Nasal Artery Research Articles

Lateral Nasal Artery Perforator Flap for Nasal Reconstruction: Clinical Applications and Risk Factors Associated With Nasal Deformities.

Nasal reconstruction is challenging because of the difficulty in balancing superior aesthetic outcomes and less invasive surgery. The use of the lateral nasal artery (LNA) perforator flap has been reported for nasal reconstruction. However, few reports have described appropriate applications of nasal reconstruction and assessments of nasal deformity. This study aimed to quantify the aesthetic outcomes on using this flap and reveal the risk factors associated with nasal deformities. Twenty patients underwent nasal reconstruction using the LNA flap with a cranial perforator adjacent to the nasal defect. Postoperative protuberant deformities were scored by 2 independent plastic surgeons using a 5-point Likert scale and classified as excellent, good, or poor. The risk factors of deformities were identified using univariate analyses. A nasal alar deviation index was developed to analyze correlations with flap harvesting. The sensory function was assessed by the Semmes-Weinstein test. Flaps survived in 19 patients (95%), and 1 flap showed distal necrosis. All arterial perforators used remained within 5 mm lateral to the boundary between the cheek and nasal ala. The flaps were most often used to cover 2 subunits, including the nasal sidewall defects. Protuberant deformities in 6 (30%), 8 (40%), and 6 (30%) patients were classified as excellent, good, and poor, respectively. Nasal defects involving more than 3 subunits caused severe protuberant deformity. Only 2 patients (5%) in the good and fair groups underwent additional debulking surgery. Nasal alar deviation was not significantly correlated with flap harvesting, when the nasal alar deviation index before and after surgery were compared. Sensory function was retained in all patients. Aesthetic outcomes and sensory function were good on using the LNA perforator flap as a propeller flap having a wide arc of rotation. This flap is suitable for nasal reconstruction involving less than 2 nasal subunits without any severe nasal alar deviation deformity. In addition, this flap allows for better outcomes because it requires less invasive 1-stage surgery.

Anatomical Study of the Dorsal Nasal Artery to Prevent Visual Complications during Dorsal Nasal Augmentation.

Summary:Dorsal nasal augmentation is a common injection associated with ocular complications. Digital compressions on both sides of the nose are recommended during injection. Considering the reported incidences of visual complications, this preventive technique may need an adjustment for more effectiveness to prevent blindness. Therefore, the dorsal nasal arteries (DNAs) were studied by conventional dissections in the subcutaneous and fibromuscular tissues of the nasal dorsum in 60 embalmed cadavers. The results showed that among the 60 faces, 32 faces had bilateral DNAs (53.3%), 23 had dorsal nasal plexus with minute arteries (38.3%), and five had a single dominant DNA (8.3%). The DNA originated from one of the four arterial sources, which influenced the location and course of the artery. These sources included the ophthalmic angular arteries in 21 faces (56.8%), terminal ophthalmic arteries in two faces (5.4%), lateral nasal arteries in 11 faces (29.7%) and facial angular arteries in three faces (8.1%). Consequently, the dominant dorsal nasal artery running close to the midline found in 8% of the cases could make side compressions during nasal dorsum augmentation less effective from preventing ocular complications. However, an adjustment of digital compressions which combines pinching and side compressions is suggested to improve the safety.

Short-term effect of angiotensin-converting enzyme inhibitor on retinal vessel diameter in patients with systemic hypertension

Purpose To determine the retinal vessel diameter changes after angiotensin-converting enzyme (ACE) inhibitor treatment in a group of hypertensive patients. Methods This study included 60 treatment-naive hypertensive patients who were treated with ACE inhibitor. Sixty healthy volunteers served as control group. An optical coherence tomography scan protocol including the measurement of peripapillary retinal vessel diameters was performed at baseline and at 1st month. The diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV), superior nasal artery (SNA), inferior nasal artery (INA), superior nasal vein (SNV) and inferior nasal vein (INV) were statistically compared. Results The baseline diameters of the STA, ITA, SNA, and INA were significantly decreased in the patient group compared with the control group (all p < 0.05). There was a significant increase at 1st month after the treatment in comparison to baseline measurements (all p < 0.05). When compared with the controls, only the diameter of SNV showed a significant decrease at baseline (p = 0.031). After the treatment, the diameters of SNV and INV were significantly increased compared with baseline measurements (p = 0.049 and p = 0.035, respectively). There were no significant differences between the control group and the patient group at 1st month (all p > 0.05). Conclusion Short-term treatment with ACE inhibitor led to a significant improvement in the retinal vessel diameters of patients with hypertension.

Nonsurgical Rhinoplasty: Indications and Safety

IntroductionThe desire for minimally invasive procedures is driven by the rise of posting “selfies” to social media, as well as the new virtual working environment with webcams. With the camera constantly on faces, the rise for injectables will only continue. Soft-tissue fillers are an efficient and successful way to provide a patient with increased self-esteem. Nonsurgical rhinoplasty is a common and desired procedure to augment the appearance of one's nose. Soft-tissue fillers have been found to be safe; however, there can be complications. Some are less severe, such as: edema, hypersensitivity reactions, erythema, and ecchymosis, while other complications can be more severe, such as: infection, granuloma formation, arterial occlusion or embolization, and blindness. Nonsurgical rhinoplasty poses higher risk, given the vasculature of the nose, which is why education on this type of injectable is vital. MethodsThe purpose of this study was to assess the predictability and safety of nonsurgical rhinoplasty procedures while reviewing the proper techniques for a successful procedure. The aim was toward those oral and maxillofacial surgeons who perform nonsurgical rhinoplasty in an outpatient setting. A 3-year retrospective assessment of clinical outcomes and adverse events was performed in patients who had nonsurgical rhinoplasty between January 1, 2018, and December 31, 2020, as outpatient procedures. ResultsA total of 163 patients (147 female and 16 male), aged 15-77 years old, underwent nonsurgical rhinoplasty between January 1, 2018, and December 31, 2020. The fillers used for treatment included: Belotero, Juvederm Ultra XC, Restylane-L, RHA2, and Dilute Radiesse. All patients were satisfied, and none of the patients reported major complications from the procedure. ConclusionThe use of soft-tissue fillers for nonsurgical rhinoplasty is a predictable and relatively safe procedure. However, some serious complications can arise. Injections in the perinasal region can lead to the risk of blindness due to retrograde travel of material in the ophthalmic artery to the choroid and retina. All perinasal injections should be made deep to the perichondrial plane on the midline and deep to the preperiosteal plane in the lateral nose. The infraorbital foramen is a key landmark when placing fillers. It is typically about one-third the distance between the medial and lateral canthi and 11mm below the infraorbital rim. Injections medial to the infraorbital foramen should be performed with caution in order to avoid the angular artery as well as the dorsal and lateral nasal arteries. When injecting in the lateral nose, the injection should be made at the midpoint of the dorsal aesthetic line and the nasofacial groove to avoid the previously mentioned arteries. These arteries create an anastomosis with the ophthalmic artery, which is the artery involved in the high-risk complication of blindness. Blindness can occur immediately, be delayed, or have late onset ranging from days to weeks after the procedure. Aspiration techniques are crucial as the nasal vasculature is shallow and branched. Providers must also know techniques and strategies to manage various complications in the event that they arise to provide patients with the best possible outcome for full recovery. Overall, nonsurgical rhinoplasty is a procedure that should be recommended to cosmetic patients, but caution must be taken to ensure safety and surgeons need to have proper training.

Fine Details That Improve Nasal Reconstruction.

After studying this article, the participant should be able to: 1. Identify common negative outcomes that arise with conventional nasal reconstruction. 2. Understand the technical refinements that help avoid and reduce negative outcomes in nasal reconstruction. 3. Learn about the utility of regional axial island flaps for nasal reconstruction, in particular, the lateral nasal artery flap. Nasal reconstruction has been a preoccupation of surgeons dating to before 600 bc. The nose is the central focal point of the face and a key identifying facial feature, and surgery to the nose can prove to be challenging to even the most experienced surgeon. The objective of this CME article is to outline the most commonly used surgical options for each nasal aesthetic subunit, and the specific complications observed for each. The best surgical options and technical refinements are highlighted, and principles that may help restore the nose are outlined.

The Layered Anatomy of the Nose: An Ultrasound-Based Investigation.

An increasing number of soft tissue filler procedures in the nasal region has been reported. Concomitant with demand, the number of complications has risen due to the difficulty in administering filler in a region where soft tissue layering is complex. The authors sought to describe the layered soft tissue arrangement of the nose as it relates to the underlying arterial vasculature and to define safer zones for nasal filler enhancement. A total of 60 (28 males and 32 females) study participants were investigated with respect to their layered anatomy in the midline of the nose utilizing ultrasound imaging. The presence and extent of the layered arrangement was examined as well as the depth of the arterial vasculature. In the mid-nasal dorsum, a 5-layer arrangement was observed in 100% (n = 60) of all investigated cases, whereas it was found to be absent in the nasal radix and tip. The 5-layer arrangement showed an average extent of 26.7% to 67.5% in relation to nasal length. The nasal arteries coursed superficially in 91.7% of all cases in the nasal radix, in 80% in the mid-nasal dorsum, and in 98.3% in the nasal tip. Soft tissue filler administration in the nose carries the highest risk for irreversible vision loss compared with any other facial region. The safety of soft tissue filler rhinoplasty procedures is enhanced by knowledge of the layered anatomy of the nose, the location and depth of the major nasal vasculature, and employment of maneuvers to decrease the risk of blindness.

An unusual variation in the termination of facial artery in south Indian population: A human cadaveric case report

The facial artery is an important artery of the face, prone to many variations. Identification of these variations is of utmost importance in clinical practice, especially rhinoplastic and orofacial surgeries and also super selective chemotherapy procedures. In this case report, we report a bilateral facial artery variation encountered in a male cadaver during routine dissection. Instead of terminating as the angular artery, the facial artery terminated as the superior labial artery, giving the lateral nasal artery as a smaller branch, much closer to the midline than normal. A prominent pre-masseteric branch was noticed along with smaller branches from the infraorbital artery which offered possible compensation for the short facial artery. The case reported is a type II variation according to Bayram classification, and a type C variation as per Loukas classification. This variation is very rare and should be kept in mind while performing any surgical procedures of the face.

Optical coherence tomography: new opportunities for detecting preclinical vision disorders in patients with HIV infection and tuberculosis

The objective of the study: detection of early preclinical manifestations of vision disorders in patients with TB/HIV co-infection using optical coherence tomography (OCT).Subjects and methods. A prospective open-label study was carried out enrolling patients with TB/HIV co-infection (Group 1, n = 19) and patients with pulmonary and extrapulmonary tuberculosis (Group 2, n = 18). In both groups, standard ophthalmological examination and OCT were performed with measurement of the thickness of the choroid and the diameter of upper and lower temporal and nasal arteries and veins, and assessment of arteriovenous coefficient (AVC).Results. In the patients of both groups, the thickness of the choroid in the fovea area decreased in comparison with healthy volunteers (control group, n = 20), however, the decrease in choroid thickness was statistically significantly more pronounced in the patients of Group 1, and this group was also characterized by change in the caliber of retina arteries and veins, which is expressed in a higher AVC.Conclusion. OCT allows early preclinical diagnosis of eye disorders (in the absence of eye complaints) in patients with tuberculosis, including those with concurrent HIV infection. Detection of choroid disorders and AVC changes in such patients allows timely prescription of therapy and prevention of pathological changes from progression.

Surgical field visualization in patients with polyposis rhinosinusitis

Introduction. Patients with nasal polyposis are predisposed to diffuse intraoperative bleeding, that could highly impair surgical field visualization. The absence of a universal technique of improving surgical field visualization became a reason for searching the specific hemostatic methods.Objective: to evaluate the efficiency of sphenopalatine artery and/or its branches coagulation as a method of hemostasis in endoscopic surgery for nasal polyposis and to describe the surgical anatomy of sphenopalatine artery.Materials and methods. Endoscopic coagulation of sphenopalatine artery and/or its branches was performed among 30 patients with nasal polyposis. Surgical field visualization was graded by Boezaart and Wormald scales before and after coagulation.Results and discussion. Intraoperative attempts to achieve the hemostasis using warm (490С) saline irrigation and then application of xylometazoline (0.1%-10ml) and lidocaine (10%-4ml) were ineffective among 28 patients with initial grade 8 and among 2 patients with grade 9 according to Wormald scale. Sphenopalatine artery and/or its branches coagulation was effectively performed in these patients, obtaining the hemostasis in 100% of cases (р &lt; 0,001). The initial surgical field grade improved to grade 5 by Wormald scale in 9 patients (30%), to grade 6 in 17 patients (56,7%) and to grade 7 in 4 patients (13,3%). Only one artery (trunk of sphenopalatine artery) was observed in 18 patients (60%), crossing the sphenopalatine foramen, and 2 arteries (posterior septal artery and posterior lateral nasal artery) – in 12 patients (40%). Endoscopic examination revealed no signs of mucosal atrophy in postoperative period.Conclusion: The appropriate choice of hemostatic technique depends on grades of surgical field visualization. If there is a grade 8–9 by Wormald scale, endoscopic coagulation of sphenopalatine artery and/or its branches is an effective and safe method to improve surgical field visualization.

Retinal Vessel Diameter Changes in COVID-19 Infected Patients

ABSTRACT Purpose: To evaluate the longitudinal changes in retinal vessel diameters in patients with coronavirus disease 2019 (COVID-19). Methods: This study included 25 patients with COVID-19 (Group 1) and 25 healthy subjects (Group 2). The diameters of peripapillary temporal and nasal retinal arteries and veins were measured at baseline and at 4 months after remission. Results: The baseline diameters of the inferior temporal vein and the artery were increased in group 1 compared to controls (p = .007 and p = .041, respectively). There was also an increase in the diameters of the inferior and superior nasal veins and arteries in group 1 at baseline (p = .001, p = .019, p = .037, and p = .008, respectively). Retinal vessel diameters decreased after remission in all quadrants in comparison to baseline measurements (all p < .05). Conclusion: Increased retinal vessel diameters were measured in COVID-19 patients during the disease. Measurement of retinal vessel diameters may be a noninvasive method of estimating the vascular risk.

Deployment of the Ophthalmic and Facial Angiosomes in the Upper Nose Overlaying the Nasal Bones.

Nasal filler placement is associated with a high risk of blindness. The arterial supply to the upper nose overlaying the nasal bones is poorly understood. The aim of this study was to visualize and analyze the deployment of the ophthalmic and facial angiosomes in the upper nose to help prevent blindness following nasal filler injections. The arterial systems of 62 cadaveric heads were filled with lead oxide contrast agent, and computed tomography (CT) images were acquired and reconstructed in 3 dimensions. Twenty-six of the cadaveric noses examined demonstrated clear CT images of the facial and ophthalmic angiosomes in the upper nose. The Type 1 upper nose (15.4%) is supplied by 2 independent ophthalmic angiosomes that communicate indirectly through a choke anastomosis. The Type 2 upper nose (38.5%) is supplied by 2 ophthalmic angiosomes with a true anastomosis between them. The Type 3 upper nose (46.1%) is supplied by both ophthalmic and facial angiosomes with true anastomoses across the dorsal midline. These true anastomoses are mediated by the radix arcade in 46% of the noses and involve the dorsal nasal artery in 65% of the cases. The anastomoses all cross the upper dorsal midline and are directly linked to the ophthalmic angiosome. The deployment and anastomosis of the facial and ophthalmic angiosomes in the upper nose fall into 3 major patterns. About 85% of the noses have true anastomotic arteries that cross the upper dorsal midline and are directly linked to the ophthalmic circulation. Dorsum filler injection poses a significant risk of blindness.

Hybrid reconstruction of distal nasal defects.

We present hybrid reconstruction of distal lateral "through-and-through" nasal defects (skin, cartilage, and mucosa) due to resection of tumor and/or infection. Retrospective descriptive study. The study was performed in multicenter clinics between July 2011 and September 2016. 13 patients with full thickness distal nasal defects secondary to tumor and/or infection were included. Defects included dorsal and/or caudal septum, upper lateral cartilage, or inner/outer nasal valve. Caudal-based turn-in flaps were planned and used to repair inner lining of nasal cavity. Conchal and septal cartilages were used as cartilage grafts. Skin defects were reconstructed with lateral nasal artery perforator flaps. All flaps healed uneventfully, without flap loss. Nasal passage collapse, adhesion, or difficulty in breathing were not seen. No hematoma, infection, and deformity at cartilage graft donor areas was observed. During nasal reconstruction, it is mandatory to consider 3D complex and functional structure of nose. The repair of skin defects may not be enough for functional restoration. We believe that single step reconstruction of full thickness nasal defects through hybrid reconstruction may lead to anticipated successful results.

Transverse facial artery: Its role in blindness after cosmetic filler and botulinum toxin injections

Masseter injections for cosmetic or pathological reasons are increasingly common, as are filler injections using dual or multiplane techniques in the lateral facial regions or for jawline contouring. The occurrence of blindness following these procedures often remains unexplained. This study aimed to determine the anatomical explanation for this debilitating complication by investigating the transverse facial artery and its relation to the masseter. For this purpose, we dissected 35 cheek specimens with latex injections and 10 specimens without latex. The external carotid artery was dissected up to its bifurcation into the maxillary and superficial temporal arteries. Results showed that the transverse facial artery arose from the superficial temporal or external carotid artery that runs between the zygomatic arch and the parotid duct. Three types of transverse facial arteries were observed: type I: a short artery that did not extend beyond the masseter muscle; type II: a transverse artery that ran to the nasolabial fold and anastomosed to the facial artery; and type III: a sizable transverse artery that substituted the hypoplastic facial artery, continued as the angular artery, and then anastomosed to the dorsal nasal artery. Knowledge of these three types of transverse facial arteries is a prerequisite to study the vascular territory. Type III provides an explanation for the occurrence of blindness after lateral face injections. We consequently define a line that runs from the tragus to the outer quarter of the upper lip as the risk area, while the safe zone is located on either side of this line.

Doppler Ultrasonographic Anatomy of the Midline Nasal Dorsum.

This study was performed to identify a safe method for filler injection to prevent blood vessel damage, by means of checking the location and depth of the blood vessels on the midline of the nose using Doppler ultrasonographic imaging. Ultrasonographic images of the nasal areas of patients for filler injection rhinoplasty were reviewed. The location and depth of the dorsal nasal arteries and the intercanthal vein in each part on the midline of the nose were checked. The intercanthal vein was detected in the midline of the radix in 22 patients and the midline of the rhinion region in two patients. There were no patients in whom the intercanthal vein was observed in the midline of the supratip region. The dorsal nasal artery was detected in the rhinion region in six patients and in the supratip region in two patients. There were no patients in whom the dorsal nasal artery was observed in the midline of the radix. The dorsal nasal artery was located within 1.2 mm from the perichondrium or periosteum in three patients in whom it was detected in the rhinion. When performing dorsal augmentation, the injection of filler into the preperiosteal layer in the rhinion region should be avoided for the prevention of vascular embolism. During dorsal augmentation in patients with a nasal hump, the filler can be injected into the preperiosteal space in the radix by introducing a needle perpendicular to the periosteum from the skin. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A case of bleeding from maxillary carcinoma embolized from the maxillary and ophthalmic arteries

BackgroundThe majority of maxillary sinus cancers are advanced at initial detection due to anatomical limitations and lack of early symptoms. In patients with orbital invasion, the feeding arteries of the tumor are often associated with the ophthalmic artery in addition to the maxillary artery. We describe a case of tumor bleeding in a patient with recurrent maxillary carcinoma that was treated with embolization from the maxillary and ophthalmic arteries.Case presentationA 70-year-old man was treated for left maxillary carcinoma from the maxillary artery with 6 cycles of selective intra-arterial cisplatin infusion with concomitant radiation therapy. He subsequently had epistaxis and underwent arterial embolization for hemostasis. He had almost no sight by this time. Angiography of the left external carotid artery and internal carotid artery revealed blood supply from the maxillary and ophthalmic arteries. Regarding the maxillary artery, coil embolization was performed after embolization with 300-500 μm Embosphere. On the other hand, for the ophthalmic artery, the 3rd portion, supratrochlear artery and dorsal nasal artery, were selected and embolized with coils. Final angiography revealed disappearance of tumor staining and a residual choroidoretinal blush. There was no bleeding that needed treatment up to 2 months after embolization.ConclusionsIn embolization of the ophthalmic artery, it is necessary to embolize the second and subsequent parts because the arteries associated with visual function branch off from the first part. Even in patients whose visual acuity has been almost lost, like in this case, there is a risk of eye pain from embolization at the proximal end, and distal embolization is necessary.

Hemodynamics of the temporal and nasal short posterior ciliary arteries in pseudoexfoliation syndrome.

The aim of this study was to investigate blood flow changes in the temporal and nasal short posterior ciliary arteries (SPCAs) in pseudoexfoliation syndrome using color Doppler ultrasonography. This prospective clinical study included 67 eyes of 53 patients scheduled for cataract surgery. Pseudophakic eyes, eyes with traumatic cataract, were excluded. The demographic characteristic of the patients were recorded. Ocular blood flow was measured using 6-10MHz Doppler ultrasound. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (Vm), and resistive index (RI) in the temporal and nasal SPCAs were determined for 39 eyes of 30 patients with pseudoexfoliation syndrome and cataract and a control group comprising 28 eyes of 23 patients with senile cataract. Compared to the control group, patients with pseudoexfoliation syndrome had significantly lower PSV (8.85 ± 2.88cm/s), EDV (3.21 ± 1.12cm/s), and Vm (5.27 ± 1.98cm/s) in the temporal SPCA (PSV P = .001; EDV P = .002; Vm P = .001). There was no difference in velocities in the nasal SPCA. RI of both the temporal and nasal SPCA did not differ statistically between the groups (temporal SPCA P = .517, nasal SPCA P = .752) CONCLUSION: There were significant decreases in temporal SPCA hemodynamic parameters in patients with pseudoexfoliation syndrome. These findings suggest that temporal SPCA ocular blood flow measurements have greater diagnostic value than those of the nasal SPCA.

Modification of the Basal View after Internal Alar Reduction

Background: Numerous alar base modification techniqueshave been reported in the literature. Specifically, three different techniques were described to manage cases with alar flaring in addition to a wide nasal base. Tissue excision from the alarlobule as well as from the inside of the nostril is executed todecrease the alar flaring and the nostril width, respectively.Further techniques include cinching sutures that help advancethe alae together and flap advancement.The aim of this study is to emphasize the aesthetic impactof the basal nasal view and to reach a maximum aestheticresult concerning nasal alar flare.Patients and Methods: A prospective study was conductedon 25 patients. All patients had alar flaring seeking alarreduction, either alone or as a part of a full rhinoplasty. Duringrhinoplasty, alar base reduction was done at the end of rhinoplastysurgery, after the closure of all rhinoplasty incisionsand after osteotomy was done. A caliper was used to sharplystab the skin from the lateral limb to the desired sill creaseto determine the medial limb of the triangular wedge to beexcised. The base of the triangular wedge was directed downwardand the apex was directed intra-nasally.Results: The current study showed that the internal alarresection significantly decrease the alar flare; as the inter-alardistance ranged between (35-43mm), Mean±SD (39.2±2.3)before surgery and becomes between (31-37mm) Mean±SD(34.8±2.0) after the surgery, with a significant improvement(p-value: <0.001).Conclusion: Internal alar resection effectively reducedthe alar flare, and improved the nostril shape and width. Thistechnique was also useful to retain symmetry of nostril shape,hide the scars internally in the nose, avoid the injury of thelateral nasal artery, preserve the natural curvature of alar rimand avoid detachment of the alar foot plate. This techniquecan effectually be applied to all patients with alar flarereduction

One-Stage Reconstruction of the Large Lower Nose Defect Involving 2 Subunits With Lateral Nasal Artery Pedicle Nasolabial Flap.

Large nose defect reconstructions involving the tip and alar subunits are still difficult to achieve in one stage. This study aimed to investigate the size of the nasal tip and alae, observe the distribution patterns of the lateral nasal artery and present our clinical experience with the lateral nasal artery pedicle nasolabial (LNAPN) flap. From June 2019 to January 2020, lower nose parameters from 60 subjects were measured by a 3-dimensional scan, and the cranial digital subtraction angiogram results of 20 patents without vascular malformation were retrospectively analyzed. The case series consisted of four patients with nasal tip and alar defects who underwent surgery with LNAPN flaps from December 2018 to June 2019. Outcomes and complications were followed-up at 6 to 12 months. For the 3-dimensional scan study, the mean area of the 2 subunits involving the tip and alae was 7.986 ± 1.728 cm. In the digital subtraction angiogram data, the lateral nasal artery was identified among all facial arteries and had a mean diameter of 1.0 ± 0.20 mm. Sixteen people (80%) had a rich connection between the lateral nasal artery and the transverse facial artery. All cases revealed satisfactory aesthetic outcomes by reconstruction of large defects in one stage. The largest flap of 4.2 cm × 3.0 cm in our study showed complete healing. The LNAPN flap represents a feasible, flexible, efficient, and easily mastered reconstructive method for large nose defects involving the tip and alar subunits.

The blood supply of the inferior nasal concha (turbinate): a cadaveric anatomical study.

The blood supply of the lateral nasal wall acquires a great deal of interest for many reasons especially for the treatment of clinical conditions such as epistaxis that sometimes needs surgical interventions and endoscopic sinus and skull base surgeries that requires a good choice of endonasal flaps including inferior nasal concha (commonly named as inferior turbinate by clinicians) flap to close the dural defects. Successful treatment of epistaxis and closure of such defects depends on detailed anatomical knowledge of lateral nasal wall vasculature and a vital flap with good blood supply, respectively. Because of these we aimed to study the blood supply of inferior turbinate, regarding the sources and courses of the blood vessels. Forty formalin-fixed hemisected cadaveric heads were used at Hacettepe University Anatomy Dissection Laboratory. Anatomical dissection of the inferior nasal concha and the lateral nasal wall was done by dissecting microscope. Coloring dye injection to the arteries was performed. After a detailed examination of the lateral nasal wall; the position of the sphenopalatine foramen (SPF) and the sphenopalatine artery (SPA) were identified. The posterior lateral nasal artery (PLNA) found to give middle and inferior conchal (turbinate) arteries. The average length of the inferior turbinate artery (ITA) was 9.057 ± 1.674mm, the diameter was 1.452 ± 0.172mm, the distance from posterior end of inferior turbinate was 7.879 ± 1.52mm. Anastomosis in the lateral nasal wall between the ITA and the anterior ethmoidal and the lateral nasal (branch of the facial artery) arteries were established. The blood supply of inferior nasal concha is mainly provided by ITA and its anastomotic contributors. Detailed knowledge related to it, before surgical interventions, may reduce intraoperative bleeding and increase endoscopic exposure.

Infrared Thermally Enhanced 3-Dimensional Time of Flight Magnetic Resonance Angiography Imaging for the Visualization of the Arteries of the Face.

BackgroundThe face is known for its extreme variation in vascular anatomy. Furthermore, the rapidly increasing number of filler treatments leads to an increase in severe filler-associated complications (such as skin necrosis and blindness) due to intra-arterial injection. Visualizing a patient’s individual complete facial arterial anatomy in a contrast- and radiation-free way has not been published before. This innovative imaging technique could, therefore, enhance the safety of minimally invasive surgical procedures as it provides a harmless way to map the arteries of the face.ObjectivesEvaluate a newly developed imaging technique to visualize the arteries of the face in a noninvasive and radiation-free manner.MethodsThe individual arterial facial anatomy of 20 volunteers was studied by an imaging technique, combining infrared (IR) facial warming and 3-dimensional (3D) time of flight (TOF) magnetic resonance angiography (MRA). The source and maximum intensity projection images were assessed by 2 investigators, familiar with the anatomy of the face.ResultsThe MRA technique visualized most of the main facial arteries, albeit in a variable way. The main facial branches of the external carotid artery (facial, angular, supralabial, and superficial temporal arteries) were illustrated well, whereas the visualization of the internal carotid branches (supratrochlear and supraorbital arteries) and nasal branches (dorsal nasal and lateral nasal arteries) was less consistent.ConclusionsThe combination of IR “heat-induced enhancement” and a 3D-TOF MRA sequence may actually be an important step toward the visualization of the variable facial vascular anatomy in a noninvasive, radiation-free, and contrast-free manner.