Abstract:Filler injections have become exceedingly popular in the last decade, and injectors across the globe are using them for facial contouring and reversing the age-related changes. Thorough knowledge about the anatomy of important vessels and tissue planes is essential for injectors. During filler injections, injectors generally tend to pinch or pull the tissues with the nondominant hand for the ease of the procedure.
“…Because of the development of various procedures in the temporal region, such as soft-tissue filler injections and flap transplantation, the ZOA has become a clinically significant blood vessel in the middle temporal region. [1][2][3][4] In addition, some neurosurgeons have injected melphalan into the ZOA to treat retinoblastoma. 5 An understanding of the anatomical features of the ZOA is necessary for the design and implementation of surgical procedures.…”
Background:
The current anatomical description of the zygomatico-orbital artery (ZOA) is mainly based on cadaver head studies and does not accurately reflect the complete anatomical information of the ZOA. The purpose of this study was to reveal the anatomical characteristics of the ZOA and to provide an anatomical basis for relevant operations in the temporal area.
Methods:
Computed tomographic scans and autopsies were performed on 78 cadaver heads perfused with lead oxide. Mimics software was used to construct a three-dimensional image based on the bilateral intertragic notches and the right inferior orbital margin for a detailed analysis of the ZOA.
Results:
The occurrence rate of ZOA in the 101 qualified hemisectioned cadaver heads was 86.14% (87 of 101). According to our observations, 46 of 87 (52.87%) originated from the superficial temporal artery above the zygomatic arch, 23 of 87 (26.44%) from the superficial temporal artery under the zygomatic arch, and 18 of 87 (20.69%) from the frontal branch of the superficial temporal artery. The ZOA communicates with the deep and superficial arches of the supraorbital artery, transverse facial artery, and ophthalmic artery.
Conclusions:
This study describes the anatomical characteristics of the ZOA. Moreover, these findings may guide skin flap transplantation and prevent associated injection complications.
“…Because of the development of various procedures in the temporal region, such as soft-tissue filler injections and flap transplantation, the ZOA has become a clinically significant blood vessel in the middle temporal region. [1][2][3][4] In addition, some neurosurgeons have injected melphalan into the ZOA to treat retinoblastoma. 5 An understanding of the anatomical features of the ZOA is necessary for the design and implementation of surgical procedures.…”
Background:
The current anatomical description of the zygomatico-orbital artery (ZOA) is mainly based on cadaver head studies and does not accurately reflect the complete anatomical information of the ZOA. The purpose of this study was to reveal the anatomical characteristics of the ZOA and to provide an anatomical basis for relevant operations in the temporal area.
Methods:
Computed tomographic scans and autopsies were performed on 78 cadaver heads perfused with lead oxide. Mimics software was used to construct a three-dimensional image based on the bilateral intertragic notches and the right inferior orbital margin for a detailed analysis of the ZOA.
Results:
The occurrence rate of ZOA in the 101 qualified hemisectioned cadaver heads was 86.14% (87 of 101). According to our observations, 46 of 87 (52.87%) originated from the superficial temporal artery above the zygomatic arch, 23 of 87 (26.44%) from the superficial temporal artery under the zygomatic arch, and 18 of 87 (20.69%) from the frontal branch of the superficial temporal artery. The ZOA communicates with the deep and superficial arches of the supraorbital artery, transverse facial artery, and ophthalmic artery.
Conclusions:
This study describes the anatomical characteristics of the ZOA. Moreover, these findings may guide skin flap transplantation and prevent associated injection complications.
“…Pinching with the non-dominant hand may serve as injection guide for avoiding inadvertent intravascular placement during temporal fossa injections through altering the tissue layer ( Table 10 ). 67 Figure 14 Diagram illustrating the most frequently affected choke anastomotic HA embolic sites. …”
Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.
“…51,137,138 The temporal fossa has a complex anatomy due to multiple vessels running within different tissue layers. 139 In severe cases, accidental injection into veins can cause vascular compression or venous occlusion and arterial injections, embolization, skin necrosis, visual changes (e.g., blurry vision, blindness), stroke, or even death . 51,140 The pathway by which intravascular injection can lead to these SAEs is via filler embolism blocking end-arteries.…”
Τα ενέσιμα υαλουρονικού οξέος εφαρμόζονται για τη διόρθωση παραμορφώσεων του κροταφικού βόθρου που σχετίζονται με την ηλικία, παρέχοντας αύξηση μαλακών ιστών καθώς και υποστήριξη αυτών (ιστών). Αν και γενικά θεωρούνται ασφαλή, σημαντικές ανεπιθύμητες ενέργειες (ΑΕ) έχουν συσχετιστεί με χρήση αυτών. Η ενδελεχής γνώση της ανατομίας της περιοχής, καθώς και η αξιολόγηση των κινδύνων και τα οφέλη που σχετίζονται με τις διαφορετικές τεχνικές έγχυσης, είναι θεμελιώδεις για τη διασφάλιση βέλτιστων αποτελεσμάτων και την αποφυγή των ΑΕ. Ειδικότερα, η αγγείωση της κροταφικής περιοχής απαιτεί ιδιαίτερη προσοχή καθώς μπορεί να σχετίζεται με σοβαρές ΑΕ, όπως η αρτηριακή απόφραξη, ισχαιμία και εμβολή. Στα πλαίσια αυτά, διερευνήσαμε την ανατομία του κροταφικού βόθρου και τον τρόπο με τον οποίο σχετίζεται με τις αγγειακές AE ύστερα από ενέσιμα υαλουρονικού οξέος. Επιπλέον, εξαιτίας της έλλειψης δεδομένων στον τομέα της αισθητικής καθώς και των επιπτώσεων στις βαθιές κροταφικές αρτηρίες (deep temporal arteries), διερευνήσαμε και αξιολογήσαμε την ανατομία της περιοχής και την επίδραση αυτών των ενέσιμων θεραπειών επί των αγγείων.
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