These findings emphasize that the chance of ocular complication is less when accidental cannulation occurs at the superficial temporal artery compared with injury to the supratrochlear or the supraorbital arteries as the terminal branches of the ophthalmic artery. Ultrasound can assist in the identification and evaluation of all the arteries at risk, thus avoiding the occurrence of vascular complications.
Glabellar augmentation is one of the most popular cosmetic procedures but can entail severe complications caused by inadvertent intravascular injection of filler. Nevertheless, few studies have investigated the arteries on the glabellar and central forehead regions. The aim of this study was to correlate the topography and location of the arteries in this area with anatomical landmarks to propose a safety guideline. Two methods were used to investigate the glabellar and central forehead areas: dissection of 19 Thai embalmed cadavers, and ultrasonographic examination of 14 healthy Thai volunteers. At the level of the glabellar point, the horizontal distances from the midline to the arteries were 4.7 mm (central artery), 7.8 mm (paracentral artery), and 14.7 and 19.2 mm (superficial and deep branches of supratrochlear artery). The depths from the skin of the arteries were 3.1 mm (central artery), 4.8 mm (paracentral artery), and 4.2 and 5.9 mm (superficial and deep branches of supratrochlear artery). The periosteal artery was detected in 71.1% as a branch of either the superior orbitoglabellar or the supratrochlear artery. It ran in the supraperiosteal layer for a short course and penetrated the periosteum above the superciliary ridge or above the medial eyebrow, adhering tightly to the bony surface. This study suggests a safe injection technique for the glabella based on a thorough knowledge of arterial distribution and topography and color Doppler ultrasonographic examination prior to the injection, which is recommended to minimize the risk of severe complications. Clin. Anat. 33:370–382, 2020. © 2019 Wiley Periodicals, Inc.
Forehead augmentation with filler injection is one of the most dangerous procedures associated with iatrogenic intravascular injection resulting in the severe complications. Nonetheless, few studies have determined the explicit arterial localization and topography related to the facial soft tissues and landmarks. Therefore, this study aimed to determine an arterial distribution and topography on the middle forehead region correlated with facial landmarks to grant an appropriate guideline for enhancing the safety of injection. Nineteen Thai embalmed cadavers were discovered with conventional dissection and 14 Thai healthy volunteers were investigated with ultrasonographic examination on the middle forehead. This study found that at the level of mid-frontal depression point, the transverse distance from the medial canthal vertical line to the superficial and deep branches of supraorbital artery were 9.1 mm and 15.1 mm, respectively. Whereas the depths from the skin of these arteries were 4.1 mm and 4.3 mm, respectively. Furthermore, the frontal branch of superficial temporal artery was detectable in 42.1% as an artery entering the forehead area. At the level of lateral canthal vertical line, the vertical distance of frontal branch was 31.6 mm, and the depth from skin of the artery was 2.7 mm. In conclusion, a proper injection technique could be performed based on an intensive arterial distribution and topography, and ultrasonographic examination before the injection is also suggested in order to restrict the opportunity of severe complications.
Background The nasolabial fold is one of the most concerning aging property in the middle face region. This fold initially appears when people are coming age‐wise to their 20s. To correct this fold, the aesthetic nonsurgical procedure, known as filler injection, has been popularly and increasingly performed. However, the arterial complications occurring as a consequence of nasolabial fold filler injection have been continually reported in a recent year. Therefore, the objective of this study was to investigate the arterial location related to nasolabial fold filler injection sites and their anastomotic pathways. Methods Thirty hemi‐faces of 15 Thai embalmed cadavers were performed by dissection method. The nasolabial folds (NLF) were used as the anatomical landmarks: at the inferior margin of NLF (NLF1), at the level of the mid philtral horizontal line of NLF (NLF2), and at the inferior alar level of NLF (NLF3). Additionally, the 5 cadavers were underwent the modified Sihler's staining procedure to investigate the arterial anastomoses. Results The main artery nearby of NLF1 and NLF2 was the facial artery. The facial artery located inferior and medial to NLF1 (Type I, 7 of 25 cases); moreover, the mean distance was 3.53 ± 2.11 mm along the X‐axis and 3.53 ± 1.75 mm along the Y‐axis. The facial artery located medial (Type V, 12 of 22 cases) to NLF2 and the distance was 4.93 ± 1.53 mm along the X‐axis. For the NLF3, there were several accurate arteries including the facial artery (10 of 30 cases), the infraorbital artery (9 of 30 cases) and the lateral nasal artery (10 of 30 cases). The anastomosis of the nasolabial arteries was served both as the connection of external‐external carotid system and the connection of internal‐external carotid system. The communication between the facial artery and the transverse facial artery was found in all specimen. Similarly, the communication between the facial artery and the infraorbital artery was seen in all cases. Finally, the anastomosis between the dorsal nasal artery and the lateral nasal artery was found in 5 of 10 (50%) cases. Conclusion At the lower part of NLF, the facial artery must be concerned. The filler injection should not over approximately 1.5 mm medial to NLF1 and 1 mm inferior to NLF1. For the NLF2, the safe injection point should less than 2.5 mm in the medial direction. In order to prevent injury of the facial artery and the infraorbital artery, the injection tools must not be exceeded 2 mm lateral to NLF3, while the injection less than 2 mm medial to NLF3 is the harmless point for the lateral nasal artery. The possibility of blindness might be caused by the anastomosis between the lateral nasal artery and the dorsal nasal artery. Support or Funding Information The 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship from the Graduate School, Chulalongkorn University Overseas Academic Presentation Scholarship for Graduate Students from the Graduate School, Chulalongkorn University This abstract is from the Experimental Biology 2018 Me...
Forehead augmentation with filler injection is one of the most dangerous procedures associated with iatrogenic intravascular injection resulting in the severe complications. Nonetheless, few studies have determined the explicit arterial localization and topography related to the facial soft tissues and landmarks. Therefore, this study aimed to determine an arterial distribution and topography on the middle forehead region correlated with facial landmarks to grant an appropriate guideline for enhancing the safety injection. The research procedures of this study were approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (IRB No. 786/61, COA No. 149/2019) and conducted in accordance with the Declaration of Helsinki of the World Medical Association (WMA). Cadaveric dissection and ultrasonographic investigation in healthy volunteers were employed to study the forehead region. The cadavers were legally donated for medical education and research, and the participants have signed the informed consent prior to the ultrasound operation. Nineteen Thai embalmed cadavers were discovered with conventional dissection and 14 Thai healthy volunteers were investigated with ultrasonographic examination on the middle forehead. At the level of mid‐frontal depression point, the transverse distance from the medial canthal vertical line to the supraorbital artery were 9.1 mm (superficial branch) and 15.1 mm (deep branch). The depths from skin of the artery were 4.1 mm (superficial branch), and 4.3 mm (deep branch). Furthermore, the frontal branch of superficial temporal artery was detectable in 42.1% as an artery entering the forehead area. At the level of lateral canthal vertical line, the vertical distance of frontal branch was 31.6 mm, and the depth from skin of the artery was 2.7 mm. In conclusion, a proper injection technique could be performed based on an intensive arterial distribution and topography, and ultrasonographic examination prior to the injection is also suggested in order to restrict the opportunity of severe complications. Support or Funding Information This presentation was supported by Overseas academic presentation scholarship from Faculty of Medicine Vajira Hospital, Navamindradhiraj University.
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