Type of Article : Case Report
Year: 2015 | Volume 3 | Issue 3 | Page No. 1404-1408
Date of Publication: 30-09-2015
A CASE OF ABRUPT TERMINATION OF THE FACIAL ARTERY WITH UNUSUAL MULTIPLE ARTERIAL ANASTOMOSES: CLINICAL IMPLICATIONS IN THE HEAD AND NECK
Priti L. Mishall *1, Oren Feder 1, Alana Lewis 1, Alex Rosenberg 1, Ul Weena 1, Ruth A. Howe 3, Todd R. Olson 1, Sherry A. Downie 1,3.
*1 Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
2 Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
3 Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Address: Dr. Priti L. Mishall, MD, MBBS, Assistant Professor, Department of Anatomy and Structural Biology, 1300 Morris Park Ave, Forchheimer 620SA, Albert Einstein College of Medicine, Bronx, NY United States 10465. Telephone number: 718-430-3483.
Having up-to-date knowledge of the variability in facial artery topography is an essential starting point in performing certain surgical and radiological procedures on the head and neck (e.g. oromucosal reconstruction flaps, transarterial embolization). We report a unique case with: (1) the left facial artery truncating as an atypical inferior labial artery, (2) the left anterolateral face being perfused by unusual arterial collaterals derived from the right superior labial, left infraorbital and left dorsal nasal arteries, (3) the transverse facial artery not being one of the perfusing collaterals, and (4) the right submental artery piercing the mylohyoid muscle and entering the oral cavity. The embryologic basis of this atypical vascular pattern is discussed. Discovery of a highly atypical facial artery highlights the importance of performing a thorough pre-operative vascular evaluation to prevent iatrogenic injuries and complications before any surgical or therapeutic procedure.
KEY WORDS: Facial artery variation - Infraorbital artery - Labial arteries - Dorsal nasal artery.
- Soikkonen K, Wolf J, Hietanen J, Mattila K. Three main arteries of the face and their tortuosity. British Journal of Oral and Maxillofacial Surgery. 1991;29:395-398.
- Koh KS, Kim HJ, Oh CS, Chung IH. Branching patterns and symmetry of the course of the facial artery in Koreans. International Journal of Oral and Maxillofacial Surgery. 2003;32:414-418.
- Lohn JW, Penn JW, Norton J, Butler PE. The course and variation of the facial artery and vein: implications for facial transplantation and facial surgery. Annals of plastic surgery. 2011;67(2):184-188.
- Loukas M, Hullett J, Louis Jr RG, Kapos T, Knight J, Nagy R, et al. A detailed observation of variations of the facial artery, with emphasis on the superior labial artery. Surg Radiol Anat. 2006;28:316-324.
- Niranjan NS. An anatomical study of the facial artery. Annals of plastic surgery. 1988;21(1):14-22.
- Hollinshead WH. The Face. Anatomy for Surgeons: The Head and Neck. 1. New York: Paul B. Hoeber, INC, Medical book department of Harper and Brothers; 1954. p. 306-324.
- Ezure H, Mori R, Ito J, Otsuka N. Case of a completely absent facial artery. International Journal of anatomic variations. 2011;4:72-74.
- Tubbs RS, Salter EG, Oakes WJ. Unilateral agenesis of the facial artery with compensation by a giant transverse facial artery. Folia Morphol. 2005;64(3):226–228.
- Whetzel TP, Mathes SJ. Arterial anatomy of the face: An analysis of vascular territories and perforating cutaneous vessels. Plast Reconstr Surg. 1992;89:591–603.
- Lasjaunias P, Berenstein A, Doyon D. Normal functional anatomy of the facial artery. Radiology. 1979;133((3 Pt 1)):631-638.
- Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, et al. Face and Scalp. In: Standring S, editor. Gray's Anatomy. 40th ed. China: Elsevier; 2008. p. 467-497.
- Midy D, Mauruc B, Vergnes P, Caliot P. A contribution to the study of the facial artery, its branches and anastomoses; application to the anatomic vascular bases of facial flaps. Surg Radiol Anat. 1986;8:99-107.
- Magden O, Edizer M, Atabey A, Tayfur V, Ergür I. Cadaveric Study of the Arterial Anatomy of the Upper Lip. Plastic and Reconstructive Surgery. 2004;114(2):355-359.
- Tansatit T, Apinuntrum P, Phetudom T. A Typical Pattern of the Labial Arteries with Implication for Lip Augmentation with Injectable Fillers. Aesth Plast Surg. 2014;38(6):1083-1089.
- Bavitz JB, Harn SD, Homze EJ. Arterial supply to the floor of the mouth and lingual gingiva. Oral Surgery Oral Medicine Oral Pathology. 1994;77(3):232-235.
- Fujita S, Ide Y Fau - Abe S, Abe S. Variations of vascular distribution in the mandibular anterior lingual region: a high risk of vascular injury during implant surgery. Implant Dentistry. 2012;21(4):259-264.
- le Noble F, Fleury V, Pries A, Corvol P, Eichmann A, Reneman RS. Control of arterial branching morphogenesis in embryogenesis: go with the flow. Cardiovascular research. 2005;65:619-628.
- Boutros S. Reconstruction of the lips. In: Thorne CH, Bartlett SP, Beasley RW, Aston SJ, Gurtner GC, Spear SL, editors. Grabb & Smith's Plastic Surgery. 6th ed. Philladelphia: Lippincott Williams & Wilkins, a Wolters Kluwer business; 2007. p. 367-374.
- Chen Y-F, Lo Y-C, Lin W-C, Lin C-H, Chiang H-J, Chen J-F, et al. Transarterial embolization for control of bleeding in patients with head and neck cancer. Otolaryngology - Head and Neck Surgery. 2010;142(1):90-94.
- Shimizu T, Sakakura Y, Hattori T, Yamaguchi N, Kubo M, Sakakura K. Superselective intraarterial chemotherapy in combination with irradiation: Preliminary report. American Journal of Otolaryngology. 1990;11:131-136.
Priti L. Mishall, Oren Feder, Alana Lewis, Alex Rosenberg, Ul Weena, Ruth A. Howe, Todd R. Olson, Sherry A. Downie. A CASE OF ABRUPT TERMINATION OF THE FACIAL ARTERY WITH UNUSUAL MULTIPLE ARTERIAL ANASTOMOSES: CLINICAL IMPLICATIONS IN THE HEAD AND NECK. Int J Anat Res 2015;3(3):1404-1408. DOI: 10.16965/ijar.2015.247