A STUDY ON COURSE AND VARIATIONS OF FACIAL ARTERY ON THE FACE

Address for Correspondence: Dr. Divya Shanthi D’Sa, Assistant Professor, Department of Anatomy, Subbaiah Institute of Medical Sciences, Shimoga -577201, Karnataka, India. Mobile no: 9448579590 E-Mail: drdivyadsa17@gmail.com Introduction: Face is mainly supplied by the Facial artery supplemented by transverse facial artery. Variations in the course and branching pattern of facial artery are commonly seen. The understanding of these variations of facial artery plays a very important role in facio-maxillary surgeries. It is also of immense importance to radiologists in interpreting facial artery angiography. Materials and Methods: The present study was conducted in the Department of Anatomy, Subbaiah Institute of Medical Sciences on 50 formalin fixed adult hemi-faces irrespective of sex. The branching pattern, terminations and variations of facial artery on the face were studied. The facial artery predominantly terminated as angular artery in 28 (56%) hemi-faces, as superior labial artery in 15 (30%) hemi-faces and as lateral nasal artery in 6 (12%) hemi-faces. Results: An inconstant posterior (pre-masseteric) branch of facial artery was observed in 3 (6%) hemi-faces. In one of the hemi-face we found a deviation in the usual course of facial artery, where the artery deviated towards the infra-orbital foramen then continued and terminated as the lateral nasal artery. An unusual termination of facial artery was observed in one of the hemi-faces where the artery terminated by giving 4 branches in the lower buccal region. Conclusion: Knowledge of these variations and anomalous branching pattern is of great academic and clinical significance in general practice, Otorhinology, Traumatology, Plastic and Maxillofacial surgeries and Radiology.


INTRODUCTION
facial artery is divided into two parts, the cervical and the facial.The facial artery is tortuous throughout its extent.The cervical part is tortuous to adapt to the movements of pharynx during deglutition.The facial part is tortuous to adapt to the movements of mandible, lips and cheek.The artery passes through the oblique fibrous cleft of modiolus, an arrangement that may limit the extent to which it is compressed by the contraction of buccolabial musculature [1].The facial artery gives named and unnamed branches on the face.The named branches are inferior labial, superior labial and lateral nasal.It terminates as angular artery at medial angle of the eye by anastomosing with the dorsal nasal branch of ophthalmic artery.Premasseteric artery is a small inconstant artery [1].When present, it passes upwards along the anterior border of masseter and supplies the surrounding tissues.
The inferior labial artery arises just below the angle of the mouth, passes upwards and forwards sinuously near the margin of the lower lip, between the muscle and the mucous membrane.Superior labial artery is larger and more tortuous than the inferior labial artery, and has a course along the superior labial margin.Lateral nasal artery is given off by the side of the nose.It may be replaced by a branch from the superior labial artery [1][2][3][4][5].Usually these branches of facial artery anastomose with the corresponding arteries of the opposite side across the midline.However facial artery is known to show variations in its origin, course and branching pattern and is of significance in Otorhinology, facial trauma, Plastic and Maxillofacial surgeries and Radiology.

MATERIALS AND METHODS
The study was conducted in the Department of Anatomy, Subbaiah Institute of Medical Sciences, Shimoga, on 50 formalin fixed adult hemi-faces.Dissection of the specimens was done following the Cunningham's manual of practical anatomy, volume 3. Course, branching pattern and termination of facial artery on the face was noted and photographed.

RESULTS
The variations of the facial artery in the face were grouped mainly according to three studies, Koh et.al, 2003, Loukas et.al, 2006and Bayram et.al, 2010.The results were also compared with other studies.
In the present study, we observed that the facial artery predominantly terminated as angular artery in 28 (56%) hemi-faces, as superior labial artery in 15 (30%) hemi-faces and as lateral nasal artery in 6 (12%) hemi-faces.
The facial artery had an abortive course in one of the hemi-face (2%).Among these specimens, we found an inconstant posterior (pre-masseteric) branch of facial artery in 3 (6%) hemi-faces.
In one of the hemi-face we found a deviation in the usual course of facial artery, where the artery after giving superior labial branch deviated towards the infra-orbital foramen where it gave an anastomosing branch to infra-orbital artery and then terminated as the lateral nasal artery.Near the infra-orbital foramen it was surrounded by infra-orbital plexus of nerves.An unusual termination of facial artery was observed in one of the hemi-faces where the artery terminated by giving 4 branches in the lower buccal region.

International
Journal of Anatomy and Research, Int J Anat Res 2018, Vol 6(1.2):4928-32.ISSN 2321-4287 DOI: https://dx.doi.org/10.16965/ijar.2017.510Article Information forwards in the submandibular region, the artery enters the face by winding round the lower border of the mandible at the antero-inferior angle of the masseter, by piercing the investing layer of deep cervical fascia.The course of the Facial artery is the principal artery of the face.It arises from the external carotid artery in the carotid triangle of the neck just above the tip of greater cornu of hyoid bone.It runs upwards and

Fig. 2 :
Fig. 2: Termination of facial artery as Superior Labial Artery.Pre-masseteric branch of facial artery is also seen.

Fig. 3 :
Fig. 3: Facial artery giving an anastomosing branch to infra orbital artery and then terminating as lateral nasal artery.

Table 1 :
Comparative data of terminal branching pattern from previous studies of the facial artery