Zygomatico-Orbital Artery as a Recipient Vessel for Microsurgical Head and Neck Reconstruction

Abstract

The selection of recipient vessels in head and neck reconstruction is one of the key factors influencing its difficulty and outcome. We report a case of a microsurgical scalp reconstruction using the zygomatico-orbital artery as a recipient vessel.A 71-year-old woman had intractable skin ulcers on her head after neurosurgeries. Computed tomography angiography findings showed that the superficial temporal artery was obstructed and that the zygomatico-orbital artery ran forward and upward. She underwent scalp reconstruction using a free anterior lateral thigh flap. The zygomatico-orbital artery was dissected distally, cut, and turned over cranially. The diameter of the zygomatico-orbital artery was 1.2 mm. The blood flow through the zygomatico-orbital artery was sufficient. The thinned scalp area was excised, and some of the titanium devices and infectious tissues were removed. An anterior lateral thigh flap measuring 20 × 9 cm was harvested and transferred to the defect in the head. The discrepancy in calibers was within double, and the zygomatico-orbital artery fit the descending branch of the lateral circumflex femoral artery. The flap was transferred successfully.The zygomatico-orbital artery is one of the branches from the external carotid artery and supports the suprazygomatic territory. The zygomatico-orbital artery is present in 78% to 92% of people and originates from the superficial temporal artery and sometimes from the frontal branch of superficial temporal artery. The mean diameter of the zygomatico-orbital artery at origin is reported to be 1.20 mm. The zygomatico-orbital artery is another option as a recipient vessel in head and neck reconstruction.

“Zygomatico-Orbital Artery: A Re-Evaluation of the Temporal Blood Vessels.”

“…The ZOA can be used in flap design or as a candidate supply vessel. 12 Previously, ZOA-based flap surgery was difficult because of a lack of understanding of the ZOA's anatomical process. 3 Our research provides an anatomical reference for such operations, and three-dimensionally reconstructed images show that the ZOA originating from the main trunk of the STA provides a rich blood supply to the temporal area.…”

Topographic Anatomy of the Zygomatico-Orbital Artery

“…A few surgical cases used the ZOA instead of the STA 5 . There have also been 2 clinical cases: (1) a forehead ZOA-based island flap used to reconstruct the lower third of the face and (2) the ZOA used as the recipient artery for a flap 5,12 . In the circumstance of a ruptured STA, the ZOA was used for treating a scalp defect, and it was successful result of the forehead for flap construction 12 .…”

“…5 There have also been 2 clinical cases: (1) a forehead ZOA-based island flap used to reconstruct the lower third of the face and (2) the ZOA used as the recipient artery for a flap. 5,12 In the circumstance of a ruptured STA, the ZOA was used for treating a scalp defect, and it was successful result of the forehead for flap construction. 12 These cases have demonstrated that the ability to utilize a parieto-occipital flap could depend on the anatomic features of this area, including of the ZOA.…”

“…5,12 In the circumstance of a ruptured STA, the ZOA was used for treating a scalp defect, and it was successful result of the forehead for flap construction. 12 These cases have demonstrated that the ability to utilize a parieto-occipital flap could depend on the anatomic features of this area, including of the ZOA. It was suggested that if the STA has a small caliber, low flow velocity, or runs toward the upper frontal area, a ZOA-based flap should be considered.…”

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

“…I read with interest the article by Liu et al entitled “Topographic Anatomy of the Zygomatico-Orbital Artery: Implications for Improving the Safety of Temporal Augmentation.” 1 It provides information on the anatomy of the zygomatico-orbital artery, which can be an option as a recipient vessel in head and neck reconstruction, as Higashino et al pointed out. 2…”