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      New Anatomical Insights on the Course and Branching Patterns of the Facial Artery : Clinical Implications of Injectable Treatments to the Nasolabial Fold and Nasojugal Groove

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          Abstract

          Improper manipulation of injectable treatments to the face can result in disastrous vascular complications. The aim of the present study was to elucidate the detoured course of the facial artery and to provide detailed metric data regarding facial artery location with a view to helping physicians avoid iatrogenic vascular accidents during injectable treatments.

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          Most cited references16

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          Clinical experience with hyaluronic acid-filler complications.

          Hyaluronic acid (HA) fillers have become the material of choice for soft-tissue augmentation. HA fillers are longer lasting, less immunogenic and can be broken down by hyaluronidase. These advantages make HA fillers the most common of the temporary fillers on the market. However, early and delayed complications, ranging from minor to severe, can occur following HA-filler injection. We evaluated and treated 28 cases of HA-filler-related complications that were referred to our hospital over a period of 5 years from July 2004 to October 2009. Twenty-eight patients were included in our study; 82.1% of the patients were female and 17.9% were male. Complications were roughly classified as nodular masses, inflammation, tissue necrosis and dyspigmentation. Affected locations, in descending order of frequency, were the perioral area, forehead, including glabella, nose, nasolabial fold, mentum, including marionette wrinkles, cheek area and periocular wrinkles. The most disastrous complication was alar rim necrosis following injection of the nasolabial fold. We propose two 'danger zones' that are particularly vulnerable to tissue necrosis following filler injection: the glabella and nasal ala. Although there is no definite treatment modality for the correction of HA-filler complications, we have managed them with various available treatment modalities aimed at minimising patient morbidity. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
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            Anatomic study of the blood supply of perioral region.

            The use of flaps to reconstruct lip defects requires detailed knowledge of the local vasculature. New flaps for surgery around the mouth can be devised if the surgeon knows the distribution of the perioral arterial branches. Examination of the anatomy of perioral branches of the facial artery (FA) confirmed the consistent presence of septal and alar branches in the upper lip and a labiomental branch in the lower lip. Mucosal flaps from the upper lip based on the deep septal branch or the alar branch of the FA can be used to restore lower lip defects. A composite flap from the lower lip supplied by the labiomental branch of the FA can be used to restore combined defects of the upper lip and nose or partial defects of the lower lip. We studied the vascular anatomy of the perioral region in 25 cadaver dissections. Fixation was by 10% formaldehyde solution. Red latex was injected into the common carotid arteries before dissection. In the 50 specimens, the primary supplying vessels were identified and the size and distribution of the vessels were investigated. The FA was symmetrical in 17 (68%) of 25 heads. It terminated as an angular facial vessel in 11 (22%), as a nasal facial vessel in 30 (60%), as an alar vessel in six (12%), and as a superior labial vessel in two (4%) facial halves. It terminated as a hypoplastic type of FA in one (2%) facial half. The average external diameter of the superior labial artery (SLA) was 1.6 mm (min-max: 0.6-2.8 mm) at its origin. The origin of the SLA was superior to the angle of the mouth in 34 of 47 specimens (72.3%), and at the angle of the mouth in 13 of 47 specimens (27.7%). In two of the remaining three specimens, the SLA was the continuation of the FA and the other was of the hypoplastic type. The SLA supplied the columellar branches in all specimens except for the hypoplastic type (49 specimens). Columellar branches were classified according to their number and their type. In five specimens (10%) the inferior labial artery (ILA) was not found. In the other specimens, the site of origin of the ILA varied between the lower margin of the mandible and the corner of the mouth. Its external diameter measured min-max: 0.5-1.5 mm. The ILA arose from the FA above the angle of mouth in 4 specimens (8%), inferior to the angle of mouth in 11 specimens (22%), and at angle of mouth in 30 specimens (60%). We observed that the labiomental arteries, which formed anastomoses between the FA, ILA, and submental artery, showed variations in their course in the labiomental region. We suggest that knowledge of the location of arteries with respect to easily identifiable landmarks will help to avoid complications at surgery.
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              Branching patterns and symmetry of the course of the facial artery in Koreans.

              The topography and the course of the facial artery were investigated in 47 Korean cadavers. The final branch of the facial artery was the lateral nasal branch in 44.0% whereas it was the angular branch in 36.3% of the cases. In 54.5% of the cases, the facial artery ended symmetrically. According to previous studies, variations in the distribution pattern of the facial artery have been regarded as racial difference. However, in this study we showed that the diverse pattern of the facial artery distribution demonstrates individual variation rather than racial difference. The superior and inferior labial arteries on the right side were more dominant than those on the left. The average distance between the branching points for the inferior alar branch and for the lateral nasal branch was 15.9 mm, and it was 25.2 mm between the points for the superior labial branch and for the inferior alar branch. The branching point of the inferior labial branch was 30.9 mm apart on average from that of the superior labial branch. The courses of the facial arteries showed no significant differences based on either laterality or gender.
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                Author and article information

                Journal
                Plastic and Reconstructive Surgery
                Plastic and Reconstructive Surgery
                Ovid Technologies (Wolters Kluwer Health)
                0032-1052
                2014
                May 2014
                : 133
                : 5
                : 1077-1082
                Article
                10.1097/PRS.0000000000000099
                24445874
                d3fb804d-c8f8-4775-ba9e-a5cfec68bb26
                © 2014
                History

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