Download Bilateral variation of facial artery and its implication for facial surgery

International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 77-81
Case report:
Bilateral variation of facial artery and its implication for facial surgery: A
case report
Deepu Singh Kataria 1, Rakesh Kumar Ranjan2, Nidhi Sharma3
1
Demonstrator, Department of Anatomy, Teerthanker Mahaveer Medical College & Research Centre, Moradabad, U.P.,
India
2 Demonstrator,
3Assistant
Department of Anatomy, Muzaffarnagar Medical College, Muzaffarnagar, U.P., India
Professor, Department of Anatomy, Teerthanker Mahaveer Medical College & Research Centre, Moradabad,
U.P., India
Corresponding author: Deepu Singh Kataria
Abstract:
Face is supplied by the three main arterial trunks: the facial, transverse facial and infraorbital arteries. Facial artery is known to
show some variation in its origin, course and branching pattern. It gives three branches on the face, the inferior labial, superior
labial and the lateral nasal and finally continues as the angular artery. The anatomical understanding of the facial artery and its
branches are especially important in the practice of medical and dental care, in the surgeries of neck and face and also for the
radiologist to understand and interpret facial artery imaging when undertaking head angiography. In the present case report we
observed that the facial artery terminated as inferior labial artery (end artery) on both side of the face. The other branches for the
face namely superior labial, lateral nasal and angular arteries arises from the transverse facial artery. Thus the transverse facial
artery is making a significant contribution to blood supply of face. This type of atypical branching of facial artery deserves
attentions because of large number of interventions on this region, not only in case of trauma, but also in the case of elective
surgeries of face pathologies.
Key words: Facial artery, Transverse facial artery, Inferior labial artery
Introduction:
carotid artery, just above the lingual artery, at the
Vascular variations are congenital morphological
level of greater cornu of hyoid bone in the carotid
differences that arise in the human body. Although,
triangle.[2] It runs upward and forward, passes deep to
for the most part, do not cause injury to the
the superficial part of submandibular salivary gland
individual, may be important in cases where it is
making a characteristic loop and wind around the
necessary a specific access to the vascular system.
inferior margin of the body of the mandible at the
For surgeons it is very important to know the exact
anteroinferior border of masseter muscle, where its
frequency and variations of the arteries in the areas
pulse can be felt as it cross the mandible. The artery
where they have to operate on.
[1]
is deep to the skin,
fat of cheek, risorius, zygo-
Face receives a rich blood supply from the facial and
maticus major and minor muscles near the angle of
superficial temporal arteries. It is also supplied by
mouth, and superficial to buccinators and levator
branches of maxillary and ophthalmic arteries. Facial
anguli oris muscles. In the face the artery tortuously
artery normally arises in the neck from the external
runs upward and forward lateral to the angle of
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ISSN: 2319-7072
International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 77-81
mouth and terminates as angular artery at medial
photographs were taken and labeled as shown in
angle of eye. It may pass over or through the nose
figure 1.
towards the medial corner of the eye. At its
Case report:
termination it is embedded in levator labii superioris
After the proper dissection of face we observed that
alaequae nasi muscle.
[3]
the right facial artery originating from the external
Occasionally the facial artery barely extend beyond
carotid artery just superior to the lingual artery. It
the angle of the mouth in which case its normal
runs forward without forming any loop in the
territory beyond this region is taken over by an
submandibular region and crosss the inferior margin
enlarged transverse facial branch from the superficial
of the body of mabndible at anteroinferior border of
temporal
the
masseter muscle. Here it gives a premassetric branch
contralateral facial artery. The facial artery supplies
and a submental branch and further runs forward and
branches to the muscles and skin of the face. Its
terminate as inferior labial artery (end artery). The
named branches on the face are the Premasseteric
transverse facial artery which is the branch of
artery, Superior and Inferior labial arteries and the
superficial temporal artery in parotid gland behind
Lateral nasal artery. The part of the artery distal to its
the neck of mandible continue forward tortuously on
terminal branch is called the Angular artery. The
masseter muscle and gives superior labial artery and
facial artery is tortuous throughout its extent. The
lateral nasal artery. Thus the transverse facial artery
cervical part is tortuous to adapt to the movements of
making a significant contribution to blood supply of
pharynx during deglutition and the facial part is
face. This variation was present on both the right and
tortuous to adapt to the movements of mandible, lips
left side of the face.
and cheek. The anesthetists often feel the facial pulse
Discussion:
for monitoring the patient during surgery that is why
Face is supplied by the three main arterial trunks: the
artery
and
by
it is called Anesthetists artery.
branches
from
[4]
facial, transverse facial, and infraorbital arteries. The
Materials & Methods:
facial artery is usually the largest and dominant artery
We used donated dead bodies for the purpose of
and plays a major role in supplying blood to the face.
medical education and research in the Department of
However there are huge variations on its size and
Anatomy, Teerthanker Mahaveer Medical College
extent between different individuals and even
and Research Centre, Moradabad, UP, India. The
between different sides of the face. In the present
study involved the head and neck dissection of a
study transverse facial artery become dominant and
middle aged Indian female cadaver fixed in formalin
supply most area of the face which is normally
based preservative (10% formaldehyde).
supplied by the facial artery.[5]
The dissection of head and neck was carried out
The anatomical study of the facial artery and its
carefully and strictly following the instructions by
branches has two important aspects of interest: first,
Cunningham's Manual of Practical Anatomy and
surgical anatomy in plastic and reparative surgery of
observed for variations in the branching pattern of
the face and lip in cases of trauma and congenital
facial artery during the year 2014-2015. Appropriate
malformation and in the surgery of malignant
disease;
second,
radiological
anatomy in
the
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ISSN: 2319-7072
International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 77-81
treatment of certain facial tumors by embolization
procedures.
[6,7,8]
(49%). In 5 cases, the facial artery was undetectable
with the transverse facial arterial dominance (1 case
According to a study of 40 facial arteries by Midy D
bilateral).[12]
et al., the facial artery has terminated as angular
Ezure H et al. also reported a case where the left
artery in 27.5% cases, superior labial in 40%, nasal in
facial artery was completely absent and it was
30% cases and abortive artery in only one case.
compensated by transverse facial artery which had a
When the facial artery terminated before reaching the
larger than normal diameter.[13]
lower lip, it has been called abortive artery.[9]
Understanding of the anatomy of facial artery is
The examination of 284 hemifaces by Loukas M et
necessary not only because it can be used as a pedicle
al., showed five types of facial artery termination
for some flap, such as nasolabial skin and oral
labeled “A” through “E”. Type A (47.5%): facial
mucosal flap, but because it is involved in other type
artery terminated by bifurcating into superior labial
of facial surgery such as rhinoplastic and orofacial
artery and lateral nasal; Type B (38.7%): facial artery
surgery. Therefore, knowledge about the precise
terminating as superior labial artery and lateral nasal
course and branching pattern of the facial artery is
and further lateral nasal continuing as superior alar
required. [14,15]
artery; Type C (8.4%): facial artery terminating as
Conclusion:
superior labial artery; Type D (3.8%): facial artery
The main arterial supply of face comes from facial
ending as superior alar artery; Type E (1.4%): facial
artery.
artery terminating as a rudimentary twig without
branching pattern of facial artery is very essential for
providing any significant branches.[10]
general practitioners and traumatologists who receive
Koh, Kim, Oh et al. studied the topography and the
profusely bleeding facial injuries for first aid and
course of the facial artery in 91 faces of Korean
specialized management respectively. Maxillofacial
cadavers. They reported that the final branch of the
and plastic surgeons should also give due honour to
facial artery was the lateral nasal branch in 44.0%
these anomalies before deciding about grafts and
whereas it was the angular branch in 36.3% of the
other surgical interventions in this region. Thus it is
cases. In 54.5% of the cases, the facial artery ended
very important for general surgical practitioners and
symmetrically.
[11]
The
knowledge
about
the
anomalous
specialists to know about this anomalous branching
LOHN, JW et al. studied the course, branching
pattern of facial artery for efficient management of
patterns, terminations and anomalous variants of the
injuries, correction of congenital anomalies like cleft
facial artery and vein on 201cadaveric dissections.
lip, cleft palate and while dealing with other
All branches originated from a single facial arterial
pathologies of maxillofacial region. The present case
trunk in 86% of specimens and branching patterns
may
were symmetrical in 53%. The facial artery
applications
predominantly terminated as a lateral nasal artery
maxillofacial surgery.
provide
useful
in
information
different
fields
for
of
clinical
oral
and
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ISSN: 2319-7072
International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 77-81
Figure 1: Dissection of the right side of the face showing facial and transverse facial artery. ( TFA: transverse facial
artery; ILA: inferior labial artery; SLA: superior labial artery; LNA: lateral nasal artery; AA: angular artery)
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