheel, and run vertically in front of the ear, and 5.9±2.7 peripheral branches were collected along the way. The length of temporal middle vein was (82.3±8.6) mm, and outer diameter of the thickest point was (3.6±0.7) mm.@*Conclusions@#Sentinel vein is the main branch of middle temporal vein. It passes through several layers of soft tissue vertically and directly into the MTV. Position of sentinel vein is relatively constant, which is an important localization marker in the operation of the temporal region. The middle temporal vein has large diameter, fixing in the superficial temporal fat pad, collecting the venous reflux of the temporal area at both superficial and deep, which may be the main cause of pulmonary infarction produced by the temporal fat transplantation, and injury should be avoided.

A retrograde island flap pedicled on the frontal branch of superficial temporal artery with additional vein anastomosis for reconstruction of peri-auricular defects / 中华整形外科杂志

Objective@#To investigate an effective method for solving the venous stasis in reverse peri-auricular flap pedicled on the frontal branch of superficial temporal artery(STA).@*Methods@#From October 2013 to May 2016, 5 patients with peri-orbital defects were reconstructed with a retrograde flap pedicled on the frontal branch of STA that incorporated additional venous anastomosis. The additional venous anastomosis was created between the parietal branch of STV (superficial temporal vein) and the middle temporal vein. The defects at donor sites were directly sutured.@*Results@#The size of flaps ranged from 2 cm×2 cm to 2 cm×8 cm. All flaps survived without venous stasis. Color and texture match of the flap were excellent .In three cases, flaps were thinned in secondary operation. During the follow-up period(6 months to 2 years, average of 12.4 months), flaps survived well on early period. Excellent color and tissue match with peri-orbital tissue were achieved on later stage. The scar at the donor site was inconspicuous.@*Conclusions@#Retrograde island flaps pedicled on the frontal branch of superficial temporal artery with vein anastomosis has the advantages of robust blood supply, good texture, and color match, and acceptable donor mobidity, while avoiding the venous stasis and flap necrosis.