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Angiography of the external carotid artery in a 38-year-old female for evaluating carotid cavernous fistula: AP view (A) and lateral view (B). Superior labial branch (black arrow) of the facial artery is the end branch in this patient, classified as type 3.
Source publication
A number of studies have evaluated the variable courses of facial artery. However, the results of these differed substantially from each other so not consistent relationships have yet been established. There has also yet to be a relevant study using conventional angiography.
We assessed the variant branching pattern of the facial artery and its bra...
Context in source publication
Context 1
... 4 types ( Fig. 2A-F) according to the final branch: Type 1, facial artery that has angular branch beyond the midline of the orbit for its final branch (Fig. 3); Type 2, facial artery that has lateral nasal artery with or without alar branch for its final branch (Fig. 4); Type 3, facial artery that has superior labial branch for its final branch (Fig. 5); Type 4, facial artery that has only inferior labial branch (Fig. 6). We further classified type 1 facial arteries into type 1a, 1b, and 1c: Type 1a, angular branch running along only the conventional course without supratrochlear branch or duplex of the angular artery; Type 1b, angular branch that has supratrochlear branch extending ...
Citations
... Less is known about the anatomy of the facial vein, the main drainage for the blood of the face region [41,42]. The facial vein in most studies on the vascular anatomy of the face so far has been ill studied [29,31,33,43,44]. Its course has been described as rather straight from the angular vein in the medial angle of the eye in a latero-caudal direction towards the margin of the mandible [12,42,[45][46][47]. ...
Background and Objectives: Facial vascular anatomy plays a pivotal role in both physiological context and in surgical intervention. While data exist on the individual course of the facial artery and vein, to date, the spatial relationship of the vasculature has been ill studied. The aim of this study was to assess the course of facial arteries, veins and branches one relative to another. Materials and Methods: In a total of 90 halved viscerocrania, the facial vessels were injected with colored latex. Dissection was carried out, the relation of the facial vessels was studied, and the distance at the lower margin of the mandible was measured. Furthermore, branches including the labial and angular vessels were assessed. Results: At the base of the mandible, the facial artery was located anterior to the facial vein in all cases at a mean distance of 6.2 mm (range 0–15 mm), with three cases of both vessels adjacent. An angular vein was present in all cases, while an angular artery was only present in 34.4% of cases. Conclusions: The main trunk of the facial artery and vein yields a rather independent course, with the facial artery always located anterior to the vein, while their branches, especially the labial vessels, demonstrate a closer relationship.
... Surgeons have to be aware of such anatomical variations to avoid inadvertent complications during mid-face procedures. Furthermore, Hong et al. assessed the diverse branching pattern of the facial artery and its branches through conventional angiography [5]. A facial artery termination as a superior labial artery was shown in 8.5% of a total of 284 angiographies [5]. ...
... Furthermore, Hong et al. assessed the diverse branching pattern of the facial artery and its branches through conventional angiography [5]. A facial artery termination as a superior labial artery was shown in 8.5% of a total of 284 angiographies [5]. Similarly to these findings, a study conducted in 2020 analyzed 284 hemifaces obtained from 142 cadavers preserved in formalin [6]. ...
The facial artery is a branch of the external carotid artery, one of the major arteries supplying blood to the head and neck. The normal route of the facial artery follows a well-defined path. It typically arises from the external carotid artery, above the superior border of the hyoid bone. During its route, the facial artery gives off branches in the neck, mandible, buccal region, and face. This case report explores a rare anatomical variation of the facial artery characterized by an unusual termination point above the upper lip as the superior labial artery, found during a routine cadaveric dissection. While variations in the course of the facial artery are documented, this particular deviation, with its termination anterior to the typical endpoint, presents a unique anatomical variation.
... In the perioral area, the facial artery gives off its distal branches, which are collectively known as the perioral arteries that supply the perioral region [20]. Previous anatomical studies on cadavers have demonstrated a horizontal distance of the facial artery from the cheilion between 13.5 and 16 mm, and from the nasal ala of 12 mm [19,[21][22][23]. In our study, the right facial artery has been correctly identified around the cheilion (AP2) and the nasal ala (AP3) in all 41 (100%) cases, while the left facial artery was visible in 39 (95.1%) cases around the cheilion and in 37 (90.2%) ...
... Moreover, the preoperative identification of the artery in case of a free flap transfer in the upper/midface regions allows to easily access to the recipient's vessels and therefore to reduce the operative time. Although a sonographic evaluation of the more distal branches of the facial artery is technically possible, they have not been included in the current work due to the little consensus about their anatomical variability among the previously published studies [22], the great majority of which were cadaveric and therefore limited in the detection of the smallest and deepest arterial branches not distinguishable with the naked eye [23]. On conventional Doppler US, the small vessels with slow motion velocity can be barely visible due to the wall filters applied to remove clutter and motion artifacts. ...
Background
Accurate knowledge of vessel anatomy is essential in facial reconstructive surgery. The technological advances of ultrasound (US) equipment with the introduction of new high-resolution probes improved the evaluation of facial anatomical structures. Our study had these objectives: the primary objective was to identify new surgical landmarks for the facial vein and to verify their precision with US, the secondary objective was to evaluate the potential of high-resolution US examination in the study of both the facial artery and vein.
Methods
Two radiologists examined a prospective series of adult volunteers with a 22–8 MHz hockey-stick probe. Two predictive lines of the facial artery and vein with respective measurement points were defined. The distance between the facial vein and its predictive line (named mandibular-orbital line) was determined at each measurement point. The distance from the skin and the area of the two vessels were assessed at every established measurement point.
Results
Forty-one volunteers were examined. The median distance of the facial vein from its predictive line did not exceed 2 mm. The facial vein was visible at every measurement point in all volunteers on the right side, and in 40 volunteers on the left. The facial artery was visible at every measurement point in all volunteers on the right and in 37 volunteers on the left.
Conclusions
The facial vein demonstrated a constant course concerning the mandibular-orbital line, which seems a promising clinical and imaging-based method for its identification. High-resolution US is valuable in studying the facial artery and vein.
Relevance statement
High-resolution US is valuable for examining facial vessels and can be a useful tool for pre-operative assessment, especially when combined with the mandibular-orbital line, a new promising imaging and clinical technique to identify the facial vein.
Key points
• High-resolution US is valuable in studying the facial artery and vein.
• The facial vein demonstrated a constant course concerning its predictive mandibular-orbital line.
• The clinical application of the mandibular-orbital line could help reduce facial surgical and cosmetic procedure complications.
Graphical Abstract
... Most reports on the vascular anatomy of the face so far focused on the facial artery and its course, variations and tributaries. However, in a majority of these studies, the facial vein is omitted [9,12,21,46,47]. Its course is often described in the literature as being rather straight and superficial from the medial canthus towards the anterior margin of the masseter muscle [40,43,48]. ...
Citation: Siwetz, M.; Widni-Pajank, H.; Hammer, N.; Pilsl, U.; Bruneder, S.; Wree, A.; Antipova, V. The Course and Variation of the Facial Vein in the Face-Known and Unknown Facts: These authors contributed equally to this work. Abstract: Background and Objectives: The facial vein is the main collector of venous blood from the face. It plays an important role in physiological as well as pathological context. However, to date, only limited data on the course and tributaries of the facial vein are present in contemporary literature. The aim of this study was to provide detail on the course and the tributaries of the facial vein. Materials and Methods: In 96 sides of 53 body donors, latex was injected into the facial vein. Dissection was carried out and the facial vein and its tributaries (angular vein, ophthalmic vein, nasal veins, labial veins, palpebral veins, buccal and masseteric veins) were assessed. Results: The facial vein presented a textbook-like course in all cases and crossed the margin of the mandible anterior to the masseter in 6.8% of cases, while being located deep to the zygomaticus major muscle in all cases and deep to the zygomaticus minor in 94.6% of cases. Conclusions: This work offers detailed information on the course of the facial vein in relation to neighboring structures, which shows a relatively consistent pattern, as well as on its tributaries, which show a high variability.
... This research assessed facial artery variant patterns 36.6% (angular branch), 48.6% (lateral nasal branches), 8.5% (superior labial branches), and, 6.3% (inferior labial branches). [12] In terms of the facial artery development, it is indicated that this artery is prone to agenesis, enlargements, and excessive narrowness, all of which are related to the development of the cardiovascular system in the fetus and how the pharyngeal arches and different branches of each disappear and fuse. [8,13] In addition, this artery may not lead to the medial canthus but goes towards the zygomatic arch or infraorbital which is recognized as a deviated branch. ...
... [14][15][16] Due to the wide range of variations of this artery in the way of blood supply to the face and the number of branches separated from it, different categories are made for the variants of this artery. [12] case report ...
... As it is mentioned above, it originates from a common trunk with the lingual artery, has unusual loops and deviations in its path, is even shorter than usual, and ends before reaching the medial canthus of the eye. [1,12,17] A study on 40 cadavers has shown that the facial artery terminates as the angular artery in 27 percent of cases, the superior labial artery in 40 percent, and the lateral nasal artery in 30 percent of cases. [9] In examining the variants of the facial artery, the existence of a common trunk with some branches of the external ceratoid artery, the path of movement of this artery in the face, and its terminal branches have always been discussed. ...
The facial artery is the main artery supplying the face occasionally. It gives three branches on the face, the inferior labial, the superior labial, and the lateral nasal, and terminates as the angular artery. Due to congenital vascular variations in the facial artery, it has been considered in the dissection of the head and neck region. During the dissection of a 65-year-old woman to expose this region, we discovered that the left facial artery is terminated by the superior labial artery after giving off the submental and inferior labial branches. At the level of the left oral commissure, the facial artery was attached to the buccinator muscle as connective tissue, with a noticeable decrease in diameter. The purpose of this study is to report a new variation of the facial artery that is particularly important for cadaver dissection, and head and neck surgeries, as well as for facial artery angiography.
... 38 The infraorbital artery typically branches out from the internal maxillary artery, but in some cases, it anastomoses with the angular artery, which connects with the posterior orbit. 39 In the majority of cases, there are no major arteries directly on the infraorbital rim, so this area may be considered relatively safe for injection. 7,24 However, some anomalies have been described wherein the position of the angular artery is shifted laterally, very close to the infraorbital rim. ...
Infraorbital hollows are one of the most common target areas for facial aesthetic treatment; however, they are often perceived to be challenging to treat due to the complex anatomy of the periorbital area, concurrent deformities, and risk of complications. Treatment options include surgical (eg, lower eyelid blepharoplasty with fat transposition or injections) and nonsurgical approaches (eg, fillers). Among these approaches, filler injections have become common practice because they are minimally invasive and provide long-term patient satisfaction. In particular, hyaluronic acid (HA) fillers have been shown to be safe and effective for infraorbital hollow rejuvenation. This review provides an overview of infraorbital hollows, including periorbital anatomy, etiology, clinical assessment, and overlapping deformities, such as malar mounds, festoons, and dark circles under the eyes. Patient and HA filler product selection, injection techniques, as well as potential adverse events, such as bruising/swelling, lower eyelid and malar edema, and vascular occlusions, are discussed. This review also highlights the importance of midfacial volumization to improve outcomes in the infraorbital region and in the overall aesthetic appearance. By selecting appropriate patients and attaining proficiency in periorbital anatomy and infraorbital hollow rejuvenation techniques, clinicians can safely and successfully perform HA filler injections that result in high patient satisfaction.
Level of Evidence: 5
... Some recent studies investigated the FA branches using various techniques such as Doppler ultrasound, CT angiography, conventional angiography, and cadaveric dissection (Hong et al., 2020;Pilsl et al., 2016;Ten et al., 2021). Pilsl et al. (2016) evaluated the FA branching patterns of 60 hemifaces of 30 cadavers using CT with 3D reconstruction. ...
... The FA was divided into four types, with type 1 present in 41.6% of cases, which showed a course involving ILA, SLA, LNA, and AA consistent with textbook descriptions (Pilsl et al., 2016). Hong et al. (2020) evaluated the variable courses of the FA using conventional angiography, and classified the FA branching pattern into four types according to the end branch. Type 1 constituted 36.6% of the 284 cases, in which the FA terminated at the AA. ...
The facial artery is the main artery supplying blood to the face and is known to have facial branches of the inferior labial, superior labial, lateral nasal and angular arteries. These known major branches of facial artery run medially, however, there are sometimes branches of the facial artery heading laterally. The purpose of the present study was to investigate the lateral branches of the facial artery in face. We dissected facial branches of the facial artery in 74 cadaveric hemifaces. We investigated the presence of the lateral branches of the facial artery. Following parameters were investigated: lateral branch presence, the location of its origin, and the lateral branch diameter. Among the lateral branches, we evaluated the prevalence and diameter of the premasseteric branch. Lateral branches were observed in 48 of the 74 hemifaces (64.9%). The total number was 81 in the 48 hemifaces. The most common origin was between the inferior border of the mandible and inferior labial artery origin (42 of 81, 51.9%). The mean diameter of all lateral branches of the facial artery was 0.7 mm. Among the lateral branches, the premasseteric branches were present in 38 of 74 specimen (51.4%) and the mean diameter was 0.8 mm. The lateral branches of the facial artery may be registered in Terminologia Anatomica based on their prevalence. Accurate knowledge of the anatomy of the lateral branches of the facial artery is helpful for clinicians to avoid complications during facial procedures or maxillofacial surgeries.
... When running up sinuously in the face, its course is highly variable among individuals. [45][46][47][48] According to recent anatomical studies, the FA runs along the nasolabial fold in most individuals, finishing up to the angular artery (36.6%), lateral nasal artery (48.6%), or superior labial artery (8.5%). However, a few individuals present a hypoplastic FA stopping at the inferior labial artery (6.8%). ...
... Type IIb), but in any case, going up vertically toward the nasojugal groove, close to the facial vein, and never above the mid-cheek groove.49 None of the other studies published in the scientific literature suggested that the facial artery could run laterally to the mid-cheek groove (including Hong et al. study (2020) on 284 patients45 ), neither did any of the authors' own cadaver dissections.Whilst this should not prevent the injector from applying other precautionary principles and monitoring signs and symptoms emerging during and after treatment, staying above the mid-cheek groove should thus minimize risks of vascular injury implicating the facial artery or vein.b. The Infraorbital Artery (IOA)The IOA emerges through the infraorbital foramen and divides into two to three main branches: the palpebral branch (IOAp), the nasal branch (IOAn), and the labial branch (IOAl). ...
Midface rejuvenation is among the most valuable indications of Hyaluronic Acid (HA) dermal fillers, as malar projection and full upper cheeks significantly contribute to a youthful appearance. HA fillers have evolved over the past two decades to meet specific clinical needs such as strong projection capacity and adaptability to facial dynamism. As a result, they now represent the treatment of choice for midface rejuvenation throughout age ranges, by offering the potential for non-invasive treatment, immediate results and minimal downtime. As the five-layered structure of the midface plays a central role in the human face, injecting the midface area may also indirectly improve other aesthetic concerns such as infraorbital hollowing and nasolabial folds. Nonetheless, midface rejuvenation requires a tailored treatment approach and a thorough knowledge of anatomy to minimize procedural risks and achieve natural-looking results. This article provides an extensive anatomical description of the midface and of the usual course and depth of vascular structures circulating nearby, to delineate a treatment area, minimizing procedural risks. Furthermore, taking into account the differential mobility and mechanical constraints of each layer of the midface, a multilayer treatment algorithm is proposed for adapting the treatment strategy to patient specificities (including age, gender, skin type, and morphology). Emphasis is also placed on desirable filler properties to create deep structural support on the one hand and accompany facial movement on the other hand.
... Despite the long history and a large number of studies on the facial artery, its anatomy remains controversial regarding its course and location. [2][3][4][5][6][7][8][9][10][11][12][13] The course of the facial artery in textbooks starts directly from the external carotid artery and then goes above the submandibular gland. After the facial artery turns at the inferior of the mandible at the anterior border of masseter, it gives off several branches to supply facial tissues, including inferior and superior labial arteries, the inferior alar artery, lateral nasal artery, and ...
... 14 However, there are significant variations in the branching patterns and termination of the facial artery in previous studies. 2,9,11,13 Multiple factors, such as racial discrepancies and embryological variations, may lead to the differences in these studies. Therefore, larger samples and ethnically diverse studies are needed to clarify the anatomy of the facial artery. ...
... Although many previous studies have been performed on the facial artery anatomy, no consensus has been established for the variations among the findings. [2][3][4][5][6][7][8][9][10][11][12][13] The differences in previous studies may be partly attributed to the characteristics of the research methods. Most studies on facial arteries are based on cadaveric dissections, but cadaveric studies typically include relatively small samples and have the disadvantages of non-living, static, and surface anatomy. ...
Background
A consensus on facial artery (FA) anatomy has not been established due to the discrepancies in previous studies.
Objectives
The purpose of this study was to assess the branches, course, and location of the FA in Asians utilizing computed tomographic angiography (CTA).
Methods
The CTA images of 300 FAs from 150 Asian patients were evaluated. According to the termination branch, the FA was classified as follows: type 1, FA terminates superior labial or inferior labial artery; type 2: FA terminates lateral nasal or inferior alar artery; type 3: FA terminates medial canthal artery; type 4: FA is divided into duplex branches with dominant medial canthal artery laterally. The relationship between nasolabial fold and FA was evaluated, and the distances from anatomical landmarks to FA were measured to position the course.
Results
70 arteries (23.3%), 163 arteries (54.3%), 49 arteries (16.3%), and the other 18 arteries (6.0%) were classified as type 1, 2, 3 and 4, respectively. 72.3% of FAs were located medially to the nasolabial fold, and only 14.7% of arteries were lateral to the nasolabial fold. The vertical distance between FA and the inner canthus or the midpoint of inferior orbital rim decreased from type 1 to type 4 FA (P < 0.0001). No significant difference was found among the four types of FA in the distances between the mandibular angle (P = 0.1226) or oral commissure (P = 0.1030) and the FA at inferior of mandible.
Conclusions
The detailed findings of facial artery will provide a valuable reference for filler injection in cosmetic procedures and flap design in reconstructive surgery.
... During osteotomy of the ramus of the mandible, for example, sagittal split osteotomy (SSRO), intraoral vertical ramus osteotomy, intraoral vertico-sagittal ramus osteotomy, and their modified techniques, the lateral surface of the ramus is exposed in order to attach the ramus retractor (Choung, 1992;Trauner & Obwegeser, 1957;Winstanley, 1968). The purpose of this retractor is to avoid the buccal soft tissues including the FA and this is well documented in anatomical studies (Hong et al., 2020;Lee et al., 2020). Pseudoaneurysm of the FA after SSRO has also been reported (Jo et al., 2013). ...
The purpose of this study was to evaluate the risk of injury to the facial (FA) and related arteries during mandibular third molar (MTM) extraction using contrast‐enhanced computed tomography (CE‐CT). CE‐CT images of the MTM region were retrospectively reviewed. The area of the MTM was equally divided into three zones in the coronal images from mesial to distal, that is, zone 1, zone 2, and zone 3. The FA, submental artery (SMA), and sublingual artery (SLA) were identified. The distance from the mandible to FA, SMA, and SLA and the diameter of the FA, SMA, and SLA was measured in three zones, respectively. The thickness of the facial soft tissues and width of the mandible were measured at their maximum. The mean distance from the FA to the buccal cortical bone in zone 1, zone 2 and zone 3 was 2.24 mm, 2.39 mm and 1.67 mm, respectively. The SMA and SLA were found to be distal to the mandible. The mean diameter of the FA was 1.26 mm in males and 1.04 mm in females, respectively (p < 0.0001). The distance between the FA and buccal cortical bone of the mandible, and the patients' weight showed moderate correlation in zones 1 and 2. Based on our findings, the FA can be damaged if the surgical invasion reaches the facial soft tissues during MTM surgery. The patients' weight might be a good predictor for FA injury when CE‐CT is not available.
