The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection

Mapping the localization of the facial artery and vein at the inferior border of the mandible for clinical applications

AIM

To spatially map the position of the facial artery and vein along the inferior border of the mandible based on specific facial reference points.

METHODS

This cross-sectional study included 40 sides of 21 formalin-fixed cadaver heads (11 female, 10 male) with a mean age of 72.92 ± 11.72 years. Superficial dissection was performed to visualize the facial artery and vein at the inferior border of the mandible (FA and FV). Measurements were taken from the FA and FV to various facial landmarks using a digital caliper and medical protractor. Statistical analysis was conducted using Shapiro-Wilk, independent sample t-tests, and paired sample t-tests.

RESULTS

The mean distance between FA and FV was 6.20 ± 2.97 mm. Distances from FA and FV to gnathion, oral commissure, nasal wing, lateral canthus, angle of mandible, intertragic notch, and Manson's point were determined, with no significant differences found between sides and genders (p > 0.05). The closest distances from FA and FV to the line between the intertragic notch and oral commissure were 38.63 ± 4.86 mm and 37.78 ± 5.28 mm, respectively. The angular measurements of FA and FV with inferior border of mandible were 61.45 ± 13.71 and 76.56 ± 10.17 degrees, respectively. The angle between intertragic notch, FA and oral commisure was 102.40 ± 11.12 degrees.

CONCLUSION

The detailed measurements and analysis provided in this study aim to enhance the precision of surgical interventions involving the facial artery and vein. The practical localization methods proposed can assist in minimizing the risk of vascular injuries, improving outcomes in reconstructive and aesthetic procedures.

Exploring the venous supply of the face: An illustrated overview of contemporary literature

Understanding the vascular anatomy of the face is crucial for ensuring safe clinical practices, especially as aesthetic procedures involving hyaluronic acid fillers are gaining popularity. Although vascular complications from these procedures are rare, there has been a documented increase in adverse events linked to venous and arterial occlusions. This review addresses the knowledge gap regarding the facial venous system compared to the well-documented facial artery system, emphasising the importance of thorough anatomical knowledge to mitigate risks during injectable cosmetic procedures. The complex and variable anatomy of the facial veins, including connections to the intracerebral venous system, allows for the retrograde spread of infections and fillers, with key tributaries such as the angular and infraorbital veins facilitating communication with the cavernous sinus. Notably, the absence of valves in certain venous regions can lead to retrograde filler flow, exacerbating complications. This illustrated review provides an analysis of the facial venous anatomy, focusing on the distribution and depth of venous structures, and aims to equip practitioners with insights that can help reduce the incidence of vascular complications associated with cosmetic procedures.

Combination Administration of Heparin and Nitroglycerin for the Treatment of Polycaprolactone-Induced Intravascular Embolism: A Preclinical Investigation

BACKGROUND

As a new-generation collagen stimulator, polycaprolactone (PCL) containing filler has been extensively applied in facial dermal fillers and other medical aesthetic fields. However, inadvertent intravascular injection of PCL may result in complications such as tissue edema, flap necrosis, and even blindness. To date, there is no effective treatment for PCL-induced intravascular embolism.

OBJECTIVES

The aim of this study was to identify a viable resolution for the embolism resulting from intravascular administration of PCL-containing fillers.

METHODS

Two different animal experiments were performed: (1) PCL-induced rat inferior epigastric arteries embolism, followed by gross observation, histological evaluation, and cytokines analysis from serum; and (2) PCL-induced rabbit auricular artery embolism, immediately treated with heparin and nitroglycerin. The ears were then evaluated by gross observation, Laser speckle imaging, in vivo imaging system (IVIS) imaging, and histological evaluation. Saline and hyaluronic acids (HA) were used as controls, hyaluronidase was used as a positive drug.

RESULTS

In a rat model of inferior epigastric arteries embolism, both intravascular injection of HA and PCL resulted in flap necrosis, indicating that the filler-induced intravascular embolism can lead to serious complications. In a rabbit model of auricular artery embolism, the combination treatment of heparin and nitroglycerin resulted in a relative blood reperfusion recovery of 80% in the ischemic area of the PCL group on day 7 post-operation, which was comparable to that of the HA group treated with hyaluronidase. Histological analysis revealed that the administration of heparin and nitroglycerin significantly attenuated intravascular thrombosis formation and inflammatory cell aggregation.

CONCLUSIONS

The combination of heparin and nitroglycerin effectively restores blood flow reperfusion in the intravascular embolization caused by PCL filler injection, alleviates local tissue edema and flap necrosis. These findings offer a novel approach for future clinical management of intravascular embolization with PCL-containing filler injection.

NO LEVEL ASSIGNED

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High-resolution US of the facial vessels with new facial vein landmarks for reconstructive surgery and dermal injection

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.

Transfemoral trans-facial vein-superior ophthalmic vein to embolize cavernous sinus dural arteriovenous fistulas

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal communication between the CS and dural arteries from the internal carotid artery and external carotid artery. CS-DAVFs are not uncommon. The preferred treatment for most CS-DAVFs is transvenous embolization (TVE), which can achieve a high cure rate with few complications. The trans-inferior petrous sinus (IPS) route from the internal jugular vein to the CS is the favorite and most direct route to perform TVE in the great majority of CS-DAVFs. However, when the trans-IPS route fails and if the facial vein (FV) is patent and dilated, transfemoral trans-FV-superior ophthalmic vein (SOV) embolization of the CS-DAVF can be attempted. However, the transfemoral trans-FV-SOV route to embolize CS-DAVFs is often challenging, and there is insufficient knowledge about it. Therefore, an updated review of the transfemoral trans-FV-SOV route to embolize CS-DAVFs is necessary, and this review includes our experience. The images in this review are from our institute without the dispute of copyright. Issues regarding the transfemoral trans-FV-SOV route to embolize CS-DAV were discussed, including the FV anatomy and variation, various TVE routes to access CS-DAVF, the procedure of the transfemoral trans-FV-SOV route to embolize CS-DAVF, difficulty, and solution of the transfemoral trans-FV-SOV route to embolize CS-DAVF, and complications and prognosis of transfemoral trans-FV-SOV to embolize CS-DAVF. By reviewing the transfemoral trans-FV-SOV route to embolize CS-DAVFs, we found that this route provides a valuable alternative to the other transvenous routes. A good prognosis can be obtained with the transfemoral trans-FV-SOV route to embolize CS-DAVFs in select cases.