Topographic Anatomy of the Zygomatico-Orbital Artery: Implications for Improving the Safety of Temporal Augmentation

Abstract

Background: Anatomical knowledge of the zygomatico-orbital artery and its most relevant clinical applications is essential for ensuring the safety of filler injection into the temporal region. The purpose of this study was to provide the precise position, detailed course, and relationship with surrounding structures of the zygomatico-orbital artery. Methods: Fifty-eight patients who underwent head contrast-enhanced three-dimensional computed tomography and 10 fresh frozen cadavers were investigated. Results: The zygomatico-orbital artery was identified in 93 percent of the samples in this work. Ninety-four percent of the zygomatico-orbital arteries derived directly from the superficial temporal artery, and the remaining arteries started from the frontal branch of the superficial temporal artery. According to the origin of the zygomatico-orbital artery, it was classified into type I and type II. Type I arteries were then classified into three subtypes. The trunk of the zygomatico-orbital artery was located between the deep temporal fascia and the superficial temporal fascia. Deep branches of the zygomatico-orbital artery pierced the superficial layer of the deep temporal fascia. The zygomatico-orbital artery originated from 11.3 mm in front of the midpoint of the apex of the tragus, and most of its trunks were located less than 20.0 mm above the zygomatic arch. The mean diameter of the zygomatico-orbital artery was 1.2 ± 0.2 mm. There were extensive anastomoses between the zygomatico-orbital artery and various periorbital arteries at the lateral orbital rim. Conclusion: The precise anatomical knowledge of the zygomatico-orbital artery described in this study could be helpful for cosmetic physicians for improving the safety of temporal augmentation.

The Middle Temporal Vein on Computed Tomographic Angiography: Implications for Filler Injection and Reconstructive Surgery

“…This may be attributable to the limited resolution of CTA, which fails to visualize vessels smaller than 1.0 mm. According to the measurements by Liu et al, 24 the zygomatico-orbital artery was located 14.0 ± 3.4 mm above the midpoint of the zygomatic arch, which was close to our results of 12.8 ± 3.5 mm. Therefore, to avoid damage to the zygomatico-orbital artery when injecting into the interfascial plane of region B, it is relatively safe to inject filler within 12.8 mm above the zygomatic arch.…”

“…According to our measurements, the zygomatico-orbital artery in type C, accounting for only 9.3% of total cases, was located 17.5 ± 6.4 mm above the jugale point and 12.8 ± 3.5 mm above the zygion point, respectively. However, Liu et al 24 reported that the zygomatico-orbital artery was identified in nearly 93% of the specimens, with a mean diameter of 1.2 ± 0.2 mm. This may be attributable to the limited resolution of CTA, which fails to visualize vessels smaller than 1.0 mm.…”

“…There is no standard recommendation for temporal filler injections, and the suggestions for injections vary from study to study 1,3,4,[21][22][23][24] (Table 3). The depth of injection is an important factor for safe injection, as well as the zones for injection.…”

Blood Supply of the Temporal Flap Pedicled With Orbicularis Oculi Muscle: Anatomy and Its Clinical Implications

“…The mean diameter of ZOA when it entered OOM was 0.40 mm in females and 0.53 mm in males who had significantly larger values than females ( P =0.012). In some previous reports, the mean diameter of ZOA was 1.2 mm, 1.1 mm, and 2.52 mm, respectively 20–22 . The reason why our values were smaller than theirs may be that the measuring positions and tools were different.…”

Reply: Topographic Anatomy of the Zygomatico-Orbital Artery: Implications for Improving the Safety of Temporal Augmentation

“…According to the measurements in our study, between the deep temporal fascia and the superficial temporal fascia, we suggest that it is relatively safe to inject filler within 14.0 mm (not 20.0 mm, as reported in an article published in 2014 3 ) above the zygomatic arch between the lateral orbital rim and the midpoint of the zygomatic arch. 1…”