Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic Procedures

Abstract

Background The facial artery (FA) is the main blood vessel supplying the anterior face and an understanding of its anatomy is crucial in facial reconstruction and aesthetic procedures. Objectives The aim of this study was to assess the many anatomical features of the FA utilizing a multidimensional approach. Methods Head and neck computed tomographic angiographies of 131 patients (255 FAs) with good image quality were evaluated. The FA was classified according to its termination pattern, course, and location with reference to soft tissue/bone surrounding structures. Results In total, each branch was present as follows: the submental artery (44.8%), the inferior labial artery (60%), the superior labial artery (82.2%), the lateral nasal artery (25.1%), and the angular artery (42.5%). The most common FA course was the classic course, situated medially to the nasolabial fold (27.1%). In total 65.5% of the arteries were located medially to the nasolabial fold, and only 12.3% of them were totally situated lateral to the nasolabial fold. The median distance (with quartiles) from the inferior orbital rim reached the FA after the superior labial artery branched off in 50.2% of cases and was 36.6 mm (33.4; 43.3). The angle between the FA and the inferior border of the mandible was 49.8o (31.9; 72.4). The horizontal distances between the oral commissure and naris to the FA were 8.5 ± 4.0 mm and 12.1 ± 6.7 mm, respectively. Conclusions An anatomical map summarizing the major measurements and geometry of the FA was generated. The detailed anatomy and relative positioning of the FA should be considered to avoid any unexpected complications in plastic surgery.

Termination points of the facial artery—A meta‐analysis

“…Characteristics of each study that fulfilled all criteria for inclusion are shown in Table 1. Out of 24 studies, 20 were based on cadaver dissections regarding a total of 1274 arteries in 745 cadavers (Dickson et al, 2014; Dupoirieux et al, 1999; Gardetto et al, 2002; Gocmen‐Mas et al, 2015; Koh et al, 2003; Laurentjoye et al, 2012; Lee, Gil, et al, 2015; Lee, Yang, et al, 2015; Lohn et al, 2011; Loukas et al, 2006; Midy et al, 1986; Mitz et al, 1973; Nakajima et al, 2002; Niemann et al, 2019; Niranjan, 1988; Pilsl et al, 2016; Pinar et al, 2005; Qassemyar et al, 2012; Saban et al, 2012; Tansatit et al, 2021), three on computed tomography angiography (CTA) images of a total of 726 arteries gathered from 423 patients (Furukawa et al, 2013; Hong et al, 2020; Koziej et al, 2019) and one included 119 arterial patterns gathered from 110 human fetuses (Kozielec & Józwa, 1977). In total, morphological data of 2119 arteries were included in this meta‐analysis.…”

“…As a solution, the authors decided to assemble the extracted termination patterns of FA in an apportionment that included all data. For this purpose, the compilation method presented by Furukawa et al (2013) with later modification by Koziej et al (2019) as shown in Figure 2 was used. In this compilation method, the FA termination patterns were divided into five types: (1) Type 1 is a short FA course, in which it terminates proximally to the superior labial artery as the superior or inferior labial artery; (2) In type 2, the FA terminates distally to the superior labial artery near the nasolabial fold as an inferior alar artery; (3) In type 3, the FA extends to the lateral nasal or angular branch and runs in the alar‐facial crease; (4) In type 4, the FA forms a duplex with the dominant lateral angular branch and traverses the supra‐alar crease, which is its anatomical landmark; and (5) In type 5, FA is hypoplastic and the remaining course is supplied by the dominant transverse facial artery (Furukawa et al, 2013; Koziej et al, 2019).…”

“…Diagram presenting termination patterns of the facial artery (FA) according to the compilation method presented by Furukawa et al (2013) with later modification by Koziej et al (2019). (A) Type 1—FA terminating as a superior or inferior labial artery; (B) Type 2—FA terminating as an interior alar artery; (C) Type 3—FA terminating as a lateral nasal or angular artery; (D) Type 4—FA terminating as a dominant lateral branch; (E) Type 5—hypoplastic FA…”

A Rare Case of Facial Artery Branching—A Review of the Literature and a Case Report with Clinical Implications

“…Preoperative knowledge on individual anatomical variations in facial artery patterns may aid maxillofacial surgeons in reconstructive planning to effectively manage facial injuries with arterial involvement, dermatologists in aesthetic procedures, and radiological anatomy professionals in the field of malignancies for the treatment of various facial tumors by embolization [13][14][15][16]. Information on variations in the facial artery may also contribute to damage risk mitigation during cosmetic procedures such as neurotoxin or filler injections [17,18].…”

Invited Response on: “Tissue Fillers for the Nasolabial Fold Area–A Systematic Review and Meta-Analysis of Randomized Clinical Trials”

“…To improve clinical outcomes, we further recommend consulting modern anatomical research. For instance, a recent anatomical study by Koziej et al revealed the presence of multiple variants of facial artery relations to the nasolabial fold [2]. In the most common variant, the facial artery is located medially to the nasolabial fold.…”