Transverse Facial Artery Research Articles

Brief Report: Ultrasonographic Assessment of Salivary Gland Response to Rituximab in Primary Sjögren's Syndrome.

To evaluate changes in salivary gland echostructure and vascularization after rituximab treatment in patients with primary Sjögren's syndrome (SS). Twenty-eight patients with primary SS included in the multicenter, randomized, double-blind, placebo-controlled Tolerance and Efficacy of Rituximab in Primary Sjögren's Syndrome (TEARS) trial underwent salivary gland ultrasonography before the first placebo or rituximab infusion and then 6 months later. Trial inclusion criteria were scores of ≥50 mm on at least 2 of 4 visual analog scales (VAS) evaluating dryness, pain, fatigue, and global disease; and recent-onset (<10 years) biologically active primary SS and/or systemic primary SS. Patients were randomly assigned (1:1) to rituximab (1 gm at weeks 0 and 2) or placebo. Ultrasonography of both parotid and submandibular glands was performed to assess echostructure (using a semiquantitative score of 0-4, with improvement defined as a ≥1-point decrease), size of each gland, and vascularization based on the resistive index of the transverse facial artery of the parotid gland before and after lemon juice stimulation. Of the 28 patients, 5 (18%; 3 in the placebo group and 2 in the rituximab group) had clinically detectable bilateral parotid gland enlargement at baseline. Parotid parenchyma echostructure improved in 50% of the rituximab-treated patients versus 7% of the placebo-treated patients (P = 0.03). In the submandibular glands, echostructure also improved in a larger proportion of rituximab-treated patients, although the difference was not significant (36% versus 7% of placebo-treated patients; P = 0.16). Gland sizes and resistive index remained unchanged. Ultrasonography showed improved salivary gland echostructure in patients with primary SS receiving rituximab, with no changes in salivary gland size or vascularization, 6 months after the first infusion.

Equivalence between invasive and oscillometric blood pressures at different anatomic locations in healthy normotensive anaesthetised horses.

Accurate blood pressure measurement is essential for effective clinical assessment and appropriate interventions in anaesthetised horses. Information on the accuracy of oscillometry for blood pressure measurement on the appendages of mature horses is limited. To assess equivalence between invasive and oscillometric blood pressures at different anatomic locations in horses. Prospective experimental study using 6 healthy mature horses. Blood pressure was measured invasively in the right transverse facial artery and noninvasively by oscillometry in nondependent limbs and tail of laterally recumbent sevoflurane- or desflurane-anaesthetised horses. Cuff widths of 5-12 cm were tested on the tail, metatarsus, metacarpus and distal radius/ulna. Equivalence between mean arterial pressure (MAP) oscillometric and MAP invasive was assessed using a linear mixed effects model with a significance level of P≤0.05. Twenty paired measurements were obtained for each cuff size in each of the locations, totalling 340 measurements. There was only one location (tail) and one cuff width (6 cm; cuff width-to-tail circumference ratio of 0.25) that resulted in equivalence between MAP measured with the oscillometric and the invasive methods (P = 0.8). All other locations (metacarpus, radius/ulna, metatarsus) and cuff widths were not equivalent (P≤0.01). A cuff width-to-tail circumference ratio of 0.25 is recommended for accurate oscillometric blood pressure measurement in mature, laterally recumbent anaesthetised normotensive horses. Studies with variable haemodynamics are warranted. Oscillometric measurements at other extremities and/or with other cuff sizes cannot be recommended for clinical use.

Neurovascular structures of the mandibular angle and condyle: a comprehensive anatomical review.

Various surgical interventions including esthetic surgery, salivary gland excision, and open reduction of fracture have been performed in the area around the mandibular angle and condyle. This study aimed to comprehensively review the anatomy of the neurovascular structures on the angle and condyle with recent anatomic and clinical research. We provide detailed information about the branching and distributing patterns of the neurovascular structures at the mandibular angle and condyle, with reported data of measurements and proportions from previous anatomical and clinical research. Our report should serve to help practitioners gain a better understanding of the area in order or reduce potential complications during local procedures. Reckless manipulation during mandibular angle reduction could mutilate arterial branches, not only from the facial artery, but also from the external carotid artery. The transverse facial artery and superficial temporal artery could be damaged during approach and incision in the condylar area. The marginal mandibular branch of the facial nerve can be easily damaged during submandibular gland excision or facial rejuvenation treatment. The main trunk of the facial nerve and its upper and lower distinct divisions have been damaged during parotidectomy, rhytidectomy, and open reductions of condylar fractures. By revisiting the information in the present study, surgeons will be able to more accurately prevent procedure-related complications, such as iatrogenic vascular accidents on the mandibular angle and condyle, complete and partial facial palsy, gustatory sweating (Frey syndrome), and traumatic neuroma after parotidectomy.

Acylcarnitine ester utilization by the hindlimb of warmblood horses at rest and following low intensity exercise and carnitine supplementation

Background: Acylcarnitines play an important role in fuel metabolism in skeletal muscle.Objective: To assess acylcarnitine ester utilization by the hindlimb of horses at rest and following low intensity exercise and carnitine supplementation.Animals and methods: Acylcarnitine ester uptake by the hindlimb was investigated using the arteriovenous difference technique. Blood from six warmblood mares (mean age 12 ± 3 (SD) years and weighing 538 ± 39 kg) was collected simultaneously from the transverse facial artery and from the caudal vena cava. Food was withheld for 12 hours prior to exercise. Exercise comprised a standardized treadmill protocol consisting of 5 minutes of walk, 20 minutes of trot and thereafter another 5 minutes of walk. At the end of the first exercise day, three horses were given carnitine supplementation (100 mg/kg bodyweight), whereas the other horses received saline. The next day the exercise was repeated and blood samples collected similarly. Free carnitine and acylcarnitines were analyzed as their butyl ester derivatives in heparinized plasma by electrospray tandem mass spectrometry. Statistical analysis was performed using a general linear mixed model.Results: C3-carnitine, C6-carnitine and C14:1-carnitine showed the largest average extraction by the hindlimb at rest and C3-carnitine, C5:1-carnitine and C16-carnitine immediately after low-intensity exercise. Carnitine supplementation significantly increased free carnitine, C5-carnitine and C8-carnitine extraction.Conclusion: Carnitine supplementation altered the extraction of acylcarnitines by the hindlimb in horses exercising at low intensity.Clinical importance: Findings might aid in optimizing performance and myopathy prevention of the equine athlete.

Topographic Relationships Between the Transverse Facial Artery, Branches of the Facial Nerve, and the Parotid Duct in the Lateral Midface in a Korean Population

The aims of the present study were to clarify the topographic relationships between various structures in the lateral midface and to provide important anatomical information pertinent to face lifting or treatment of damage to the midface structure. Thirty-two fixed cadavers were dissected (23 males and 9 females; mean age, 66.8 years) and 55 sides of midface were used. The transverse facial artery (TFA), zygomatic branch (Zb) and buccal branch (Bb) of the facial nerve, and the parotid duct (PD) were identified. The structures of the lateral midface were measured relative to the zygion and tragion. The vertical average distances from the zygion to each structure increased in the following order: ZB of the facial nerve, TFA, first Bb of the facial nerve, and PD. The horizontal average distance from the tragion to the point of emergence from anterior border of the parotid gland was also measured. The TFA was the closest and the third Bb of the facial nerve was the farthest away. The angles between the horizontal line and ZB of the facial nerve, TFA, PD, and first Bb of the facial nerve were +10.4, -2.3, -18.5, and -27.1 degrees, respectively. These results may be used to establish the precise locations and the courses of the important midface structures, and represent valuable data that may help to prevent complications during surgery for face lifting and reconstruction of the facial nerve and PD.

SP0083 The Role of US for Diagnosing SjÖGren's Syndrome - Practical Aspects

Primary Sjögren's syndrome (pSS) is a chronic autoimmune disorder characterized by lymphocytic infiltrates in the lachrymal and salivary glands. Dryness of the eyes (keratoconjunctivitis sicca) and mouth (xerostomia) are the...

Comparative analysis of the course of the facial and transverse facial arteries in selected ruminant species

The paper describes variations in patterns of origin from the main arteries as well as of branching and course demonstrated on the basis of selected facial arteries in several species of ruminants. The studies included 35 species of 27 genera, 9 subfamilies of animals belonging to families of Bovidae, Cervidae, Giraffidae and Moschidae from the suborder of Ruminantia, including species maintained by humans. Altogether, 435 preparations of head arteries were studied. Arteries of the examined animals were filled with acetone-dissolved stained vinyl superchloride or stained latex LBS3060. The facial artery was found to originate from the main arteries of the head in three different manners. In species devoid of facial arteries, the presence of a pronounced transverse facial artery could be demonstrated. Division of the animals into large and small ruminants, generally accepted by authors of animal anatomy textbooks, was found to be oversimplified and lacking in universal character, as to the patterns of origin and course of the facial artery and the transverse facial artery.

A Rare Variation in Facial Artery and Its Implications in Facial Surgery: Case Report

Facial artery is usually the main artery supplying the face. It gives three named branches on the face, the inferior labial, the superior labial and the lateral nasal and continues as the angular artery. Face is also supplied by the transverse facial artery and the arteries accompanying the cutaneous nerves. In our present case report, we observed that the lingual and facial arteries were originating from the front of External Carotid artery (ECA) as a common linguofacial trunk on the left side and coursed upwards towards the mandible for about 1.2 cm and then divided into facial and lingual arteries. We observed that the facial artery terminated as Inferior labial artery as end artery (without anastomoses). The other branches for the face namely Superior labial, lateral nasal and angular arteries are arises from the Transverse facial artery. Conclusion: In this study, we noticed that a variation in the morphological aspect of arterial pattern of face, until then not documented. In this sense, the objective of this study was to report a variation of the facial artery and to analyze it relative to the literature state of the art. The present case may provide useful information in different fields of oral and maxillofacial surgery.

Coexistence of anomalies in the termination of facial artery and the origin of transverse facial artery. A case report

AbstractSeveral studies in the past have shown variations in the vessels of facial region. Facial artery may show variations in its origin, course, termination and branching pattern. Undocumented termination of facial artery as inferior labial artery and transverse facial artery emerging as a branch of maxillary artery was observed in the present study. Also, associated with it two distinct facial veins were also observed. To our knowledge, coexistence of this anomalous branching pattern has not been reported in the literature. A thorough knowledge about normal as well as variant vascular anatomy is crucial for interpretation of various interventional vascular procedures and performing surgical explorative procedures in this region including plastic surgery.

外傷性横行顔面動脈仮性動脈瘤に対して1.5Fr. Marathon microcatheterとED-coilおよびNBCAを使用して治療した1例

外傷性横行顔面動脈仮性動脈瘤に対して1.5Fr. Marathon microcatheterとED-coilおよびNBCAを使用して治療した1例

Management of parotid sialocele after facial trauma creating a transoral salivary fistula: two case reports

Sharp penetrating trauma of the face, besides causing a cosmetic defect, may also injure deeper anatomic structures. Lacerations in the cheek region may involve branches of the facial nerve, parotid gland or its duct, and vascular structures such as the transverse facial artery. Failure to recognize a parotid duct injury may result in the formation of a sialocele or cutaneous fistula. We describe a simple technique using intravenous tubing for the management of a persistent parotid sialocele.

FACIAL ARTERY ON FACE - A STUDY ON SOUTH INDIAN CADAVERS AND SPECIMENS

Abstract Context: Facial artery is usually the main artery supplying the face. It gives three named branches on the face, the inferior labial, the superior labial and the lateral nasal and continues as the angular artery. Face is also supplied by the transverse facial artery and the arteries accompanying the cutaneous nerves. Aim: In the present study, variations of facial artery on face were observed. Settings &amp; design: Department of Anatomy, Kasturba Medical College, Manipal. Material &amp; method: The present study was performed on 38 males and 12 females' formalin-fixed hemi-faces. Diameter of facial artery was noted at two specific points using a fine microcaliper. Results: The variations were divided into 3 categories. Out of 38 male hemi-faces, 100% right and 78% left hemi-faces belonged to type I category; 22% left hemi-faces belonged to Type III category. Out of 12 female hemi-faces, 80% right and 80% left hemi-faces belonged to Type I category, 18% left hemi-faces belonged to Type II category and 20% right and 2% left hemi-faces belonged to Type III category. Premasseteric branch was observed in 4 hemi-faces; a duplex with a prominent lateral angular branch was observed in 4 hemi-faces and anenlarged transverse facial artery was seen in 2 hemi-faces. The diameter of facial artery at its origin and at the antero-inferior angle of masseter muscle was larger in males. Conclusion: This study shows that the variations in the branches and the diameter of the facial artery were relatively larger in males when compared to females.

THU0267 Ultrasonographic Salivary Glands Response to Rituximab in Primary SjöGren Syndrome Patients (Tears Sononographic Study)

BackgroundUltrasound (US) is a non-invasive tool validated to identify structural abnormalities of salivary glands and to diagnose primary Sjögren Syndrome patients (pSS) (1). However, no previous study evaluated the follow...

비스포스포네이트 연관 악골 괴사증 환자에서 유경 협부 지방 피판을 이용한 치료

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a disease characterized by jaw necrosis and delayed wound healing in patients who had received bisphosphonates. Buccal fat pad (BFP) can be used as a pedicled flap in the posterior region of the oral cavity. BFP pedicle flap needs simple surgical technique and it shows less donor site morbidity and aesthetic problem than other vascularized flap. BFP pedicled flap was fed by 3 arteries-facial, internal maxillary, and transverse facial artery. Osteomyelitis was generally related with poor blood supply. Thus, rich blood supply of BFP pedicle flap can have a potential advantage to BRONJ patients. In this case report, we presented 3 BRONJ patients treated by BFP pedicle flap after sequestrectomy.

Amino acid utilization by the hindlimb of warmblood horses at rest and following low intensity exercise

Background: In particular branched-chain amino acids might limit muscle protein loss in pathological conditions. Little is known on basic amino acid utilization of muscle in horses. Objective: To assess amino acid utilization by the hindlimb of horses at rest and following low intensity exercise. Animals & methods: Amino acid uptake by the hindlimb was investigated using the arteriovenous difference technique. Blood from six warmblood mares (mean age 12 ± 3 (SD) years and weighing 538 ± 39 kg) was collected simultaneously from the (transverse) facial artery and from the caudal vena cava. Food was withheld for 12 hours prior to exercise. Exercise comprised a standardized treadmill protocol consisting of 5 minutes of walk, 20 minutes of trot, and thereafter another 5 minutes of walk. Amino acids were determined quantitatively by means of anion exchange chromatography. Statistical analysis was performed using a general linear mixed model. Results: Amino acids with the largest average extraction at rest were citrulline (11.1 ± 9%), cystine (8.3 ± 36%), serine (7.9 ± 11%), and leucine (5.9 ± 9%). Of the 25 amino acids studied, none showed a significant difference following exercise. Glycine (485 ± 65 μmol/L), glutamine (281 ± 40 μmol/L), valine (183 ± 26 μmol/L), and serine (165 ± 22 μmol/L) showed highest plasma concentrations. The average extraction for α-aminobutyric acid at rest was 18.2 ± 26%. Arterial plasma citrulline concentration was higher than venously. Conclusion: Citrulline, cystine, serine, and leucine might be regarded as most important amino acids at rest in warmblood mares. Clinical importance: Further investigation is necessary into the specific role of leucine supplementation to preserve or restore body protein in horses.

The arterial blood supply of the temporomandibular joint: an anatomical study and clinical implications

PurposeThe aim of this study was to analyze three-dimensional images of the arterial supply to the temporomandibular joint.Materials and MethodsTen patients (five men and five women, mean age 36 years) without signs or symptoms of temporomandibular disorders, who underwent contrast-enhanced computed tomographic (CT) scanning with intravenous contrast, were studied. The direct volume rendering technique of CT images was used, and a data set of images to visualize the vasculature of the human temporomandibular joint in three dimensions was created. After elaboration of the data through post-processing, the arterial supply of the temporomandibular joint was studied.ResultsThe analysis revealed the superficial temporal artery, the anterior tympanic artery, the deep temporal artery, the auricular posterior artery, the transverse facial artery, the middle meningeal artery, and the maxillary artery with their branches as the main arterial sources for the lateral and medial temporomandibular joint.ConclusionThe direct volume rendering technique was found to be successful in the assessment of the arterial supply to the temporomandibular joint. The superficial temporal artery and maxillary artery ran along the lateral and medial sides of the condylar neck, suggesting that these arteries are at increased risk during soft-tissue procedures such as an elective arthroplasty of the temporomandibular joint.

Direct intra‐abdominal pressures and abdominal perfusion pressures in unsedated normal horses

AbstractObjectivesTo determine whether direct intra‐abdominal pressures (IAP) and calculated direct abdominal perfusion pressures (APP) are location dependent within the abdomen of standing horses. We hypothesize that IAP will be increased and calculated APP will be decreased at a ventral abdominal location (V) when compared to values obtained from the left (LFl) or right flank (RFl).DesignProspective experimental design.SettingUniversity‐based equine research facility.AnimalsSeven healthy adult horses, 4 geldings and 3 mares.InterventionsMeasurements of direct IAP obtained from the RFl, LFl, and V locations via abdominal cannulation and direct arterial blood pressures obtained via catheterization of the transverse facial artery were obtained in fasted, standing, unsedated horses. APP was calculated for each location by the subtraction of IAP from the mean arterial pressure. Differences between sites of measurement for IAP, APP, and their gradients were calculated and compared by ANOVA and t‐tests.Measurements and Main ResultsMean flank IAP measurements were subatmospheric and negative compared to ventral IAP values (LFl = –3 mm Hg, RFl = –5 mm Hg, V = 25 mm Hg; P &lt; 0.001 between each flank and the ventral location). Ventrum APP was lower than flank APP (V = 82 mm Hg; LFl = 106 mm Hg; RFl = 108 mm Hg; P = 0.029 between each flank and the ventral location). Gradient calculations between sites showed the IAP increased and APP decreased from dorsal to ventral (P &lt; 0.05) and from right to left (P = 0.004) within the abdomen.ConclusionsIAP and calculated APP are location dependent. These data provide new information regarding abdominal pressure profiles in standing healthy adult horses.

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

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

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

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

Topography of the arteries supplying the masseter muscle: Using dissection and Sihler's method

Various surgical procedures require surgeons to have detailed knowledge of the course of blood vessels in the masseter muscle, such as masseter muscle flap formation, mandibular angle resection, parotidectomy, and mandibular ramus osteotomy. Without this knowledge serious complications can occur, endangering the lives of patients. Occasionally, during routine dissections we sometimes encounter an additional branch. The purpose of this study was to provide a comprehensive detailed anatomic description of the blood supply of the masseter muscle. This will provide critical information for various surgical procedures. Twenty-five Korean cadavers were dissected and subjected to modified Sihler's method to reveal the branching patterns of the arteries surrounding the masseter muscle, and its intramuscular blood supply. The masseter can be supplied by seven branches from the external carotid artery. Among these, the masseteric branch from the deep temporal artery has not been described previously. This previously undescribed branch enters the medial surface of the masseter, turning medially around the anterior border of the ramus immediately after the branching point of the deep temporal artery. The branch originating from the transverse facial artery was the largest, and the branches originating from the external carotid artery and deep temporal artery were the smallest. Examination of intramuscular patterns revealed that the branches of the transverse facial artery were the most widely distributed. When considering arterial diameters and distribution areas, the branches of the transverse facial artery can be considered the main components of the seven branches supplying the masseter muscle.