High Throughput Screening of Full Face Clinically Relevant Arterial Variations using Three-Dimensional Postmortem Computed Tomography.

BACKGROUND: Vascular complications resulting from intravascular filler injection and embolism are major safety concerns for facial filler injection. It is essential to systematically screen full face arterial variations and help design evidence-based safe filler injection protocols.

METHODS: The carotid arteries of 22 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 12 cadaveric heads were injected with the contrast in a sequential order. A computed tomography (CT) was acquired after each contrast injection, and three dimensional (3D) CT was reconstructed using validated algorithms.

RESULTS: The 3D CT clearly demonstrated the course, relative depth and anatomosis of all major arteries in 63 qualified hemifaces. The ophthalmic angiosome consistently deploys two distinctive layers of branch arteries to the forehead. The superficial temporal and superior palpebral arteries run along the preauricular and superior palpebral creases respectively. The study found that 74.6 percent of the hemifaces have nasolabial trunks coursing along the nasolabial crease, and that 50.8 percent of the hemifaces have infraorbital trunks that run through the infraorbital region. Fifty percent of the angular arteries are the direct anastomotic channels between the facial and ophthalmic angiosomes, and 29.2 percent of the angular arteries are members of the ophthalmic angiosomes.

CONCLUSIONS: Full face arterial variations are mapped using postmortem 3D CT. Facial creases are in general correlated with underlying deep arteries. Facial and angular artery variations are identified at high resolution, and reclassified into clinically relevant types to guide medical practice.