Three-Dimensional Computed Tomographic Study on the Vessels of the Zygomatic Region: Arterial Variations and Clinical Relevance

Abstract

Background: Injection-based techniques for “cheek augmentation” have gained popularity in recent years. The aim of this study was to perform a topographic analysis of the depth and distribution of the vessels in the zygomatic region to facilitate clinical procedures. Methods: The external carotid arteries of seven cadaveric heads were infused with lead oxide contrast medium. The facial and superficial temporal arteries of another 12 cadaveric heads were injected sequentially with the same medium. Computed tomographic scanning was then performed, and three-dimensional computed tomographic scans were reconstructed using validated algorithms. Results: The vessels on the zygomatic arch received a double blood supply from across the upper and lower borders of the arch, and the number of the vessels varied from one to four. Ninety percent of the vessels on the zygomatic arch were at a depth of 1 to 2.5 mm, and 75 percent were at a depth of 10 to 30 percent of the soft-tissue thickness. The vessels were concentrated on the midline of the zygomatic arch and the lateral margin of the frontal process. All samples showed a vessel travel along the lateral margin of the frontal process that eventually merged into the superior marginal arcades. Conclusions: This study reported a topographic analysis of the depth and distribution of the vessels in the zygomatic region based on three-dimensional scanning. The results indicated that injection on the zygomatic arch should be performed deep to the bone, and the vascular zones anterior or posterior to the midline of the zygomatic arch were relatively safe injection areas.

Anatomical Basis for Malar Augmentation Injection With the Zygomatic Ligamentous System

“…Therefore, it is advisable to perform the injection in the deep layer directly on the bone and avoid vascularly dense areas. 12…”

“…According to our previous study regarding the vessels on the zygomatic arch, 12 most of the vascular branches are located in the superficial layer and concentrated on the region of the jugale and the midline of the length of the arch (Figure 3). Therefore, it is advisable to perform the injection in the deep layer directly on the bone and avoid vascularly dense areas.…”

“…Therefore, it is advisable to perform the injection in the deep layer directly on the bone and avoid vascularly dense areas. 12 Position of Site 1 Site 1 could be placed along the zygomatic arch within the range of the ZRL based on individual needs. The posterior portion of the zygomatic arch is a relatively safe area for injection, whereas attention must be paid to the anterior third because of the presence of the ZMj's origin and concentrated vascular branches.…”

“…From August 2016 to December 2020, a total of 66 cadaver heads (46 men and 20 women, aged between 18 and 65 years, average age 40.19 years) were analyzed with CT scanning and three-dimensional reconstruction of the vessels. In line with previous studies in our laboratory, [9][10][11][12] a head CT scan was acquired for each specimen after every arterial contrast injection using the same 64-row spiral CT scanner (Philips Brilliance 64 Scanner; Philips Healthcare, Cleveland, OH) under the same conditions. The twodimensional CT images of each specimen were volumerendered into three-dimensional CT images using a Philips IntelliSpace workstation with default settings.…”

Reply: Three-Dimensional Computed Tomographic Study on the Vessels of the Zygomatic Region: Arterial Variations and Clinical Relevance

“…We really appreciate that Dr. Liu showed interest in our article 1 and shared a focus on vascular perfusion and computed tomography scanning methods.…”