Labial Artery Research Articles

Lumen Diameter and Associated Anatomy of the Superior Labial Artery With a Clinical Application to Dermal Filler Injection.

Vascular compromise and subsequent tissue necrosis is a rare but disfiguring complication of dermal filler injection that frequently occurs in regions of the lip and nasolabial fold supplied by the superior labial artery (SLA). The purpose of this study was to examine lumen diameter and other anatomical features of the SLA relevant to dermal filler injection in the clinical setting. Eighteen adult cadavers were dissected. Detailed measurements of the SLA were taken at predetermined points along its course. Lumen diameter of the SLA was largest at the labial commissure (0.85 ± 0.34 mm; Point P1) and smallest at the midline (0.56 ± 0.21 mm; Point P4). The deepest mean cutaneous depth of the SLA was at its branch point from the facial artery (5.49 ± 1.95 mm; SLA branch point), whereas the most superficial mean cutaneous depth was at the midpoint between the labial commissure and peak of Cupid's bow (4.29 ± 1.54 mm; Point P2). The variable, superficial course of the SLA and its large caliber place it at significant risk for intra-arterial injection with dermal filler at all points along its course.

Three-dimensional visualization of blood supply of the upper lip using micro-CT and implications for plastic surgery.

The anatomy of the arterial branches in the upper lip and their relationships to soft tissue are not well described in the literature. The purpose of this study was to explore a method for visualizing the microvessels and soft tissue three-dimensionally to gain better understanding of the upper lip blood supply. Seventeen stillborn fetuses were injected with lead oxide-gelatin and stained with iodine. Thirty-four half upper lip specimens were obtained and scanned by micro-computed tomography. The images were then examined and Inveon analysis software was used for three-dimensional reconstructions. The main supplies to the upper lip were from the superior labial and inferior alar arteries. In some cases, the infraorbital and lateral nasal arteries also branched off to the upper lip. The anatomical variations were classified into six types on the basis of the observed vascular composition patterns. The skin was supplied by the subcutaneous vascular network, formed by the superficial ascending branches of the superior labial and inferior alar arteries. The mucosa was supplied by the submucosal vascular network, formed by the deep ascending branches of the superior labial artery and the labial branches of the infraorbital artery. The muscles were supplied by small vertical branches from the subcutaneous and submucosal vascular networks. This study provides new anatomical insight into the upper lip by describing the microvessels and the relationship between the arteries and the soft tissue involved. This is important information for clinical applications in upper lip plastic surgery.

Lip reconstruction using the Gillies fan flap

The Gillies Fan flap is a single-stage composite rotational-advancement flap for reconstruction of medium to large full thickness lower lip defects. It can be thought of as an extension of the Estlander flap. It is nourished by a narrow superiorly-based pedicle of the superior labial artery. Mobilized tissue includes adjacent lower lip tissue as well as tissue from the opposing lateral lip. The oral commissure is distorted with use of this technique, and sometimes requires a second stage for refinement using a commissureplasty, discussed elsewhere in this issue. This flap is unique when compared with other reconstructive modalities of the lip because it requires a full thickness incision through the lip, thereby resulting in division of neurovascular and muscular structures, and as such has largely been replaced by the Karapandzic flap, which maintains the radial neurovascular supply, better preserving functions of the lip. This is accomplished by making incisions through mucosa and skin only, rather than full thickness as described herein. The Gillies fan flap can also be utilized using the MacGregor modification depending on the scenario.

Lifting de lèvre et restauration philtrale par le lambeau en moustache

The restoration of the philtrum is an often neglected aspect in the technique of labial lifting with a perinasal scar, or it is secondarily resorted to by simple injections of hyaluronic acid. We are not in favor of the classic continuous bull's horn scar because, on the one hand, we consider that most of the labial shortening is due to the nasal floor resection -the internal excursion of which determines the final result-, and on the other hand that the approximation of 2 skins of very different nature (columella and lip) may cause a visible scar. The base of the columella is particularly well vascularized by the anastomosis of branches derived from the external carotid artery via the superior labial artery and septal branches distributed from the internal carotid system. We therefore consider that this zone on each side of the base of the columella constitutes the vascular pivot of our "mustache flap" drawn according to the classic peri nasal incision: this flap is desepidermized and then totally elevated from the orbicularis muscle except for its internal part where it is simply discarded so as not to compromise its vascularity; it is then rotated at 90° and inserted into a tunnel fitted in the subcutaneous plane down to the red lip corresponding to the restoration of the 2 philtral crests. Thus, all of the superior labial deformations observed over time (elongation and convexity of the white lip, flattening of the philtrum are corrected in a long lasting manner. The intervention is carried out under local anesthesia and, if necessary, the other elements of aging (loss of volume of the red lip, vertical wrinkles, defect of pigmentation etc.) can be corrected without risk at the same time.

The mental artery: anatomical study and literature review.

The mental artery is a terminal branch of the inferior alveolar artery arising from the maxillary artery. It often communicates with the submental and inferior labial arteries branching off the facial artery. To our knowledge, few reports have described its anatomy and clinical significance in detail. The aim of this paper was to clarify the anatomy of the mental artery. Ten sides from five embalmed Caucasian cadaveric heads were used. The facial artery was identified at the point passing through a notch for the facial vessels and was traced medially. The mental artery and its anastomoses with other arteries were observed in detail. It was detected on all sides. Fourteen anastomoses were found, eight with the inferior labial artery and six with the submental artery. On one side, the mental artery directly supplied the lower lip with no anastomosis. The inferior labial artery tended to anastomose with the mental artery superior to the mental foramen and was likely to anastomose with the submental artery anterior to the mental foramen. We clarified the detailed anatomy of the mental artery. Our results could provide dentists with information that will help them to make oral surgery safer and moresuccessful.

Clinical implications of aberrant neurovascular structures coursing through the submandibular gland.

BackgroundVariation within the submandibular triangle, including variant paths of facial neurovasculature, could increase risk of neurovascular derangement during submandibular gland (SMG) dysfunction, enlargement, interventions, or removal.MethodsFrequency of anatomical variants enveloped within or piercing the SMG, including facial artery, vein, or branches of CN VII, were assessed in 70 cadaveric submandibular glands (39M/31F).ResultsEighteen of 70 SMGs (25.7%) were pierced by at least one aberrant neurovasculature structure: Facial artery most frequently (n = 13), followed by facial vein (n = 2), inferior labial artery and vein (n = 1), and CN VII cervical branch (n = 1). This study demonstrated the high variability of neurovasculature within submandibular parenchyma. These aberrant neurovascular structures, especially facial artery, are in danger of compromise during surgical and other medical procedures on the SMG. To avoid potential neurovascular compromise, ultrasonographic or other imaging is recommended prior to procedures involving the SMG.

Releasing incisions of the buccal periosteum adjacent to the lower molar teeth can injure the facial artery: an anatomical study.

Periosteal releasing incision (PRI) techniques are often used with guided bone regeneration procedures. As complications such as intra- and postoperative bleeding have been noticed, we aimed to study and clarify these as related to the PRI, especially on the mandibular buccal periosteum. Fourteen sides from seven fresh-frozen Caucasian cadaveric heads were used in this study. The seven cadavers were derived from two females and five males. The mean age at the time of death was 75.9 ± 10.8years. The PRI was made using a no. 15c blade using a surgical microscope. Subsequently, the fat tissue lateral to the periosteum was slightly dissected. The diameter of the facial artery (or its branch) and closest relationship between the tooth and position of the artery was recorded. Finally, the artery was traced back proximally to clarify its origin. On all sides, the inferior labial artery (ILA) was identified in the fat tissue lateral to and close to the periosteum. The ILA was closest to the periosteum at the midpoint of the PRI (approximately between the first and second molar teeth area or 10mm mesial to the apex of the retromolar pad). The mean diameter of the ILA was 2.72 ± 0.26mm. This anatomical finding should encourage dentists to make the PRI incision without invading the tissue underneath the periosteum.

Translucent and Ultrasonographic Studies of the Inferior Labial Artery for Improvement of Filler Injection Techniques.

Background:Lower lip augmentation by filler injection is an aesthetic procedure essential for achieving a feminine look and to enhance attractiveness. Complications as a result of injury to the inferior labial artery can result in undesirable outcomes.Methods:The translucent technique was used to study the origin of the inferior labial artery in 11 cadavers. Ultrasonography of the inferior labial artery was also performed in 20 volunteers, which provided supplemental data to this study, in relation to establishing recommendations for filler injection.Results:Five different types of inferior labial artery were described. These types were found in various combination patterns. Types 2, 4, and 5 are more vulnerable to arterial injury during filler injection. Ultrasonography revealed a depth of 6 mm and an arterial position at the vermillion border as the dangerous injection plane.Conclusion:The origins and courses of the inferior labial artery are classified into 5 types. These types are often found in combination with each other in different faces, resulting in large anatomical variation between people. Types of combination influence severity of lower lip necrosis when arterial injury occurs. The physician should be aware of these anatomical variations during aesthetic treatments and reconstructive procedures to avoid the dangers of accidental arterial injury.

Positional relationship of superior and inferior labial artery by ultrasonography image analysis for safe lip augmentation procedures.

The aim of this study was to use ultrasonography to determine the locations and distributions of the superior labial artery (SLA) and the inferior labial artery (ILA) relative to the vermilion border (VB). Sixty healthy Korean volunteers (35 males, 25 females; age, 21-36 years) were investigated using ultrasonography. The participants had not received any noninvasive treatment or surgical procedure in the facial regions during the previous 6 months. Based on the VB, the overall thicknesses of the upper and lower lips were 9.4 ± 0.4 mm (mean ± SD) and 10.9 ± 0.7 mm, respectively. In most cases, the labial arteries were located in the wet mucosal layer on both the upper (35-57%) and lower lips (28-55%), respectively. In the upper lip, the SLA was in the intramuscular layer in 20-45% of cases, making it the second most common type. At some of the measuring points, the SLA was observed more often in the intramuscular layer than in the wet mucosal layer. In the lower lip, the ILA was also located in the dry mucosa (5-27%). The dry-wet mucosal junction is unclear in the lip area, and the ILA was commonly observed at the dry-wet mucosal junction. The arterial depth was 5.3 ± 0.3 mm in the upper lip and 4.2 ± 0.4 mm in the lower lip. The SLA and ILA are evenly distributed over all parts of the oral mucosa. Injection procedures for lip augmentation should therefore use very superficial approaches. Clin. Anat. 33:158-164, 2020. © 2019 Wiley Periodicals, Inc.

Erratum to: Anatomical Variations in the Course of Labial Arteries: A Literature Review.

Erratum to: Anatomical Variations in the Course of Labial Arteries: A Literature Review.

Treating the Lips and Its Anatomical Correlate in Respect to Vascular Compromise.

Treating the lips to increase facial attractiveness and youthfulness is challenging when trying to consider ethnic differences in an increasingly more diverse society. Multiple injection techniques are currently available for treating lip contour and volume, but a validation in the cadaveric model under the aspects of safety has not been performed yet. The injection techniques presented in this study are based on the experience and personal selection of the authors. The authors have assessed, treated, and evaluated for more than 20 years patients from the Middle East and Central Europe. Cadaveric verification was performed for each of the presented techniques to identify the positioning of the injected product inside the lips and its relation to the superior/inferior labial arteries. The results of the anatomic analyses revealed that in 58.3% of the performed injections, the product was placed close to the superior/inferior labial arteries. In 60.0% of the cases, applications using a needle placed the injected product in endangered locations, whereas 57.1% of the cases using cannulas placed the product in endangered locations (i.e., in the vicinity of the superior/inferior labial arteries). This anatomic study revealed that injected material into the lips is frequently placed in close proximity to labial arteries representing a high risk for intra-arterial applications, leading to tissue loss (necrosis) and potential end-arterial embolism (potential blindness). Nevertheless, treatment of the lips should be a multistep approach focusing first on the far (upper and middle face) and close (labiomandibular and labiomental) perioral regions.

Depth and Lumen Diameter of the Superior Labial Artery with a Clinical Application to Dermal Filler Injection

IntroductionSince 2000, the annual administration of dermal filler treatments has risen by over 250 percent, stemming from their minimally invasive and relatively inexpensive nature compared to traditional cosmetic surgery. Currently, numerous levels of healthcare practitioners administer over 160 temporary and permanent filler treatments for correcting age‐related wrinkles/folds and non‐age‐related tissue volume defects from surgery or trauma. Unfortunately, the variance in clinician level of training combined with the use of unapproved products has increased the incidence of dermal filler complications in recent years. While common complications such as bruising, erythema, and edema are relatively mild and temporary, the rarer complication of vascular occlusion and subsequent tissue necrosis is disfiguring and difficult to reverse. Lip and nasolabial fold injections—which involve regions supplied by the superior labial artery—are the most likely to result in tissue necrosis.PurposeThe purpose of this study was to examine anatomic features of the superior labial artery (SLA) relevant to dermal filler injection in the clinical setting.Materials & MethodsEighteen adult embalmed cadavers (36 hemi‐faces; 9 males, 9 females; ages 52–99) were dissected. Cutaneous SLA depth, lumen diameter, external diameter, plane, and common variable location at pre‐determined points in the lip and nasolabial fold regions were measured. These points included the SLA branch point (from the facial artery), P1 (labial commissure), P2 (midpoint between labial commissure and peak of Cupid's bow), P3 (peak of Cupid's bow), and P4 (midline). ANOVA, independent samples t‐tests, and paired samples t‐tests were conducted to compare measurements between sites.ResultsThe lumen diameter of the SLA was largest at point P1 (labial commissure; 0.85 ± 0.34 mm) and smallest at point P4 (midline; 0.56 ± 0.21 mm). The SLA branch point was found to have the deepest mean cutaneous depth (5.49 ± 1.95 mm), while point P2 (midpoint between the labial commissure and the peak of Cupid's bow) was found to have the most superficial mean cutaneous depth (4.29 ± 1.54 mm). There were no significant differences between left and right hemifaces as well as between male and female arterial parameters.ConclusionsAll SLA parameters should be interpreted carefully; for example, the point with the largest mean external diameter (P1; labial commissure) represents a greater chance of needle contact, but the point with the smallest mean lumen diameter (P4; midline) represents a smaller bolus of filler required to occlude the arterial lumen. Commonly used 27‐gauge filler needles are 0.41 mm in diameter; since the smallest mean lumen diameter was 0.56 mm (P4; midline), this means that the needle could potentially enter the lumen of the SLA and result in intra‐arterial injection at any point along the SLA course from its origin to the midline. Overall, the SLA's variable, superficial, and large‐caliber course places it at significant risk for intra‐arterial injection with dermal filler at all points in its course.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Evaluation of the Superior Labial Musculomucosal Flap in Dogs: An Angiographic Study and Case Report.

The aim of this study was to evaluate the angiosome of the superior and inferior labial arteries within the superior and inferior labia and to describe superior and inferior labial musculomucosal axial pattern flaps that can be used for intra-oral wound reconstruction. This study also presents the clinical use of a superior labial musculomucosal flap in a dog. The common carotid arteries of six canine cadavers were injected with barium sulphate. The skin of the face and labial mucosa was removed and radiographed to study the vascular supply of the superior and inferior labia. The angiograms in all dogs demonstrated that the superior and inferior labial arteries were located within the musculomucosal layer of the labia. At the junction of the rostral and caudal half of the upper lip, extensive choke anastomoses joined the angiosome of the infra-orbital artery. The inferior labial artery perfused the caudal half of the lower labium and had extensive choke anastomoses with the middle and rostral mental arteries. The musculomucosal flaps of the superior and inferior labia contain a rich arterial blood supply, which suggests that these flaps may survive in live dogs. The superior labial musculomucosal flap was successfully used to reconstruct a large cleft palate in a single clinical case.

Anatomical Map of the Facial Artery for Facial Reconstruction and Aesthetic Procedures.

The facial artery (FA) is the main blood vessel supplying the anterior face and an understanding of its anatomy is crucial in facial reconstruction and aesthetic procedures. The aim of this study was to assess the many anatomical features of the FA utilizing a multidimensional approach. Head and neck computed tomographic angiographies of 131 patients (255 FAs) with good image quality were evaluated. The FA was classified according to its termination pattern, course, and location with reference to soft tissue/bone surrounding structures. In total, each branch was present as follows: the submental artery (44.8%), the inferior labial artery (60%), the superior labial artery (82.2%), the lateral nasal artery (25.1%), and the angular artery (42.5%). The most common FA course was the classic course, situated medially to the nasolabial fold (27.1%). In total 65.5% of the arteries were located medially to the nasolabial fold, and only 12.3% of them were totally situated lateral to the nasolabial fold. The median distance (with quartiles) from the inferior orbital rim reached the FA after the superior labial artery branched off in 50.2% of cases and was 36.6 mm (33.4; 43.3). The angle between the FA and the inferior border of the mandible was 49.8o (31.9; 72.4). The horizontal distances between the oral commissure and naris to the FA were 8.5 ± 4.0 mm and 12.1 ± 6.7 mm, respectively. An anatomical map summarizing the major measurements and geometry of the FA was generated. The detailed anatomy and relative positioning of the FA should be considered to avoid any unexpected complications in plastic surgery.

Commentary on: Anatomical Variations in the Course of Labial Arteries: A Literature Review.

Commentary on: Anatomical Variations in the Course of Labial Arteries: A Literature Review.

Anatomical Variation of Facial Artery Branch: A Case Report

Introduction The facial artery and its branches are the major vessels that supply blood to the face region. This artery and its branches can present variations in path and branching pattern and thus complicate the location of these arteries during invasive procedures. There is still a great need to inform and clarify the variant or unusual organization of the display of these arteries. Case Report During the dissection of the head and neck region of a cadaver, an anomalous branch of the unilateral facial artery was observed in the superior labial artery. Conclusion The lack of knowledge about the possible pathways of the facial artery and its branches can lead to errors in surgical procedures or fillers, causing severe complications to the facial structures.

The pedicled levator labii superioris alaeque nasi flap: A durable single-stage option for reconstruction of full-thickness nasal defects.

Repair of full-thickness nasal defects can often be associated with multi-stage operations that can result in significant physical and psychological morbidity for patients. We present a single-stage option for reconstruction of these defects. Demonstrate the utility of the pedicled levator labii superioris alaeque nasi flap and consistency of its vascular pedicle. Anatomical study using fresh cadavers. Academic medical center. Evaluation of vascular anatomy of pedicled flap and measurements of distances with relationship to facial anatomic landmarks. With few noted anatomic variations, the vascular pedicle of the pedicled levator labii superioris alaeque nasi flap arises from the superior labial artery and is reliably located within 1 cm lateral and inferior of the nasal sill. As a robust single-stage option, the pedicled levator labii superioris alaeque nasi flap can serve as a powerful option in the arsenal of the reconstructive surgeon. The technique for harvest is simple with attention to a few anatomic variations as described herein, and excellent results can be obtained with proper application.

Anatomical Variations in the Course of Labial Arteries: A Literature Review.

Nonsurgical lip enhancement using dermal fillers is a very popular procedure. The trend for enlarged lips has been popularized by media and social media. The lips have considerable aesthetic and functional importance, in addition to having a complex anatomy. Serious complications, including vascular compromise or occlusion leading to cutaneous necrosis and blindness, can occur as the result of lip enhancement using dermal fillers. Therefore, aesthetic practitioners require an in-depth understanding of the anatomy and vasculature of the lips and the perioral area prior to providing lip enhancement using dermal fillers. This literature review aimed to summarize existing data describing the origin, path, and depth of the superior and inferior labial arteries, and to help aesthetic practitioners in providing safer injections to the lips. A literature search was carried out to summarize the available data describing the origin, path, and depth of the labial arteries. Analysis of the literature revealed that the labial arteries display great variability with respect to path (distribution), presence, and location. Increasing the volume of lips through injections of dermal filler needs to be undertaken with caution, and awareness of the anatomical variation in artery location and path is a crucial concept that is essential when injecting the lips.

Morphometric and Vascular Modifications of the Clitoris During Pregnancy: A Longitudinal, Pilot Study.

During pregnancy, women go through a series of physical and emotional changes that may have an impact on their sexuality. The aim of the study was to examine modifications in sexual function during pregnancy by means of translabial ultrasonography and administration of questionnaires on sexual activity. Eighteen healthy and adult (25-35years) pregnant women without sexual dysfunction and with a stable heterosexual relationship were examined at 10-12, 18-20, and 30-32weeks of gestation. Patients underwent ultrasonographic translabial clitoral volume and labia minora thickness measurements and color Doppler assessment of the dorsal clitoral and posterior labial arteries. On the same day, each patient completed the two-factor Italian McCoy Female Questionnaire (MFSQ) and the Female Sexual Function Index (FSFI). The mean clitoral body volume progressively increased during pregnancy, and color Doppler analysis of the dorsal clitoral artery showed a significant decrease in the pulsatility index from the first to the third trimester. Similarly, the labia minora thickness increased and the posterior labial artery pulsatility index progressively decreased throughout gestation. The MFSQ score for sexuality and partnership and the number of intercourses/week did not significantly change during the study period. However, the MFSQ score for partnership reached the lowest value in the third trimester of pregnancy. Analysis of the FSFI data showed no significant differences throughout pregnancy for the majority of the domains (sexual desire, arousal, orgasm, lubrication, and pain), with the exception of the satisfaction item, which decreased during the third trimester. A significant proportion of women are concerned that changes in their body during pregnancy may have a detrimental effect on sexuality. Despite significant changes in genital morphology and vascularity throughout gestation, these modifications do not seem to have an impact on sexual function in pregnancy.

Nose and Lip Graft Variants: A Subunit Anatomical Study.

In the field of vascularized composite tissue allotransplantation, the surgical design of facial subunit grafts is an evolving concept. The purpose of the present article is to study the possibility of dividing the historical nose and lip face transplant into several morphologic and functional subunit grafts, depending on their respective supply. This study was conducted in 20 adult cadavers. The facial artery and its branches were dissected bilaterally in 16 fresh and four embalmed heads. Nasolabial perfusion was assessed by selective injection of methylene blue and eosin (n = 2) or India ink (n = 2) in the superior labial and distal facial arteries. Dynamic perfusion through the distal facial artery was illustrated by fluoroscopy (n = 3). Three nose-upper lip grafts were harvested and injected with barium sulfate for microangiography computed tomographic analysis. Finally, three isolated nasal and bilabial grafts were procured and their vascular patency assessed by fluoroscopy. The distal facial artery can perfuse the entire nose, septum, and upper lip, without any contribution of the superior labial artery. A dense anastomotic network indeed exists between the respective distal rami of both vessels. Furthermore, the exclusion of the superior labial artery from the harvested nasal subunit allowed safe bilabial subunit procurement, from the same specimen. The authors' results demonstrate the feasibility of harvesting nasal and labial subunits, in an isolated or a combined manner. These results can find applications in subunit autologous replantation, allotransplantation, allogenic face partial retransplantation, and the emerging field of vascularized composite tissue engineering.