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Concept: Facial artery


The superior labial artery, which is a branch of the facial artery, supplies the upper lip area. The aim of this study was to determine the distribution pattern of the superior labial artery and provide precise topographic information of the artery for dermal filler injection.

Concepts: Arteries of the head and neck, Upper lip, Lip, Topographic map, Facial artery, Superior labial artery, Superior labial vein


With the current tendency of increasing minimally invasive cosmetic surgeries, some rare but disastrous complications of facial filler injections come into sight, such as visual loss. The study aims to investigate the possible route that the injected droplet accesses the ophthalmic artery to explain and prevent such devastating complications. We searched the National Library of Medicine’s PubMed database for cases of visual loss secondary to cosmetic facial filler injection, and reviewed relevant case reports/surveys, as well as accompanying references. Data obtained were analyzed, with special interest in injected sites and filler material, and clinical features of visual loss. Based on the anatomy of facial vessels, we inferred the possible route of injected droplet migrating from injection sites to ophthalmic artery. Most physicians propose a retrograde embolic mechanism, but the culprit artery when injecting different sites is not determined. We consider accidentally breaking into supraorbital artery or supratrochlear artery may cause occlusion of ophthalmic artery when injecting into glabella or forehead region. Speaking of the nasolabial fold and nasal dorsum region, any injections in the anastomosis of the dorsal nasal artery, angular artery, and lateral nasal artery can lead to retrograde embolism. Similarly, in the temporal region, we believe there is abnormal anastomosis between frontal branch of superficial temporal artery from external carotid artery and supraorbital artery from ophthalmic artery. In our hypothesis, we can explain the accompanying brain infarction after iatrogenic visual loss. If the injecting pressure is forceful enough, it may push the embolic materials into middle cerebral artery. Although iatrogenic ophthalmic artery occlusion is a rare complication after the facial filler injection surgery, it is usually devastating. Both the patient and the surgeon should be aware of the risk of irreversible blindness. Ideally, the injection sites should avoid the small vessels nearby, the injecting force and velocity should be as gentle and slow as possible.

Concepts: Internal carotid artery, External carotid artery, Arteries of the head and neck, Parotid gland, Scalp, Ophthalmic artery, Superficial temporal artery, Facial artery


The submental island flap (SIF) is a pedicled flap based upon the submental artery and vein. Its utility in reconstruction following ablative head and neck procedures has been applied to various subsites including skin, lip, buccal mucosa, retromolar trigone, parotidectomy defects, and tongue. We review our experience using the SIF for reconstruction following tumor ablation.

Concepts: Head and neck anatomy, Head and neck, Mucous membrane, Mouth, Facial artery, Submental artery


The previous cadaveric studies of facial artery perforators have frequently reported high variability, and those results remain to be validated in the Colombian population. Thus, we aimed to describe the vascular anatomy of the lateral nasal artery cutaneous branches and their clinical applications using Colombian cadavers.

Concepts: Biology, Evaluation methods, Organ, Anatomy, Arteries of the head and neck, Dissection, Facial artery, Lateral nasal branch of facial artery


The purpose of this study was to illustrate the submental island flap elevation technique with simultaneous level I neck dissection followed by the inset and reconstruction of an oropharyngeal defect.

Concepts: Head and neck, Facial artery, Submental artery


An essential stage in head and neck microsurgical reconstruction is the choice of recipient vessels. To make relevant choices, surgeons must rely on accurate imaging techniques. The objective of the study was to examine the feasibility of Phase-Contrast sequences to conduct the pre-operative tests without injection and provide precise radio-anatomical data over the entire vessel region. The challenges were the large velocity range, the lack of contrast, and the large spatial resolution needed to image vessels below 5 mm in diameter. Thirty-one healthy volunteers were included in an MRI prospective study. The anatomical and morphometrical characteristics of the collaterals of the external carotid artery were determined associating 3D PCA and 2D Cine MRI-PC sequences (average protocole duration time of 49 min ± 4 min). The average diameter was measured to be 2.1 ± 1.4 mm for the superior thyroid artery, 2.2 ± 1.1 mm for the lingual artery, 2.7 ± 1.6 mm for the facial artery, 2.6 ± 1.4 mm for the internal maxillary artery, and 2 ± 1.4 mm for the superficial temporal artery. With a vessel identification success rate of 98%, the study showed for the first time that Phase Contrast MRI allowed non-invasive and non-operator dependent anatomical analyses of small caliber vessels without the use of agent contrast. It also proved that the designed sequences could be used on patients and provided valuable pre-operative information for head and neck surgery.

Concepts: Common carotid artery, External carotid artery, Arteries of the head and neck, Parotid gland, Maxillary artery, Superior thyroid artery, Superficial temporal artery, Facial artery


Vascular complications after hyaluronic acid (HA) filling of the chin have rarely been reported. In this report, two cases of vascular occlusion after HA augmentation of the mentum are presented. The first case involved local skin necrosis that resulted from a massive microcirculatory embolism and/or external compression of the chin skin microvasculature. The second case involved vascular compromise in the tongue that resulted from HA injection in the chin. The diagnosis was established on the basis of interventional angiography findings. Concerning the pathogenesis, we hypothesized that the filler embolus flowed into the branches of the deep lingual artery through the rich vascular anastomoses among the submental, sublingual, and deep lingual arteries, after being accidentally injected into the submental artery (or its branches). Level of Evidence V 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 .

Concepts: Blood vessel, Evidence-based medicine, Systematic review, Arteries of the head and neck, Tongue, Facial artery, Lingual artery, Deep lingual artery


The purpose of this study is to describe maxillary reconstruction using the submental artery island flap and the sagittal mandibular ramus and coronoid process graft pedicled with the temporalis muscle through the modified lateral lip and submandibular approach.

Concepts: Arteries of the head and neck, Bones of the head and neck, Facial artery


Lingual mandibular foramina are peculiar anatomical variations often present on the bone surface of the inferior jaw. These structures host vascular and nervous anastomosis deriving from the branches of the submental artery, lingual artery, and the mylohyoid nerve. Reports pointed out intra-operative massive bleeding accidents during implant interventions occurred in this area. The aim of this systematic review and meta-analysis was to summarize quantitatively the features of the lingual foramina on the midline of the inferior jaw. We performed a systematic review and meta-analysis complying the PRISMA statement and registering it in PROSPERO database. The frequency rate of the foramina resulted to have a point estimate of 0.965. The means of the diameters showed to have a point estimate of 0.840 with a standard error of 0.06. The results showed a significant high frequency reported in the literature of this variation, with a quite important diameter, sign of significant caliber of the related vessels. Even if this variation is underreported in modern textbooks of oral anatomy, we suggest an accurate screening via CT scan pre-operatively. In addition, a proper risk management is necessary to minimize injure hazard and properly managing the vascular plexus of the anterior floor of oral cavity.

Concepts: Bone, Anatomy, Arteries of the head and neck, Foramina of the skull, Tongue, Inferior alveolar nerve, Facial artery, Mylohyoid nerve


Intramuscular hemangioma (IMH) is a rare vascular disease involving skeletal muscle, comprising only 0.8% of hemangiomas. About 10% to 15% of IMHs occur in the head and neck region, mostly involving the masseter muscle. IMH occurs mostly in childhood, but is often not found until unexpected enlargement, pain, or cosmetic asymmetry occurs in adulthood. Several non-surgical treatments including cryotherapy, sclerosant injection, and arterial ligature have been described, but complete surgical resection is the curative intervention. In this report, we present two rare cases of IMH. One IMH case in a 48-year-old male occurred in the masseter muscle feeding from the transverse facial artery. Embolization of the distal branch of the facial artery was first conducted, and then the buccal mass was removed surgically via the intraoral approach. A second IMH case in a 58-year-old female occurred in the orbicularis oris muscle feeding from the superior labial artery, and the mass was excised surgically without embolization.

Concepts: Surgery, Arteries of the head and neck, Muscles of the head and neck, Orbicularis oris muscle, Facial artery, Masseteric artery, Transverse facial artery, Superior labial artery