Understanding a Facial Bypass Found in a Medical Donor

Abstract

We describe a surgical reconstruction after what appears to be an orbital fracture in a donor being dissected in a first‐year anatomy course. The donor was 72 years old and died from respiratory failure and cardiac arrest. Dissection of the face revealed a bypass that originated at the inferior aspect of the right orbit and traversed along the face to enter existing vasculature. Orbital fractures are a common result of trauma and involve complex vascularity. Blood supply to the orbit is from the ophthalmic artery with minor contribution from the external carotid artery. Orbital fracture repairs often use nylon orbital implants as their thickness allows for flexibility needed for reconstruction.3 This report aims to explore variations in reconstruction to better understand that of our medical donor.A literature review was conducted to explore reconstruction procedures and search terms included “orbit reconstruction blood supply” and “orbit necrosis and bypass”. First‐year students were following Grant’s Dissector to complete their facial dissection when the bypass was first found.2 Upon further dissection, fractures of the orbit along with bony necrosis were seen. Multiple anatomists and a surgeon were consulted; none had seen this reconstruction before. Further, neck vasculature was not fully observable at this point since a full dissection has not been done at this time.After conducting the literature review, no research explained the reconstruction that was seen. Current research demonstrates use of a radial artery graft for bypass of the proximal superficial temporal artery to the proximal middle cerebral artery.5 This graft highlights a bypass of facial vasculature, but also emphasizes the rarity of what was found on our donor.With limited research detailing specifics of this reconstruction, further focus on ophthalmological procedures should be done and consultation of an ophthalmologist may provide valuable input. Although it was not found in the literature review, a proposed theory includes the bypass being conducted because of orbital necrosis following the placement of implant.This surgical reconstruction variation emphasizes the educational importance of medical students to use examples such as this medical donor to further understand the complexities of why certain procedures are done. As donor’s are typically known as a medical student’s first patient, anomalies such as these remind us at how much variability exists from one patient to another. Often, medicine does not always have an answer for us and requires students, physicians, and anatomists to delve deeper to formulate a better understanding. Büyükmumcu, M., Güney, O., Ustün, M. E., Uysal, I. I., & Seker, M. (2004). Proximal superficial temporal artery to proximal middle cerebral artery bypass using a radial artery graft: an anatomic approach. Neurosurgical review, 27. Detton, A. J., & Tank, P. W. (2017). Grant's dissector. Grob, S., Yonkers, M., & Tao, J. (2017). Orbital Fracture Repair. Seminars in plastic surgery, 31(1), 31–39 Ogiwara, H., Maeda, K., Hara, T., Kimura, T., & Abe, H. (2005). Spontaneous intracranial internal carotid artery dissection treated by intra‐arterial thrombolysis and superficial temporal artery‐middle cerebral artery anastomosis in the acute stage‐‐case report‐‐. Neurologia medico‐chirurgica, 45.