Facial Vessels Research Articles

Vascular Anatomy of the Nose and the External Rhinoplasty Approach-Reply

In response to the above letter to the editor, we acknowledge that there may be some confusion about the terminology of the lymph nodes draining the supratip region of the nose. However, the reasoning for not describing a specific lymph node is owing to some of the limitations of the radionuclide scanning techniques that were used in this study.1 The radionuclide injections (technetium Tc 99m bound to antimony trisulfide colloid) used for lymphoscintigraphy were placed intradermally and probably did drain into the superficial, cutaneous papillary network described in Goepfert's letter. In our study, we noted that the lymphatics followed the external maxillary blood vessels (facial blood vessels) at the inferior part of the face to drain toward the submaxillary lymph nodes. The confusion occurs with the terminology used to describe the first set of lymph nodes between the lateral wall of the nose and the submaxillary nodes. We considered describing

Studies of the course of the marginal branch of the facial mandibular nerve

In many operations involving the submandibular and lower cheek region, the mandibular branch of the facial nerve is in danger. On the basis of 55 facial dissections, we classified the course of the nerve into one of three types. In about 66% of cases, the nerve runs below the angle and below the inferior border of the mandible. Typically, the mandibular branch consists of up to four major branches. The maximum distance between the lowest point of the mandibular branch and the inferior border of the mandible was 1.4 cm. We also studied the location of the nerve in relation to the facial vessels and the posterior facial vein. Incisions in the submandibular region should be performed at least 2 cm below the inferior border of the mandible. The nerve can be spared by ligature and by retracting the anterior facial vein.

Treatment of facial telangiectasia with sclerotherapy, laser surgery, and/or electrodesiccation: a review.

Facial telangiectasia is extremely common in patients with fair complexion. Electrosurgery has been the primary form of treatment in the past. The authors retrospectively evaluated over 300 patients treated with sclerotherapy for facial telangiectasias. Retrospective analysis of over 300 patients with facial telangiectasia treated with sclerotherapy and 55 facial spider telangiectasias treated with laser. Sclerotherapy utilizing hypertonic saline, Sclerodex, polidocanol, and sodium tetradecyl sulfate resulted in-between 50 and 100% resolution of facial telangiectasia with minimal complications. The treatment of facial telangiectasia should include sclerotherapy and laser treatment modalities, which effect a higher rate of clearance with less adverse sequela.

Autoimmune diabetes and interleukin-2

Sturge–Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge–Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto–occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.

下顎骨動静脈奇形の１例

A 13-year-old boy was referred to our clinic on December 10, 1988, with diffuse swelling of the left mandible which extended to the left cheek and bleeding from the gums of the left lower molar region.Radiographs showed a multilocular radiolucency extending from the left lower first premolar region to the left mandibular foramen, bony expansion around the area, and dilation of the left mandibular canal.Arteriograms confirmed the presence of an arteriovenous malformation (AVM) of the left mandible. The feeding vessels appeared to be branches of the internal maxillary and facial arteries, while the main draining vessel was the left inferior alveolar vein. A nidus was recognized around the left mental foramen.After embolization of the feeders, the left facial and inferior alveolar vessels ligated and lesion of the mandible was packed with oxidized cellulose and bone wax.A panorex study revealed regeneration of bone in the area of the lesion and no evidence of AVM after 3 years and 6 months of postoperative follow-up.

Recipient vessels for microvascular transplants in patients with hemifacial microsomia.

Hemifacial microsomia is a developmental abnormality involving structures derived from the first and second branchial arches. Microvascular transplants are increasingly being used to improve facial contour in patients with this condition. We have reviewed 9 patients with this abnormality to determine which recipient vessels have been used. In 6 patients, the facial vessels were located and used for flap revascularization. In 3 patients, the facial vessels could not be identified intraoperatively, and the occipital artery and a branch of the external jugular vein were used as recipient vessels. In this series of hemifacial microsomia patients, therefore, the facial vessels could not be located in 3 patients. We recommend that surgeons performing microsurgical transplants in cases of hemifacial microsomia be prepared to explore the external carotid and external jugular systems for recipient vessels.

Selective destruction of facial telangiectasia using a copper vapor laser.

Copper vapor lasers emit pulsed light at 511 and 578 nm. The 578-nm option corresponds with a peak in the absorption of oxyhemoglobin and a diminished absorption by melanin. The pulse width of this light (20 nanoseconds) is significantly shorter than the thermal relaxation time of typical facial telangiectatic vessels (20 to 100 milliseconds). This laser is therefore able to selectively destroy facial telangiectatic vessels with little damage to the overlying epidermis. Twenty patients with facial telangiectasia were treated with the 578-nm option of a copper vapor laser. Treatment was administered in an office-room setting, and no anesthesia was used. Eighteen of the 20 patients experienced satisfactory clearance of their telangiectasia. Three patients developed temporary postinflammatory hyperpigmentation, which cleared within 6 to 8 weeks, and one patient developed a small depressed scar, which was not noticeable at 3 months. Copper vapor lasers are thus safe and effective in treating facial telangiectasia.

Orthotopic homotransplantation of vascularized composite mandibular tissue in rabbits immunosuppressed with cyclosporine A

To develop the surgical model, composite mandibular tissue was transplanted at the same site. Revascularization was accomplished by end-to-end anastomosis of the facial vessels using standard microvascular techniques. A total of 33 vascularized composite mandibular tissue allografts were similarly performed between two incompatible strains of rabbit. In a control group of 9 animals, no immunosuppression was administered. All of these allografts were rejected acutely within 10 days after surgery. 7 allograft recipients were immunosuppressed with azathioprine and prednisone at 5 mg/kg.d and 2 mg/kg.d, respectively. Their allografts were also rejected acutely within 10 days. 17 allograft recipients were immunosuppressed with cyclosporine A (CsA). All allografts showed primary wound healing and hair growth and took on normal appearance. 8 of these recipients were given CsA at 5 mg/kg.d i.v. and their allografts were rejected at a mean time of 17.9 days. The remaining 9 recipients given CsA at 10 mg/kg.d i.v. rejected their allografts at a mean time of 36.1 days. In 3 of them, the rejection was reversed with CsA (20 mg/kg.d) injection for five days successfully, and one allograft survived more than 100 days. This pilot study suggests that the surgical model is reliable and that CsA will be useful as an immunosuppressive agent in the study of vascularized composite mandibular tissue allografts.

Facial vessels of desert camel (Camelus dromedarius): role in brain cooling

The reactivity of the superficial veins of the camel was investigated in vitro in response to stretch, heat, norepinephrine, and transmural nerve stimulation (TNS). Stretch at 30 degrees C or 37 degrees C produced a maintained tone and phasic contractions of the facial and nasal veins. The developed tone increased significantly with increasing the temperature (from 30 to 45 degrees C), especially in the proximal part of the buccal facial vein. Norepinephrine caused a constrictor response in the facial vein with the proximal part showing a lower maximum. TNS evoked a constrictor response in proximal segment and a dilator response in the more proximal segment of the buccal facial vein. Either responses were blocked by bretylium or tetrodotoxin. Morphological examination of the vasoactive segment of the facial vein showed a thick muscular layer and a valve in the proximal segment of the buccal facial vein. These results show functional variation in the distribution of adrenoceptors in the facial vein. The high-temperature sensitivity of the buccal facial vein suggests that this part could serve as a temperature-sensitive sphincter that diverts cool nasal blood to the brain for selective cooling of the camel brain during heat stress.

Microvascular Free Flap in Hereditary Hemorrhagic Telangiectasia

A 69-year-old male patient with hereditary hemorrhagic telangiectasia presented with severe epistaxis requiring repeated transfusions. Both nasal passages were densely populated with these vascular malformations that involved the entire nasal mucosa. A total rhinotomy was performed and all the nasal mucosa and turbinates were excised. Both nasal passages were completely resurfaced with a free radial forearm skin flap. The vascular pedicle was delivered from the nasal passage via the maxillary antrum to anastomose with the facial vessels in the cheek. Following surgery the patient had no further significant epistaxis.

遊離腹直筋皮弁を用いて下顎再建を行った口腔癌の１例

A case of one-stage free rectus abdominis myocutaneous flap was reported. The patient was a 68 year old male with a very small primary cancer lesion in the right molar region of the mandible.However, the X-ray films at first visit (30-9-1988) showed abnormal figure.He was clinically diagnosed as mandibular cancer (T3N0M0). He had taken radiotherapy of Linac 2, 000 rads from June 13th to June 24th before operation.In as much as cervical lymph node metastasis was absent, we decided to operate on the mandibular cancer lesion.We used a free rectus abdominis myocutaneous flap to replace the loss of the mandible and the mouth floor.The mouth floor and the mandible were resected continuously at the 8-3 portion (and the mouth floor) and an upper neck dissection was performed.An A-O plate and a free abdominis myocutaneous flap was put in place in the mouth to close the defect.The flap was revascularized by anastomosing the inferior epigastric artery and vein to the facial vessels. The flap being well revascularized, no functionary morbidities occurred after its replacement. A denture was constructed after 6 months. The prognosis for this case is satisfactory. The main characteristics of this flap are as follows:(1) The flap is very easily and quickly elevated with the patient in a supine position.(2) In many cases flap elevation and oral cancer surgery can be performed simultaneously, thereby reducing operating time.(3) There are very few anatomical variations in the deep inferior epigastric vessels.

A prefabricated hair-bearing island flap for lip reconstruction

We report a case of reconstruction of the upper lip in the male using a prefabricated hair-bearing island flap. The flap was made by implantation of a superficial temporal vascular bundle with microvascular anastomoses to the facial vessels. We conclude that the technique is a useful alternative to other methods of reconstruction because of its reliable blood supply.

Reconstruction after radical hemimaxillectomy using a free multidimensional latissimus dorsi myocutaneous flap

A series of safe, simple and single-staged reconstructions following radical resection of maxillary antral carcinomas with soft tissue involvement is presented. These reconstructions were performed using free triple-folded latissimus dorsi myocutaneous flaps revascularised via the facial vessels. This technique can be safely used in irradiated patients and, when indicated, allows for the administration of early postoperative radiotherapy, thus improving the potential cure rate. Advantages and disadvantages of the technique are discussed.

Sympathetic nerve fibers in rat orofacial and cerebral tissues as revealed by the HRP-WGA tracing technique: a light and electron microscopic study

Horseradish peroxidase-wheat germ agglutinin injected into the superior cerical ganglion is taken up by the neuronal perikarya and transported anterogradely in large quantities into peripheral fibers and axonal terminals in a variety of orofacial and cerebral tissues, including the iris, cornea, pineal gland, facial skin and the adventia of cerebral and facial blood vessels. Subsequent histochemical processing according to the tetramethylbenzidine procedure produces a unique, highly visible intraaxonal marker that makes the identification and 3-dimensional tracing of the sympathetic nerve fibers clear and unambiguous at both the light and electron microscopic levels.

The intrinsic vasculature of the cat facial nerve.

Treatment of facial nerve disorders is based in part on assumptions regarding the intrinsic blood supply of the nerve. This study was designed to comprehensively delineate the intrinsic facial nerve microcirculation and its relation to the extrinsic circulation in an animal model. Twenty-eight cat facial nerves were removed intact from brain stem to stylomastoid foramen following intravital fixation. Specimens were studied by gross dissection, silicone injection and tissue clearing, complete vessel counts on serial cross sections of individual nerves, and scanning electron microscopy or transmission electron microscopy. The labyrinthine segment of the cat facial nerve contains strikingly fewer intrinsic blood vessels than the mastoid and tympanic segments. The geniculate ganglion, however, has a distinct, rich vascular plexus. The ultrastructure of the intrinsic facial nerve vessels is similar to other small vessels of the body with tight junctions of the endothelium and overlapping spiral smooth muscle fibers of arterioles, as well as surrounding pericytes.

血管ふん合術による遊離前腕皮弁を用いて口くうがん手術後の即時再建を行った３例

Three cases of one-stage reconstruction with a free forearm flap were reported. The first of three cases was a 61-year-old man and he had a 20×35mm primary cancer lesion in the left border of his tongue (T2NOM0). The second case was a 64-old-year old woman and she had 27×22mm primary cancer lesion in the right border of her tongue (T2N0M0). They received an operation for the partial resection of the tongue and mouth floor, and an upper neck dissection. The last case was a 51-old-year woman and she had 25×12mm primary cancer lesion on the mouth floor and a tumor invation to the mandible was observed by X-P (T4N0M0). She received an operation for the partial resection of her mouth floor, marginal resection of the mandible and a bilateral neck disection after radiotherapy.We used a free-skin flap from the forearm to replace the loss of tongue and mouth floor. The flap was revascularized by anastomosing the radial artery and cephalic vein to facial vessels. Then, the flap was well revascularized and there were no functionary morbidities after the replacement of the flap. The donor-site defect was closed with a free skin graft.We think, consequently, that the radial free forearm flap is ideal for intra-oral reconstruction, offering thin, pliable and predominantly hairless skin to replace oral mucosa.

The median forehead flap revisited: the blood supply.

In 6 fresh cadavers, an injection study of the facial vessels with disulfine blue dye and Microfil demonstrated visualization of large-caliber vessels of the median forehead skin even when the supraorbital and supratrochlear vessels were interrupted. The results of the study would suggest that the median forehead flap can be elevated without incorporating the supratrochlear vessels, but the flap design should be reserved for those clinical situations where the pedicle must be extensively mobilized, e.g., reconstruction of the nasal tip and columella and the presence of a low-lying frontal hairline.

Emotion and facial efference: a theory reclaimed.

A theory of emotional expression, ignored since 1906, holds that facial muscles act as ligatures on facial blood vessels and thereby regulate cerebral blood flow, which, in turn, influences subjective feeling. The theory, developed by Israel Waynbaum, a French physician, hypothesizes the subjective experience of emotions as following facial expression rather than preceding it. It answers Darwin's question of why different muscles contract or relax in different emotions better than Darwin's own theory. When restated in terms of contemporary neurophysiological knowledge, it explains and organizes several ill-understood emotional processes and phenomena.

ろっ骨付遊離筋皮弁を用いた下がく即時再建手術の１例

A case of one-stage serratus anterior osteomyoctaneous free flap was reported. The patient was a 42-year-old male. He had 45×35 mm primary cancer lesion in the middle of the mandible. However the X-ray films at first visit (9-2-1981) showed no abnormal figure. He was clinically diagnosed as mandible cancer (T3 NO MO), He had taken radiotherapy of Linac 4, 000 rads and Au-grain mold 6, 600 rads from September 17th to November 30th. After 5 months, radio-osteonecrosis of mandible was observed in the region of 6+6. He had complained of severe pain, especially contact pain, of the mandible for 10 months. Metastasis of cancer did not occur in the cervical lymph nodes. Then we deceided to operate on the mandibular radio-osteonecrosis. We used a free osteomyocutaneous flap from the chest to replace a loss of the mandible and the mouth floor. The mandible was resected continuously at the 7+7 portion, and the mouth floor was resected partially. For closure of the defect, the serratus anterior flap with the 6th rib was turned into the mouth. The flap was then revascularized by anastomosing the nutrient thoracodorsal vessels to the facial vessels. Then the flap was well revascularized and its color and texture became significantly better after 6 months. As absorption of the transferred bone was minimal, we made a denture. The prognosis is now satisfactory.

Steeple flap reconstruction of the lower lip.

A new method of lower lip reconstruction using a full-thickness cheek island flap based on the facial vessels is described. The functional potential of the method is assessed in six patients. The technique outlined is simple in design and execution. It is capable of total lower lip reconstruction without appreciable microstomia. Other major techniques of lip reconstruction are briefly reviewed.