Reply: A new perspective regarding the topographical anatomy of the facial and transverse facial arteries

Abstract

To the Editor, Clinical Anatomy:We would like to thank the authors of the letter tothe editor (Crainiceanu and Matusz, 2011) for theirinterest in our report (Eid et al., 2011) as well as forthe valuable comments.Based on the data included in the website of ana-tomical variations (Bergman et al., 2011) and otherstudies (Soikkonen et al., 1991), Crainiceanu andMatusz (2011) suggest that the reported high sub-mental artery (SA) arising from the external carotidartery (ECA), as seen in our study (Eid et al., 2011),should be considered a hypoplastic facial artery (FA).However, based on recent reports describing theanatomical criteria of a hypoplastic FA and abnormalSA, we believe that this anomalous SA should not bedescribed as a hypoplastic FA. Although the websiteof anatomical variations (Bergman et al., 2011) is asubstantial work, it by no means describes allanatomic variations.Regarding FA types, Crainiceanu and Matusz(2011) mention that Soikkonen et al. (1991) foundthat Type D (9%), the hypoplastic FA, was repre-sented by the submental branch. Unfortunately,there appears to be a misunderstanding of what wasreported in the Soikkonen et al. (1991) study, wherea hypoplastic FA (Type D) crossed the lower mandib-ular border and stopped just below the lower lip. Inaddition, Soikkonen et al. (1991) did not mentionthat the hypoplastic FA was represented by the sub-mental branch. They also found that the hypoplasticFA was replaced by a strongly developed transversefacial artery (TFA) complemented by the infraorbitalartery.Five patterns (A–E) of FA have been reported byLoukas et al. (2006). In Type E (1.4%), the FA ter-minated as a rudimentary twig under the lower lipwithout providing any significant branches. The FAhas been considered hypoplastic (2%), when it endsat the lower lip with no branches to the nose (Pinaret al., 2005). Taken together, it is too hard to acceptthat the large SA shown in our study (Eid et al.,2011), should be considered a hypoplastic FA. Fur-thermore, the course, distribution and location of theanomalous SA is completely different from what hasbeen reported regarding a hypoplastic FA (Soikkonenet al., 1991; Pinar et al., 2005; Loukas et al., 2006).The SA is the largest cervical branch of the FA(Standring, 2008). The SA has been reported toarise from the ECA sharing a common trunk with theFA (Jiang et al., 2008). Moreover, in a leading study,Martin et al. (1993) described a new island flapbased on the SA for reconstruction of orofacialdefects. They found that the SA was usually a con-stant branch, arising 5–6.5 cm from the origin of theFA, running in a groove on the medial aspect of thesubmandibular gland (SMG) bounded medially bythe mylohyoid muscle and above by the mandibularborder, before its termination behind the symphysisof the mandible. This normal pattern of SA was alsoobserved in other studies (Parmar et al., 2009).However, Martin et al. (1993) found that in onecase, the SA arose abnormally from the ECA (one of56 dissections) close to the origin of the FA. Thisabnormal pattern of SA has been observed in ourstudy (Eid et al., 2011), where the SA originatedfrom the ECA distal to trifurcation of the latter intoTFA, maxillary, and superficial temporal arteries. Asshown in Figure 1, the high origin large SA crossedthe superior border of the SMG from behind themandibular angle coursing below the mandibularborder toward the symphysis menti, where it termi-nated after giving glandular and muscular branchesin the digastric triangle. However, in our study (Eidet al., 2011), we performed a deep dissection of thecervicofacial region, while turning up the SMG toshow its medial surface; therefore, the SA wasslightly displaced above the mandibular border.According to its course, the branches of the FA arearranged under two headings; cervical component