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Objective To investigate the application value of the facial artery perforator pedicled V-Y advancement flap in the treatment of middle and lower facial tumors in the elderly population. Methods A retrospective analysis was performed on the data of 35 elderly patients who underwent extensive resection of middle and lower facial tumors and reconstruction using the facial artery perforator pedicled V-Y advancement flap from January 2017 to December 2023 in Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University. Collect their basic information, postoperative flap survival rate, incidence of postoperative complications, and patient satisfaction, and conduct retrospective analysis. Results All 35 patients' skin flaps survived, and there were 2 cases of skin flap tip bruising after surgery, with a total complication rate of 5.71%. After a follow-up period of 3 to 6 months postoperatively, there was no significant difference in the color and texture of the recipient skin flap compared to the surrounding skin. The overall patient satisfaction rate was 94.29%. Conclusion The V-Y advancement flap of the perforating branch of the facial artery has reliable blood supply, similar color and texture to the recipient area, low cost in the donor area, and high patient satisfaction. It has high clinical application value in the treatment of lower facial tumors in elderly patients. [ABSTRACT FROM AUTHOR]

A true aneurysm is a dilation of the arterial wall that preserves vessel continuity, retains three layers (intima, media, and adventitia), and commonly occurs in the aorta, including the thoracic and abdominal aorta. In contrast, true aneurysms of the external carotid artery and its branches are rare. Among several therapeutic options for true aneurysms, catheter-based embolization is the traditional treatment method. However, parent artery occlusion may not always result in permanent exclusion of the aneurysm from the systemic circulation. Dilation of the vasa vasorum is one of the mechanisms of occlusion recanalization. Herein, we present a rare case of a true aneurysm of the facial artery aneurysm. The patient underwent coil embolization as the initial treatment. Subsequently, surgical resection was performed due to aneurysm regrowth caused by vasa vasorum dilation. Although embolization is a useful and safe treatment option for facial aneurysms, careful follow-up radiological examinations are required because of the possibility of regrowth. [ABSTRACT FROM AUTHOR]

Background: Injection cosmetics have become popular in recent years. The nasolabial fold is one of the most important and dangerous regions in the midface, and its three-dimensional relationship with the facial artery remains unclear. Methods: Fifty-two cadavers infused with lead oxide contrast medium via the external carotid arteries were scanned by computed tomography (CT). The three-dimensional model was reconstructed using Mimics and Origin software, and the relevant data were calculated using validated algorithms. Results: There were three facial artery types according to its course in relation to the nasolabial fold. In the most common type, accounting for 83.7% of specimens, the facial artery evolves into an angular artery, with a horizontal distance between facial artery and nasolabial fold of − 1.90 ± 2.40, − 3.90 ± 2.95, − 5.18 ± 3.42, − 5.59 ± 3.53, − 5.59 ± 3.83, − 6.07 ± 4.10, − 6.92 ± 3.70, − 6.79 ± 3.37, − 4.52 ± 3.20, and − 2.76 ± 3.60 (mm) from the nasal ala to the oral commissure and a vertical distance of − 4.03 ± 2.56, − 3.27 ± 2.27, − 2.81 ± 2.57, − 2.1 ± 2.64, − 1.5 ± 3.32, − 0.71 ± 3.99, 0.92 ± 4.43, 0.4 ± 5.31, − 4.14 ± 5.14, − 7.05 ± 4.74 (mm). Conclusions: The facial artery is vulnerable to damage when injecting filler in the nasolabial fold. For the upper 1/3 of the nasolabial fold, the supraperiosteal layer is recommended for injection, while for the lower 2/3 of the nasolabial fold, the dermal layer along the nasolabial fold is recommended. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266. [ABSTRACT FROM AUTHOR]

During the dissection of the cervicofacial area in a donated male cadaver, an asymmetrical division of the facial artery (FA) and a premasseteric artery (PA) were identified. Specifically, on the left side, the FA stem is divided into four branches (quadrifurcation) 4.26 mm below the lower border of the mandible. In contrast, it is divided into two branches (bifurcation) on the right side. Whether symmetrical or asymmetrical, these variants can have significant implications for rhinoplastic, maxillofacial, or reconstructive surgery. This finding underscores the crucial role of surgeons in exercising caution and paying close attention during these procedures to avoid potential damage. [ABSTRACT FROM AUTHOR]

Arteriovenous malformations (AVMs) are rare vascular abnormalities that can result from defects in blood vessels. They are not often found in the facial area, and this report describes a case of a high-flow AVM in an adult patient with swelling in the left mandibular region. Since there were no complications related to swelling, a comprehensive investigation ultimately resulted in the accurate identification of the AVM. The potential risks associated with these malformations highlight the importance of accurate diagnosis and comprehensive diagnostic approaches involving detailed patient history, clinical examination, and advanced imaging techniques. Computed tomography angiography confirmed the diagnosis before undergoing angioembolization and complete excision of the AVM. This case underscores how important accurate diagnosis is for preventing serious complications associated with AVMs and emphasizes using a multidisciplinary strategy when managing these uncommon vascular anomalies.

Purpose: The present evidence-based systematic review with meta-analysis aimed to investigate the fusion morphology of the lingual artery and facial artery (in the form of the linguofacial trunk-LFT) pooled prevalence and morphometry. After carefully investigating the data literature, a retrospective computed tomography angiography (CTA) study was performed to investigate a few parameters that were not well-studied. Materials: An evidence-based systematic review retrieved 41 studies that met our inclusion criteria to identify the LFT pooled prevalence. The literature search was performed using PubMed, Google Scholar, Scopus, and Web of Sciences databases. Then, a meta-analysis of the literature was performed using the open-source R programming language and the RStudio software. Moreover, two hundred CTAs were randomly selected and retrospectively studied to identify LFT topography, morphology, and morphometry. Results: The LFT pooled prevalence was calculated at 16.41%. The subgroup analyses for nationality, type of study, laterality, and gender retrieved no statistically significant association. The unilateral appearance was estimated at 15.92%, compared to the bilateral at 3.28% (p < 0.001). Concerning the findings of our original study, 50 LFTs were identified (12.5%) unilaterally in 34 patients and bilaterally in 8 patients. A significant correlation was observed between the distance LFT origin from the carotid bifurcation (CCB) (p < 0.001) and the distances LA and FA origin from the CCB (p = 0.004). Conclusions: A systematic review with meta-analysis of the LFT were presented, along with an original imaging retrospective study investigating detailed parameters of LFT topography, morphology and morphometry. Knowledge of LFT presence is essential for interventionists in the head and neck region. [ABSTRACT FROM AUTHOR]

Purpose: The literature has for too long described the arterial supply of the mandible as coming from a single artery, the inferior alveolar artery, and being of the terminal type. Rather, it appears to come from an extensive and complex arterial network dependent on the lingual, facial, and maxillary arteries and their collateral branches. Our study aims to confirm and demonstrate the arterial vascular richness of the mandible and to establish arterial mapping. Methods: The arterial vascularization of the mandible was revealed in six anatomic specimens after performing selective injections of the lingual, facial, and maxillary arteries with different dyes. A specimen was injected intra-arterially with colored latex at the level of the maxillary artery for a morphometric study. Results: Eighteen selective arterial injections were performed on six anatomic specimens. The mucocutaneous, musculoperiosteal, and intramedullary vascularizations were analyzed. Each of the arteries has a defined and delimited cutaneo-mucous vascular territory. The facial and maxillary arteries supply the musculoperiosteal vascularization of the mandible from the condyle to the symphysis. The lingual artery supplies only the inner cortex of the parasymphyseal and symphyseal regions. The facial and maxillary arteries provide intramedullary vascularization from the angle of the mandible to the parasymphysis. The vascularization of the symphysis depends on the facial artery. No staining was found in the condyle region. Neoprene latex injection was performed on an anatomic specimen, revealing a permeable anastomosis between the inferior alveolar and facial arteries. Conclusion: The arterial vascularization of the mandible is dependent on the maxillary, facial, and lingual arteries. This is a network vasculature. This study makes it possible to establish an arterial map of the mandible. The presence of an anastomosis between the inferior alveolar artery and the facial artery confirms the existence of dynamic and borrowed vascularization. Knowledge of this arterial system makes it possible to adapt maxillofacial surgical care and to anticipate possible intraoperative complications. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to establish the relationship of facial artery with nasolabial fold by color Doppler sonography and to determine facial artery variations and their relationship with age, gender, or hemifaces. Methods: The study included 188 patients (94 women, 94 men) aged 18–60 years. Overall, 376 facial arteries in both hemifaces were evaluated for the course within nasolabial fold, symmetry, and relationship with gender. Results: The mean age of the patients was 39.29 ± 12.81 years. Type A (55.7%) was the most common type in both hemifaces. There was no significant relationship between the course of facial artery and age (P >.05). Asymmetrical course of facial artery was more common in females (54.3%). In both genders, type A was the type with highest symmetry detected. Conclusions: Nasolabial fold is one of the important facial regions for filler injection. To prevent vascular injection, course of facial artery should be identified within the nasolabial fold. Type A was the most common type in both hemifaces and genders. Although the rates were close to each other, asymmetry in the course of the facial artery was observed in most of the patients. Ultrasonographic examination which is non‐invasive and non‐ionizing imaging method can be performed carefully before filler injection to determine vascular tissues. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background and Objectives: Typically, the external carotid artery (ECA) sends off separate anterior branches: the superior thyroid, lingual, and facial arteries. These could, however, form common trunks: thyrolinguofacial, linguofacial (LFT), or thyrolingual. Although known, the LFT variant was poorly detailed previously, and most authors just counted the variant. We aimed to demonstrate the individual anatomical possibilities of the LFT on a case-by-case basis. Materials and Methods: 150 archived angioCT files were used. After applying inclusion and exclusion criteria, 147 files of 86 males and 61 females were kept for this study. Results: In 34/147 cases, LFTs were found (23.12%). Bilateral LFTs were found in 13/34 cases (38.24%) and unilateral LFTs in 21/34 (61.76%) cases. Forty-seven LFTs were thus identified and further studied for different variables. Regarding the vertical topography of LFT origin, type 1a (suprahyoid and infragonial) was found in 28 LFTs (59.57%), type 1b (suprahyoid and gonial) was found in eight LFTs (17.02%), type 3 (suprahyoid and supragonial) was found in two LFTs (4.25%), type 2 (hyoid level of origin) in eight LFTs (17.02%), and type 3 (infrahyoid origin) in just one LFT (2.12%). Types of the initial course of the LFT were determined: type I, ascending, was found in 22/47 LFTs; type II, descending, in 12/47 LFTs; and type III, transverse, in 13/47 LFTs. Regarding the orientation of the first loop of the LFT, 23/47 LFTs had no loop, 4/47 had anterior loops, 1/47 had a posterior loop, 5/47 had superior loops, 5/47 had inferior loops, and 9/47 had medial loops. The position of the LFT relative to the ECA was classified as medial, anterior, or antero-medial. An amount of 12/47 LFTs were anterior to the ECA, 22/47 were antero-medial, 10/47 were medial, 2/47 were inferior, and 1/47 was lateral. Regarding their general morphology, 23/47 LFTs had a rectilinear course, 22/47 had loops, and 2/47 were coiled. A case-by-case presentation of results further demonstrated the diversity of the LFT. Conclusions: In conclusion, the morphology and topography of the LFT are individually specific and unpredictable. It can be anticipated case-by-case by surgeons on CT or MR angiograms. [ABSTRACT FROM AUTHOR]

The external carotid artery is the main artery of the head and neck region. It has eight branches, and there are various variations in the emergence and distribution of these branches. In particular, frequent changes can be observed in the emergence of facial artery, and lingual artery. Knowledge of the vascular anatomy of the lingual artery and facial artery is important in terms of neck surgery and radical treatments. For this reason, in the present case report we aimed to report a case with linguofacial trunk and its morphometric and morphological features. [ABSTRACT FROM AUTHOR]

To evaluate the difference in average operating time and intraoperative blood loss in transcervical submandibular gland excision for isolated benign submandibular diseases, while preserving the facial artery and ligating the facial artery. A prospective study was conducted in our institute for a duration of 6 months from January 2022 to June 2022. 30 patients undergoing excision of the submandibular gland as an isolated procedure were included. They were randomly divided into 2 groups of 15, Group "A" where the facial artery was preserved, and "B" where the artery was ligated. The operating time in minutes and intra operative blood loss was compared. The mean operating time was 48.26 min in Group A, and 46.2 min in Group B. The p value between the two groups was 0.189586, which was not significant. The mean blood loss in group A was 44.6 ml, and 45.8 ml in group B. The p value was not significant at 0.331254. Preserving the facial artery in benign tumours while excising the gland neither increases operating time nor intraoperative bleeding. This will not only retain the anatomy, but provide a second option for flap reconstruction in case needed later. [ABSTRACT FROM AUTHOR]

The bony notch on the inferior border of the mandible, anterior to the attachment of the masseter muscle, where the facial vessels commonly pass, has been called different names in the literature, e.g., premasseteric notch, antegonial notch, and notch for the facial vessels. Interestingly, various disciplines have leaned toward different names for this notch. Therefore, to aid in consistent communication among professionals, the present study aimed to analyze usage of these varied terms and make recommendations for the best terminology. Based on the adjacent anatomical structures used to name this notch, three groups were analyzed in this study, a group using masseter in the term, a group using gonion in the term, and a group using facial vessels in the term. A literature search found that the group using gonion in the term was found most in the literature. The orthodontics field used gonion in the term the most (29.0%: 31/107) followed by the oral and maxillofacial surgery field (14.0%: 15/107), the plastic surgery field (4.7%: 5/107), and the anatomy field (3.7%: 4/107). The dental field used gonion in this term the most (43.9%: 47/107) and the medical field used facial vessels in the term the most (33.3%: 6/18). Based on these results, the use of gonial terms for this notch seems to be preferred. [ABSTRACT FROM AUTHOR]

The facial artery (FA) is the main blood vessel supplying blood to the face. It is essential to understand the anatomy of FA around the nasolabial fold (NLF). This study aimed to provide the detailed anatomy and relative positioning of FA to help avoid unexpected complications in plastic surgery. FA was observed from the inferior border of the mandible to the end of its terminal branch in 66 hemifaces of 33 patients with Doppler ultrasonography. The evaluation parameters were: (1) location, (2) diameter, (3) FA-skin depth, (4) relationship between the NLF and FA, (5) distance between the FA and significant surgical landmarks, and (6) the running layer. The FA course is classified based on the terminal branch. The most common FA course was Type 1, which had an angular branch as the final branch (59.1%). The most common FA-NLF relationship was that the FA was situated inferior to the NLF (50.0%). The mean FA diameter was 1.56 ± 0.36 mm at the mandibular origin, 1.40 ± 0.37 mm at the cheilion, and 1.32 ± 0.34 mm at the nasal ala. The FA diameter on the right hemiface was thicker than that on the left hemiface (p < 0.05). The FA mainly terminates in the angular branch, running in the medial NLF and in dermis and subcutaneous tissue, with a blood supply advantage in the right hemisphere. We suppose that a deep injection into periosteum around the NLF may be safer than an injection into the superficial musculoaponeurotic system (SMAS) layer. [ABSTRACT FROM AUTHOR]

Introduction: The facial artery (FA) was observed with distinctive variations and anomalous, which occur during the embryological developmental process due to the ablation of neural crest cells that impact embryonic aortic arch vessels, resulting in distinctive branching patterns. Therefore, this study aimed to investigate the types, clinical importance, localization, and differences of FA in fixed cadavers according to gender and body side. Methods: The current study was conducted on 19 formalin-fixed cadavers (68.4% males, n = 13; 31.6% females, n = 6). The types, variations, prevalence, and distance to nearby surgical landmarks of FA were recorded on both sides. Measurements were taken with a surgical microscope (Zeiss Meditec, Berlin, Germany) and a digital caliper (INCA, DCLA-0605, 0.6–150 mm). Results: Angular type % 73.1 (n = 14, right; n = 19, left), labial type % 5.3 (n = 1, right), alar type % 5.3 (n = 1, right), and nasal type % 5.3 (n = 1, right) were detected. The following parameters were significant according to gender; the distance between the ala of the nose and the origin of the FA on both sides (p = 0.007 right; p = 0.018 left), the diameter of FA at the cheilion (p = 0.019 left), diameters of the superior and inferior labial arteries at their origin (p = 0.031 right; p = 0.025 right) and PO lines. Conclusion: The significant differences in gender according to the distance of the FA and its branches from the origin should be considered to reduce complications during surgery. The differences in studies according to the types and variations of FA may be due to the scale of the study, gender, or study design.

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.

Pseudoaneurysms of facial artery usually arise from the distal part of the vessel. Only 4 cases were described in the literature involving the proximal part of facial artery. We present a case of a traumatic pseudoaneurysm involving the proximal part of facial artery. A 50-year-old man was referred to our department for a progressively growing submandibular mass. He was injured by a sharp object during a car crash 30 days ago. After 3 weeks, the patient noted the appearance of a subcutaneous mass in the left submandibular area. Physical examination revealed a freely movable, painful, and pulsatile swelling. Ultrasound and computerized tomography scan showed a nodular lesion in the left submandibular area in continuity with the facial artery. The diagnosis of pseudoaneurysm of facial artery was suspected. The patient was treated by surgery. The pseudoaneurysm was resected with ligation of the proximal and distal ends of the facial artery. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify variations in the origins of the anterior branches of the external carotid artery (ECA) and to propose an update of the current classification. Methods: The study included 100 carotids arteries from fifty human donors. Classification of anterior branches of external carotid artery was performed according to Vaz'quez et al. (2009). Results: The configuration origins of anterior branches were found as follows: Type I, 82%; Type II, 1%; Type III, 16%. No Type IV was observed. The study identified seven subgroups of anterior branch variations in the external carotid artery. The most frequently observed variations were Subtype Ia in 40% (n = 20) of cases on the right side and Subtype Ib in 38% (n = 19) on the left side. In addition, a rare and previously unclassified configuration was observed in a 72-year-old male donor, where the carotid artery was pentafurcated on the left side. Conclusions: In conclusion, the presence of anatomical variants not previously included in the anterior external carotid artery branching classifications supports the consideration of a revision to the present classification system. [ABSTRACT FROM AUTHOR]

Introduction The reconstruction of intraoral soft tissue and bony defects is important to restore function and esthetics. For large defects, there is a need for regional pedicled flaps or free flaps. The hard palate separates the nasal and oral cavities. Due to the small remaining surface area between the flap and the palate after surgical resections, an optimal blood supply to the flap is required for reconstructions of the hard palate. Case Report This article demonstrates the immediate reconstruction with submental island flap of a patient with partial maxillectomy after wide excision of maxillary adenoid cystic carcinoma and discusses a brief overview of this flap. Conclusion The submental island flap is an effective and reliable method for intraoral reconstruction of large softtissue defects in the oral cavity. Morbidity at the donor site is low and the remaining scar is unremarkable. Head and neck surgeons familiar with the facial artery and its branching pattern make this flap an appropriate choice for clinical practice. [ABSTRACT FROM AUTHOR]

Background: Supratrochlear (STA), supraorbital (SOA), and dorsal nasal artery (DNA) branches from the ophthalmic artery and angular artery (AA) from the facial artery are the primary suppliers of blood to the upper face. Filler injection without precise knowledge of its vascular topography poses a risk of severe complications. Methods: Seventy-four hemifaces from 37 subjects with a median age of 25.0 (21.0, 35.0) years and a median body mass index of 21.2 (20.0, 25.4) kg/m2 underwent high-frequency ultrasound tests between March 2022 and April 2022. The bilateral location, depth, peak systolic velocity (PSV), and inner diameter (ID) of the four periorbital arteries (STA, SOA, DNA, AA) were measured. Results: The average ID ranges from 0.6~1.0 mm, and the average PSV ranges from 9.2~24.9 cm/s. All arteries detected passed through the superficial subcutaneous fascia. Most subjects' STAs traveled within 1.0 to 2.0 cm from the midline (left 96.8%, right 93.8%), while SOAs were mainly concentrated within 2.0 to 4.0 cm (left 83.9%, right 81.3%). STAs were more superficial and had a larger internal ID and PSV than SOAs (p<0.001). Except for the ID of the right SOA2 being significantly larger than that of the left SOA2 (p<0.05), no dominant side was found. The depth of STAs and SOAs was moderately correlated with BMI (p<0.05), except for STA1 on the left side. The course of AAs presented a high variability. Conclusion: These findings emphasize that the periorbital arteries carry with it a likelihood of ocular complication risks during injection. Targeting the supraperiosteal layer in the STA area and the supramuscular layer in the SOA area of the inferior forehead during injection seems reasonable, and an area within 1.0~2.0 cm from the midline should be avoided. Additionally, the high variability of AAs will enhance the understanding of the anatomy of the facial artery terminals. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background and Objectives: Typically, the external carotid artery (ECA) sends off separate anterior branches: the superior thyroid, lingual, and facial arteries. These could, however, form common trunks: thyrolinguofacial, linguofacial (LFT), or thyrolingual. Although known, the LFT variant was poorly detailed previously, and most authors just counted the variant. We aimed to demonstrate the individual anatomical possibilities of the LFT on a case-by-case basis. Materials and Methods: 150 archived angioCT files were used. After applying inclusion and exclusion criteria, 147 files of 86 males and 61 females were kept for this study. Results: In 34/147 cases, LFTs were found (23.12%). Bilateral LFTs were found in 13/34 cases (38.24%) and unilateral LFTs in 21/34 (61.76%) cases. Forty-seven LFTs were thus identified and further studied for different variables. Regarding the vertical topography of LFT origin, type 1a (suprahyoid and infragonial) was found in 28 LFTs (59.57%), type 1b (suprahyoid and gonial) was found in eight LFTs (17.02%), type 3 (suprahyoid and supragonial) was found in two LFTs (4.25%), type 2 (hyoid level of origin) in eight LFTs (17.02%), and type 3 (infrahyoid origin) in just one LFT (2.12%). Types of the initial course of the LFT were determined: type I, ascending, was found in 22/47 LFTs; type II, descending, in 12/47 LFTs; and type III, transverse, in 13/47 LFTs. Regarding the orientation of the first loop of the LFT, 23/47 LFTs had no loop, 4/47 had anterior loops, 1/47 had a posterior loop, 5/47 had superior loops, 5/47 had inferior loops, and 9/47 had medial loops. The position of the LFT relative to the ECA was classified as medial, anterior, or antero-medial. An amount of 12/47 LFTs were anterior to the ECA, 22/47 were antero-medial, 10/47 were medial, 2/47 were inferior, and 1/47 was lateral. Regarding their general morphology, 23/47 LFTs had a rectilinear course, 22/47 had loops, and 2/47 were coiled. A case-by-case presentation of results further demonstrated the diversity of the LFT. Conclusions: In conclusion, the morphology and topography of the LFT are individually specific and unpredictable. It can be anticipated case-by-case by surgeons on CT or MR angiograms.

Introduction: the present study reports three unusual cases of a supernumerary septal branch (SSB) originated directly from the facial artery and with a horizontal course towards the nasal septum. In addition, possible repercussions to nasal trauma and to procedures on orofacial harmonization were discussed. Analyzes were carried out by means of dissection of the facial artery, the SSB, the superior labial artery and the septal branch of the superior labial artery. Five measures were taken for each case using a digital caliper. The course and depth of both the SSB and the regular septal branch were registered and reported. The presence of a SSB, especially with an atypical origin, shows the importance of solid anatomical knowledge for the areas of orofacial harmonization and nasal trauma. Dental surgeons, plastic surgeons, and other healthcare professionals that performed procedures on the nose and upper lip areas may benefit from the findings of the present study. [ABSTRACT FROM AUTHOR]

Detailed knowledge about the normal anatomy and its variations is a necessity in good clinical and surgical practice. The case we are reporting here shows a rare configuration origin of the superior thyroid, lingual and facial arteries arising directly from a pentafurcated common carotid artery. A fresh frozen latex-infiltrated cadaver was dissected. The superior thyroid artery, the lingual artery and the facial artery were found to be directly detached from the common carotid artery as terminations of the five terminal rami variations. The current classifications of anatomical variants are discussed in detail in relation to this case. [ABSTRACT FROM AUTHOR]

Mönckeberg medial calcinosis (MMC) is a potentially serious vasculopathy involving calcification of the arterial tunica media of the extremities, heart, and other viscera. There are a limited number of cases reported in the dental literature, usually associated with the facial artery. Although MMC is often discerned as an occult radiologic finding in middle‐aged adults, its presence may serve as a harbinger for end‐stage renal disease, diabetes, other pathologic processes, and possible regional hypoperfusion. The objective of this report is to feature an elderly patient with MMC of the facial and infraorbital arteries. In addition, a brief review of published cases of MMC and its differential diagnosis have been provided. It is recommended that affected patients be referred for a comprehensive medical assessment. Timely discovery of calcified arteries may improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The superior labial artery (SLA) is a facial artery (FA) that drains into the peri-oral region (dangerous area of face). Owing to the recent rise in the demand for reconstructive procedures and filler injections in this region, it is important to understand its arterial topography. This paper aims to study the embranchment pattern of the labial arteries in the eastern Indian population. Method: An observational study using conventional dissection and dry dye injection methods was conducted to visualize the facial and superior labial arteries in 56 hemifaces. The origin, morphometry (length and diameter), branching pattern, and termination of the arteries were recorded and compared with the existing data. Results: Two hemifaces were excluded from analysis (vessels damaged in dissection); in the remaining 54, a single SLA was present in all samples originating at a mean distance of 1.29 ± 0.32 cm from oral commissure (68.51% originating above). Lee type II (independent SLA giving off alar branch) was the predominant pattern (56.2%), followed by type I (independent SLA and alar branches, 33%) and type III (FA terminating as SLA, 10.8%). The average length of SLA was 4.75 ± 1.28 cm and 4.56 ± 0.78 cm on the right and left sides, respectively. Conclusion: The SLA is highly variable in occurrence, course, and depth, sometimes even occurring unilaterally; therefore, any intervention in this region should be done with caution. Since the SLA was not found subcutaneously at the vermillion border, the intradermal and the subcutaneous injections used here are relatively safer. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Pseudoaneurysm is a rare vascular complication of trauma, causing an incomplete tear of the vessel wall. We present a clinical case report arising from the distal branch of facial artery in an infant. Facial artery pseudoaneurysm is a rare complication of facial trauma and can easily be misdiagnosed especially in the paediatric age group. Prompt investigation and diagnosis with timely and apt intervention is the key to the successful management of facial artery pseudoaneurysm.

Anatomical knowledge of the facial vasculature is crucial for successful plastic, reconstructive, and minimally invasive procedures of the face. The facial artery is palpated as it crosses the inferior mandibular rim immediately anterior to the insertion of the masseter muscle. This point is also helpful in locating the course of the mandibular branch of the facial nerve. After crossing the mandibular rim, the facial artery and vein then follow an anterosuperior course in the direction of the oral commissure. Near the angle of the mouth, the inferior labial artery and then the superior labial artery branch off medially The facial vein, also referred to as the anterior facial vein, is a paired vessel and the main vein of the face. The facial veins stem from the angular veins on each side of the root of the nose. Some sources claim that the angular vein, which arises from the confluence of the supratrochlear and supraorbital veins, is only an initial segment of the facial vein.

Background: The aim of this study was to identify variations in the origins of the anterior branches of the external carotid artery (ECA) and to propose an update of the current classification. Methods: The study included 100 carotids arteries from fifty human donors. Classification of anterior branches of external carotid artery was performed according to Vaz’quez et al. (2009). Results: The configuration origins of anterior branches were found as follows: Type I, 82%; Type II, 1%; Type III, 16%. No Type IV was observed. The study identified seven subgroups of anterior branch variations in the external carotid artery. The most frequently observed variations were Subtype Ia in 40% (n = 20) of cases on the right side and Subtype Ib in 38% (n = 19) on the left side. In addition, a rare and previously unclassified configuration was observed in a 72-year-old male donor, where the carotid artery was pentafurcated on the left side. Conclusions: In conclusion, the presence of anatomical variants not previously included in the anterior external carotid artery branching classifications supports the consideration of a revision to the present classification system.

Background: Commonly, arterial anatomic variants are reported as single entities. However, different such variants can occur in a single patient. Materials and methods: During a retrospective study of computed tomography angiograms of 52 adult patients, 2 cases were found with unilateral maxillofacial trunks. In each case different other anatomic variants were documented. Results: The maxillofacial trunk in the first case was associated with bilateral posterior kinks of the internal carotid artery which passed beyond the transverse processes of the atlas vertebra and indented and displaced the internal jugular veins. Common carotid origins of the superior thyroid arteries were found, as well as a high origin of the contralateral facial artery. In the second case a plethora of variants were associated with a unilateral maxillofacial trunk: 1) direct occipital- vertebral arterial anastomosis; 2) ipsilateral atresia of the distal vertebral artery and of the A1 segment of the anterior cerebral artery; 3) bilateral atresia of posterior communicating arteries; 4) linguofacial and labiomental trunks; 5) terminal trifurcation of the external carotid artery. Conclusions: The arterial anatomical variants of the head and neck should be carefully documented prior to specific surgical and interventional procedures, as well as for understanding the compensatory anatomical pathways of circulatory insufficiencies. [ABSTRACT FROM AUTHOR]

Free functional muscle transfer (FFMT) is a salvage procedure recommended in cases of brachial plexus injury with late presentations or failures of primary nerve reconstruction. The workhorse for most authors is the gracilis, and the most common indication is the restoration of elbow flexion. For successful revascularization of the muscle, donor vessels must be in proximity of the site of the muscle fixation and allow direct coaptation to a donor nerve, ideally without the use of nerve grafts. A major problem occurs when patients have sustained concomitant vascular injuries to the subclavian and/or axillary arteries and had previous surgical dissections in the area where the most common vascular pedicles are located. The authors report the use of the rerouted facial vessels as donors in these complex cases. The surgical technique is presented, along with three cases where the procedure was used. The flaps survived in all the patients and grade > 3/5 muscle contraction was observed in the two patients who had adequate follow-up. Conclusion: the use of the facial vessels as donor vessels is an option to revascularize a FFMT in the setting of severe vascular injury to the subclavian and axillary arteries.

Facial artery is a branch of the external carotid system extending from the upper neck to the nasion. Various flaps are described in the literature based on the facial artery and vein in the neck and face to reconstruct the head-and-neck cancer defects, either superiorly based or inferiorly based. This article summarizes the flaps and their variations based on the facial arteriovenous system. The flap harvest techniques, the indications, advantages and the limitations of the nasolabial flap, facial artery myomucosal flap, and submental flap are described, with appropriate case demonstrations. Variations of the flaps are also discussed.

Background and Objectives: Vascular variations appear as morphologically distinct patterns of blood diverging from the most commonly observed vessel patterns. The facial artery is considered to be the main vessel for supplying blood to the anterior part of the face. An anatomical understanding of the facial artery, its course, its topography, and its branches is important in medical and dental practice (especially in neck and face surgery), and is also essential for radiologists to be able to interpret vascular imaging in the face following angiography of the region. A profound knowledge of the arteries in the region will aid in minimizing the risks to the patient. Materials and Methods: In our publication a narrative literature review and a case report are presented. Results: A rare case of a facial artery pattern has been described anatomically for the first time with respect to its course and branching. This variation was found on the left side of a 60-year-old male corpse during anatomical dissection. The anterior branch of the facial artery arched in the direction of the labial angle, and there divided into the inferior and superior labial arteries. At the same time, the posterior branch coursed vertically and superficially to the masseter muscle. It here gave off the premasseteric branch, and continued towards the nose, where it ran below the levator labii superioris and the levator labii superioris alaeque nasi muscles and terminated at the dorsum nasi. Conclusions: Our review of the literature and the case report add to knowledge on the facial artery with respect to its topographical anatomy and its branching and termination patterns, as well as the areas of supply. An exact knowledge of individual facial artery anatomy may play an important role in the planning of flaps or tumor excisions due to the differing vascularization and can also help to prevent artery injuries during aesthetic procedures such as filler and botulinum toxin injections. [ABSTRACT FROM AUTHOR]

In the Video S1, a modified technique for submandibular gland resection in benign disease is shown. The main plane of dissection is below the fascia and immediately superficial to the fibrous capsule of the gland. The video shows the surgical steps and the structures that become evident along the procedure and illustrates some tips and tricks. Facial vessels are dissected, easily spared, and not ligated as it occurs in the classical technique. This technical variant is minimally invasive, respectful of anatomy, and through preservation of the fascial layer investing the gland aims at reducing the risk of injury to the marginalis mandibulae branch of the facial nerve, which lies within the fascia itself. [ABSTRACT FROM AUTHOR]

Background: As deep nasolabial folds (NLF) are associated with facial aging, there is an increasing demand for esthetic correction with filler injections. Understanding the anatomy of the angular artery (AA) and facial artery (FA) around the NLF region is essential for ensuring the safety of dermal filler injections into the NLF. The purpose of this study was to provide detailed vascular anatomical information on the course and depth of AA and FA around NLF using Doppler ultrasound on live cases. Methods: FA was observed from the origin level adjacent to the mandible corpus to the end of its terminal branch AA in 168 hemifaces of 84 cases with Doppler ultrasonography. Results: We made a classification of the FA course based on the NLF. The minimum and maximum depths of the FA along its course were measured in 84 cases. The results showed that its course may be highly superficial (2.5 mm at the mandibular origin, 3.7 mm at the cheilion, 3.7 mm at the nasal ala) or it may follow a very deep course near the periosteum (15.0 mm at the mandibular origin, 18.7 mm at the cheilion, 23.5 mm at the nasal ala). FA depth was varied between 5.98 mm and 6.62 mm at the mandibular origin, between 8.36 mm and 9.20 mm at the cheilion, between 9.52 mm and 10.51 mm at the nasal ala at a 95% confidence interval. Conclusions: This study suggests that there is no absolutely safe depth or region for nasolabial fold filler injections. [ABSTRACT FROM AUTHOR]

Objective: The main artery in the blood supply of the head and neck region is the external carotid artery (ECA), and it's branches are superior thyroid artery, ascending pharyngeal artery, lingual artery (LA), facial artery (FA), occipital artery, posterior auricular artery, superficial temporal artery maxillary artery. Variations are observed in the origin of these arteries from the ECA. This study aims to present the unilateral linguofacial trunk (LFT) case. Case: During the routine neck dissections performed in the Anatomy Laboratory of Dokuz Eylul University Faculty of Medicine, it was observed that the LA and FA originating from the ECA on the right side in a 67-year-old male cadaver fixed with formaldehyde, originated from a common trunk. The length of this trunk was measured as 9.19 mm. The distance of the point where the LFT originated from the ECA to the carotid bifurcation was 21.44 mm, and the vertical distance to the horizontal plane passing over the carotid bifurcation was 16.23 mm. The vertical distances of the point where the LFT originated from the ECA and divided into LA and FA to the horizontal plane passing over the hyoid bone were 13.15 mm and 24.30 mm, respectively. Conclusion: Variations in the branching of the ECA are important in terms of surgery and radiology. Previous studies have reported that LFT occurs in a wide range, between 6% and 20%. Clinicians must be aware of these variations when performing head and neck surgery, maxillofacial surgery, radiological and diagnostic procedures. [ABSTRACT FROM AUTHOR]

Aim of the study: The purpose of the study is to document in the specialised literature the variations in origin of the facial artery (FA) at the level of the carotid triangle. Material and methods: we analysed 89 summaries of scientific papers and 41 complete articles, using ISI Thomson Web of Knowledge and PubMed databases, and additionally, we performed a search in 9 anatomy books. Results: the most common variation of origin of the facial artery was in the form of a common trunk with the lingual artery, a linguofacial trunk, with an average percentage of 16.39% of the cases. A rare variation of origin of the facial artery was the thyrolinguofacial trunk with an average percentage of 2.1% of the cases. The results observed were mostly unilateral, but many publications did not present observations regarding the unilateral or bilateral nature of these origins. Conclusions: the results depict a wide variety of origins of FA from the external carotid artery (ECA) and can contribute to the clinical success of surgical procedures performed in the anterior region of the neck and the face

Pseudoaneurysm is a rare vascular complication of trauma, causing an incomplete tear of the vessel wall. We present a clinical case report arising from the distal branch of facial artery in an infant. Facial artery pseudoaneurysm is a rare complication of facial trauma and can easily be misdiagnosed especially in the paediatric age group. Prompt investigation and diagnosis with timely and apt intervention is the key to the successful management of facial artery pseudoaneurysm. [ABSTRACT FROM AUTHOR]

Local anesthesia techniques are widely used in dentistry because of their numerous advantages, including safety. Several articles have been published on local and systemic complications stemming from the use of local anesthesia, one of which is accidental intravascular injection, usually reported during inferior alveolar nerve blocks. A 58-year-old man presented to the dental office for extraction of the lower left first molar. During delivery of a supplemental injection in the buccal vestibular mucosa to anesthetize the buccal nerve, an accidental intra-arterial injection to the facial artery occurred, causing sudden sharp pain and immediate pallor along the course of the facial artery. The pallor resolved in approximately 20 minutes. Buccal infiltration was repeated successfully, and the tooth was extracted uneventfully. This case appears to be the first report in the literature to describe the accidental intravascular injection of local anesthetic involving the facial artery and discuss its clinical implications. [ABSTRACT FROM AUTHOR]

PURPOSE. The facial artery is one of the main arteries which supply the face with blood. The different types have been researched not only for anatomical purposes but also to facilitate the different medical specialties. METHODS AND RESULTS. Our team found an unusual case of a facial artery with smaller lumen. The region, which it supplies, is partially substituted by the transverse facial artery. In the observed course the facial artery had a considerably smaller caliber than usual. After it appears on the surface of the face it divides into two untypical branches - anterior and superior. Contrariwise the transverse facial artery has a significantly bigger lumen. The separate branches, which usually originate from the facial artery, here arise from the aforementioned artery. CONCLUSIONS. These types of anatomical variations are very important for muscle and skin flaps in plastic surgery of the face. Every deviation from the normal anatomy of the main blood vessels can also lead to errors in invasive surgery procedures and medical imaging. The vascularization of the face and its variations is subject for many different disciplines.

Introduction. Various skin parameters such, as the thickness of the epidermal echo, dermis and subcutaneous tissue, the surface area of individual layers, the thickness of the subepidermal band with a low echogenic effect, the caliber of blood vessels, as well as the presence or absence of blood flow in the vessels, can be investigated with ultrasound. The aim of our investigation was to evaluate skin layers thickness in women of different age groups and the use of invasive cosmetic procedures, using the ultrasound method for its subsequent standardization. Materials and methods. The thickness epidermis, dermis, hypodermis in the interbrow, chin, nasolabial fold and cheeks (salivary gland), submandibular, occiput, sternocleidomastoid muscle zones was study in 102 women aged 15-75 years (average age 40,2 ± 1,2 years) using the Mindray DC-8 ultrasound scanner. In 14 women was investigated height, width and diameter of facial artery. The study was carried out in Department of Fundamental Medicine of the Baltic Federal University named after Kant. Statistical processing for the study results was performed in Microsoft Excel 2017 using average values (M), the reliability was determined using Student's criterion, and its critical level in this study was taken to be 0.05. Results and its discussion. It was revealed that on face the thickness of the epidermis was minimal in the submandibular area (0,037 cm) and in neck and occiput it was smaller (0,033 cm). The epidermis maximum was detected in the chin area (0,040 cm). Analysis of the dermis thickness indicates the largest size on face was in the interbrow area (0,048 cm) and smallest in the submandibular (0,020 cm). The hypodermis thickness on face was greatest in the area of the chin (0,129 cm), while in occiput it reached 0,141 cm. The smallest thickness of the hypodermis we had detected in the submandibular area (0,070 cm). We found a thickening of the dermis in patients after 40 years in all anatomical areas of the face with a statistically significant difference (p<0,05). The maximum thickness of the dermis was documented in the interbrow area, regardless of age. The dermis thickness in nasolabial folds in patients using dermal fillers was in 2 times greater versus surveyed women without it. Conclusion. The ultrasound technique in the skin and vessels study has clear advantages, since its results can be assessed in real time, it is non-invasive, inexpensive, reliable and absolutely safe for patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the anatomical variations and morphology of the external carotid artery (ECA) and its anterior branches. Methods: Using computed tomography angiography (CTA), the origin, internal diameter, and surface laterality emergence of the superior thyroid (STA), lingual (LA), and facial (FA) arteries were evaluated retrospectively evaluated and classified. The bifurcation level of the common carotid artery (CCA) in relation to the cervical vertebrae and disc was also determined. Results: A total of 76 CTA were included in the study. STA originated from the carotid bifurcation (CB) (type I), CCA (type II) and ECA (type III) in 20.4 (31/152), 17.1 (26/152) and 50.7% (77/152) cases, respectively. Also 10.5% (16/152) arose from a shared trunk with LA as a thyrolingual trunk (TLT) (type IVa), and absent in 1.3% (2/152). LA originated in the CB in only one case. A linguofacial trunk (LFT) was present in 14.5% (22/152). Mean diameters of STA, LA and FA were 1.70, 1.95 and 2.45 mm, respectively. Meanwhile, surface laterality were predominately from anteromedial, medial, and anterior, respectively. CB was mainly on C3 or C3–C4 (55.9% of cases). Conclusions: STA origin below the ECA is a common finding. Our population presented the highest percentage of TLT (10.5%) and high CB (9.8%) in literature. Considering these variations are important to prevent complications in neck surgical procedures. [ABSTRACT FROM AUTHOR]

Arterial dissections may occur spontaneously or be preceded by mild or severe trauma, resulting in immediate rupture of the vessel. Spontaneous arterial dissection is defined when the nature of the trauma is small and/or its rupture occurs late and 'traumatically'. However, the literature has reported little about spontaneous dissection of arteries originating from the external carotid artery, and until the production of this article, there was no case report about spontaneous dissection of the facial artery. In this case, 30 days after the surgical procedure of bloody reduction in condylar and mandibular parasymphysis fractures caused by trauma, the patient returned to the emergency room with submental oedema and internal bleeding, caused by dissection of the facial artery. This is a serious condition that can lead the patient to death within a few minutes, being the correct diagnosis and an accurate approach, fundamental to the success in trying to save the patient's life. [ABSTRACT FROM AUTHOR]

The aim of this study is to describe in depth the precise anatomy of the vascular supply of the submandibular gland, trying to determine the existence of patterns of glandular vascularization. Knowledge of these patterns could facilitate surgical management of the gland and the submandibular gland flap. Neck dissections of formaldehyde preserved human cadavers were performed. Submandibular and transmandibular approaches were used during the dissections. All the vascular branches found were registered and classified into 2groups: main or accessory branches. The anatomical data analyzed was: The diameter and length of the main and accessory branches, as well as the most important measurements of the submandibular gland flap pedicle. 33 glands were dissected to study the arterial supply of the submandibular gland (17 right, 16 left; 17 males, 16 females) and 29 were dissected to study the venous supply (15 left, 14 right; 15 males,14 females). A total of 123 arterial branches were found reaching the 33 submandibular glands (47 main and 76 accessories) and 116 venous branches were found draining the 29 submandibular glands (47 main branches and 69 accessory branches). A constant main venous branch that ran parallel to the Wharton duct and drained in the sublingual vein was found in all of cases (Concomitant Wharton Duct Vein or CWDV). The CWDV is a constant venous branch for the drainage of the gland and should be considered as venous pedicle during the dissection of submandibular gland flaps. [ABSTRACT FROM AUTHOR]

Purpose: Understanding anatomical variations of the facial artery and its branches is important for dental and medical practitioners. Methods: Routine cadaveric dissection of the head and neck was performed to demonstrate the origin and branches of the facial artery. Results: Facial artery emerged from a common linguofacial trunk off the external carotid artery. On the face, the facial artery first gave off a pre-masseteric branch. Immediately after, an aberrant artery emerged from the facial artery that coursed along the ramus of the mandible, which upon further dissection and examination was found to anastomose with inferior alveolar artery within the ramus of the mandible. Conclusions: We report a unique anastomosis between facial and inferior alveolar arteries, vessels that have not been previously shown to communicate. This case report may provide useful information for oral and maxillofacial surgeons as well as dentists performing inferior alveolar nerve blocks. [ABSTRACT FROM AUTHOR]

Although the foramina of the adult mandible are well known and extensively studied, still additional foramina and canals could persist from the fetal stage and be detected occasionally in adult. At a routine anatomical evaluation of the Cone Beam Computed Tomography (CBCT) scan of a female patient of 47 years old, a rare anatomical variant of the mandible was found, and is presented here. It was termed foramen lineae obliquae and it was found in the right hemimandible at the level of the second molar, on the oblique line. From that foramen a canal continued within the mandible to join the mandibular canal. On orthogonal slices was accurately detected that the content of that foramen and canal was connected to an intramasseteric network, which was strongly suggestive for that content being vascular. Although a contribution from the buccal nerve could not be withdrawn, the most reasonable content to speculate is the aberrant anastomotic artery of the facial and inferior alveolar arteries. Vascular foramina of the mandible are relevant during various surgical procedures. Surgeons should be aware that if an artery is commonly regarded as a supplier of a muscle inserted on the mandible, it should not be rejected a priori the possibility for that artery being also an extrinsic supplier of the mandible, through an unexpected foramen in the vicinity of that muscle. [ABSTRACT FROM AUTHOR]

Free functional muscle transfer (FFMT) is a salvage procedure recommended in cases of brachial plexus injury with late presentations or failures of primary nerve reconstruction. The workhorse for most authors is the gracilis, and the most common indication is the restoration of elbow flexion. For successful revascularization of the muscle, donor vessels must be in proximity of the site of the muscle fixation and allow direct coaptation to a donor nerve, ideally without the use of nerve grafts. A major problem occurs when patients have sustained concomitant vascular injuries to the subclavian and/or axillary arteries and had previous surgical dissections in the area where the most common vascular pedicles are located. The authors report the use of the rerouted facial vessels as donors in these complex cases. The surgical technique is presented, along with three cases where the procedure was used. The flaps survived in all the patients and grade > 3/5 muscle contraction was observed in the two patients who had adequate follow-up. Conclusion: the use of the facial vessels as donor vessels is an option to revascularize a FFMT in the setting of severe vascular injury to the subclavian and axillary arteries. [ABSTRACT FROM AUTHOR]

Objective: to develop on the skull and polymer embalmed preparations the projection of the triangles of the facial skull and infratemporal fossa and to study the topography of vascular-nervous structures within them. Materials and methods. The study was performed on 40 corpses and 20 polymer embalmed specimens of the head and neck of adults aged 22 to 60 years. To determine the topography of vascular-nervous formations of the midface we selected new topographic landmarks: lateral facial, anterior maxillary, lateral maxillary, lateral infratemporal triangles. Results. It is established that according to the standard points on the skull and polymer embalmed preparations it is possible to create a projection triangles: lateral facial, anterior maxillary, lateral maxillary, lateral infratemporal. The topography of the maxillary artery and its branches should be studied within the infratemporal lateral triangle. The topography of the facial artery, facial vein, branches of the trigeminal and facial nerves should be assessed within the lateral facial, anterior maxillary and lateral maxillary triangles. Conclusions. The proposed projection of the triangles of the facial skull can be widely applied in practice of doctors of oral and maxillofacial surgeons for the planning of operative accesses to the structures of the midface. [ABSTRACT FROM AUTHOR]

Objective: Defects of the nasal, perinasal, and infraorbital areas usually develop after trauma or tumoral excision. The key points of reconstruction of these areas are achieving a good color match and tissue compatibility, avoiding or minimizing functional deficits, and preventing disfigurement in the surrounding tissue. This study is a review of midfacial defects reconstructed with a facial artery perforator flap. Methods: Nineteen patients were operated on for midfacial tumoral masses between 2008-2017. After excision of the lesion with the appropriate surgical margins, the resulting defects were reconstructed with facial artery perforator flaps. Recovering the anatomical and functional structure of the area or avoiding deterioration was the goal. In order to avoid ectropion, flaps were anchored to the periosteum when the lower eyelid was involved. All flap donor sites were primarily repaired. Results: In 1 patient, venous insufficiency was observed, and in another, hematoma and ecchymosis developed, but flap failure did not occur. A trap door deformity was observed in 2 flaps. The patients were satisfied with the aesthetic and functional outcomes. Conclusion: The facial artery perforator flap is a good option for reconstruction of midface defects because it is elevated in a single stage, it provides freedom to design and transfer, and the donor site can be primarily closed.