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Evaluation of Facial Artery with CT Angiography Using 64 slice MDCT: Implications for Facial Reconstruction in Plastic Surgery
David W. Mathes, MD, Matakazu Furukawa, MD, Yoshimi Anzai, MD.
University of Washington, Seattle, WA, USA.

Purpose:
The successful design and execution of flaps to reconstruct defects in the midface is dependent on a through understanding of the location as well as the variations observed in facial artery (FA) anatomy. Most studies FA anatomy have been performed in cadaveric specimens that appear to over estimated the presence of the angular branch. In addition, a less invasive in-vivo technique for assessment would be beneficial for use in preoperative evaluation, especially in the field of reconstructive transplantation. The aim of this study is to evaluate the value of CT angiography in assessment of anatomical variations of the facial artery and its branches and to determine the true incidence of anatomic variations in the facial artery course and branching.
Methods:
Total 94 cases with 187 FA were included in this study. Thin-slab maximum intensity projection and volume rendering were used for post processing. The anatomical variations of FA were classified into the following 4 groups (Figure 1); Type-1: short course, terminate proximal to the superior labial artery (LA), Type-2: terminate distal to the superior LA near nasolabial fold, Type-3: classic course, extends to lateral nasal-superior alar or angular branch, Type-4: duplex with dominant lateral angular branch. The anatomy of inferior and superior LA was evaluated separately.
Results:
Sixty-four branches (34.2%) of FA were classified as Type-1, 74 branches (39.6%) were classified as Type-2 (figure 2), and 45 branches (24%) extend beyond nasolabial fold and classified as Type-3. Type-4 was seen only in 4 branches (2.1%). Thus, while the Type 3 distribution (the classic facial artery course with an intact angular arterial branch) was the most common in the cadaveric studies, it was only observed in 24% of the arteries in this study. The distribution of inferior labial artery was on the right side in 47.3% of the cases, and bilaterally in 16.5%. Superior labial arteries were present bilaterally in 53% of the cases, only on the right side in 30.3%, only on the left side in 10.6%, and on neither side in 6.1%, respectively
Conclusion:
Based on our study it appears that the facial artery commonly dissipates near the nasal ala and that the presence of an angular artery less common than previously reported. This study also demonstrates that facial CT angiography can provide useful anatomic information and has the potential to serve as an imaging tool for preoperative planning of complex reconstructive surgeries of the face.


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