OBJECTIVE: The literature has for too long described the arterial supply of the mandible as coming from a single artery, the inferior alveolar artery, and being of the terminal type. Rather, it appears to come from an extensive and complex arterial network dependent on the lingual, facial, and maxillary arteries and their collateral branches. Our study aims to confirm and demonstrate the arterial vascular richness of the mandible and to establish arterial mapping.
METHODS: The arterial vascularization of the mandible was revealed in six anatomic specimens after performing selective injections of the lingual, facial, and maxillary arteries with different dyes. A specimen was injected intra-arterially with colored latex at the level of the maxillary artery for a morphometric study.
RESULTS: Eighteen selective arterial injections were performed on six anatomic specimens. The mucocutaneous, musculoperiosteal, and intramedullary vascularizations were analyzed. Each of the arteries has a defined and delimited cutaneo-mucous vascular territory. The facial and maxillary arteries supply the musculoperiosteal vascularization of the mandible from the condyle to the symphysis. The lingual artery supplies only the inner cortex of the parasymphyseal and symphyseal regions. The facial and maxillary arteries provide intramedullary vascularization from the angle of the mandible to the parasymphysis. The vascularization of the symphysis depends on the facial artery. No staining was found in the condyle region. Neoprene latex injection was performed on an anatomic specimen, revealing a permeable anastomosis between the inferior alveolar and facial arteries.
CONCLUSIONS: The arterial vascularization of the mandible is dependent on the maxillary, facial, and lingual arteries. This is a network vasculature. This study makes it possible to establish an arterial map of the mandible. The presence of an anastomosis between the inferior alveolar artery and the facial artery confirms the existence of dynamic and borrowed vascularization. Knowledge of this arterial system makes it possible to adapt maxillofacial surgical care and to anticipate possible intraoperative complications.

BACKGROUND: Injection cosmetics have become popular in recent years. The nasolabial fold is one of the most important and dangerous regions in the midface, and its three-dimensional relationship with the facial artery remains unclear.
METHODS: Fifty-two cadavers infused with lead oxide contrast medium via the external carotid arteries were scanned by computed tomography (CT). The three-dimensional model was reconstructed using Mimics and Origin software, and the relevant data were calculated using validated algorithms.
RESULTS: There were three facial artery types according to its course in relation to the nasolabial fold. In the most common type, accounting for 83.7% of specimens, the facial artery evolves into an angular artery, with a horizontal distance between facial artery and nasolabial fold of - 1.90 ± 2.40, - 3.90 ± 2.95, - 5.18 ± 3.42, - 5.59 ± 3.53, - 5.59 ± 3.83, - 6.07 ± 4.10, - 6.92 ± 3.70, - 6.79 ± 3.37, - 4.52 ± 3.20, and - 2.76 ± 3.60 (mm) from the nasal ala to the oral commissure and a vertical distance of - 4.03 ± 2.56, - 3.27 ± 2.27, - 2.81 ± 2.57, - 2.1 ± 2.64, - 1.5 ± 3.32, - 0.71 ± 3.99, 0.92 ± 4.43, 0.4 ± 5.31, - 4.14 ± 5.14, - 7.05 ± 4.74 (mm).
CONCLUSIONS: The facial artery is vulnerable to damage when injecting filler in the nasolabial fold. For the upper 1/3 of the nasolabial fold, the supraperiosteal layer is recommended for injection, while for the lower 2/3 of the nasolabial fold, the dermal layer along the nasolabial fold is recommended.
METHODS: 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 .

Background and Objectives: Facial vascular anatomy plays a pivotal role in both physiological context and in surgical intervention. While data exist on the individual course of the facial artery and vein, to date, the spatial relationship of the vasculature has been ill studied. The aim of this study was to assess the course of facial arteries, veins and branches one relative to another. Materials and Methods: In a total of 90 halved viscerocrania, the facial vessels were injected with colored latex. Dissection was carried out, the relation of the facial vessels was studied, and the distance at the lower margin of the mandible was measured. Furthermore, branches including the labial and angular vessels were assessed. Results: At the base of the mandible, the facial artery was located anterior to the facial vein in all cases at a mean distance of 6.2 mm (range 0-15 mm), with three cases of both vessels adjacent. An angular vein was present in all cases, while an angular artery was only present in 34.4% of cases. Conclusions: The main trunk of the facial artery and vein yields a rather independent course, with the facial artery always located anterior to the vein, while their branches, especially the labial vessels, demonstrate a closer relationship.

BACKGROUND: The facial artery perforator flap is a valuable alternative for reconstruction of small to medium defects in the central midface and provide pleasing cosmetic results, allowing reconstruction in a one-stage procedure. Since Doppler ultrasound is not applicable to distinguish perforator from source artery, anatomical studies are needed to identify perforator areas along the course of the facial artery.
METHODS: Twenty facial arteries of 10 fresh anatomical head specimens were dissected. All perforators with an outer diameter of at least 0.50 mm were identified and injected with dye to color their respective vascular territories. Size and location of colored skin territories as well as the location of its perforators were documented and statistically analyzed.
RESULTS: In total, 89 perforators were identified. The average number of perforators per facial artery was 4.45±1.15. The mean outer diameter of the perforator at the origin of the facial artery was 0,65±0.14 mm. The mean size of the colored skin territories was 577.57±488.81 mm2. Perforator diameters were significantly associated with the size of its resulting perforasomes. Furthermore, perforators mostly originated in two specific areas: 3.5 cm lateral and caudal and 4.5 cm lateral and 5.5 cm caudal of the anterior nasal spine.
CONCLUSIONS: This study provides evidence of two predominant locations of emergence of facial artery perforators. Additionally, the significant correlation between perforator size and its appendant perforasomes as well as their location with reference to the anterior nasal spine as relevant osseous landmarks helps surgeons in decision making for flap design and surgery.

BACKGROUND: The superior labial artery (SLA) is a facial artery (FA) that drains into the peri-oral region (dangerous area of face). Owing to the recent rise in the demand for reconstructive procedures and filler injections in this region, it is important to understand its arterial topography. This paper aims to study the embranchment pattern of the labial arteries in the eastern Indian population.
METHODS: An observational study using conventional dissection and dry dye injection methods was conducted to visualize the facial and superior labial arteries in 56 hemifaces. The origin, morphometry (length and diameter), branching pattern, and termination of the arteries were recorded and compared with the existing data.
RESULTS: Two hemifaces were excluded from analysis (vessels damaged in dissection); in the remaining 54, a single SLA was present in all samples originating at a mean distance of 1.29 ± 0.32 cm from oral commissure (68.51% originating above). Lee type II (independent SLA giving off alar branch) was the predominant pattern (56.2%), followed by type I (independent SLA and alar branches, 33%) and type III (FA terminating as SLA, 10.8%). The average length of SLA was 4.75 ± 1.28 cm and 4.56 ± 0.78 cm on the right and left sides, respectively.
CONCLUSIONS: The SLA is highly variable in occurrence, course, and depth, sometimes even occurring unilaterally; therefore, any intervention in this region should be done with caution. Since the SLA was not found subcutaneously at the vermillion border, the intradermal and the subcutaneous injections used here are relatively safer.
METHODS: 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 .

The purpose of this study was to evaluate the risk of injury to the facial (FA) and related arteries during mandibular third molar (MTM) extraction using contrast-enhanced computed tomography (CE-CT). CE-CT images of the MTM region were retrospectively reviewed. The area of the MTM was equally divided into three zones in the coronal images from mesial to distal, that is, zone 1, zone 2, and zone 3. The FA, submental artery (SMA), and sublingual artery (SLA) were identified. The distance from the mandible to FA, SMA, and SLA and the diameter of the FA, SMA, and SLA was measured in three zones, respectively. The thickness of the facial soft tissues and width of the mandible were measured at their maximum. The mean distance from the FA to the buccal cortical bone in zone 1, zone 2 and zone 3 was 2.24 mm, 2.39 mm and 1.67 mm, respectively. The SMA and SLA were found to be distal to the mandible. The mean diameter of the FA was 1.26 mm in males and 1.04 mm in females, respectively (p < 0.0001). The distance between the FA and buccal cortical bone of the mandible, and the patients\' weight showed moderate correlation in zones 1 and 2. Based on our findings, the FA can be damaged if the surgical invasion reaches the facial soft tissues during MTM surgery. The patients\' weight might be a good predictor for FA injury when CE-CT is not available.

OBJECTIVE: To determine the anatomical variations and morphology of the external carotid artery (ECA) and its anterior branches.
METHODS: Using computed tomography angiography (CTA), the origin, internal diameter, and surface laterality emergence of the superior thyroid (STA), lingual (LA), and facial (FA) arteries were evaluated retrospectively evaluated and classified. The bifurcation level of the common carotid artery (CCA) in relation to the cervical vertebrae and disc was also determined.
RESULTS: A total of 76 CTA were included in the study. STA originated from the carotid bifurcation (CB) (type I), CCA (type II) and ECA (type III) in 20.4 (31/152), 17.1 (26/152) and 50.7% (77/152) cases, respectively. Also 10.5% (16/152) arose from a shared trunk with LA as a thyrolingual trunk (TLT) (type IVa), and absent in 1.3% (2/152). LA originated in the CB in only one case. A linguofacial trunk (LFT) was present in 14.5% (22/152). Mean diameters of STA, LA and FA were 1.70, 1.95 and 2.45 mm, respectively. Meanwhile, surface laterality were predominately from anteromedial, medial, and anterior, respectively. CB was mainly on C3 or C3-C4 (55.9% of cases).
CONCLUSIONS: STA origin below the ECA is a common finding. Our population presented the highest percentage of TLT (10.5%) and high CB (9.8%) in literature. Considering these variations are important to prevent complications in neck surgical procedures.

OBJECTIVE: Resection of the submandibular gland (SMG) is a common surgery and many surgeons leave a drainage system in the surgical field. However, surgical drain may increase risk of complication and related prolonged hospitalization time. The purpose of this study was to investigate the safety of SMG resection without any surgical drainage system.
METHODS: This retrospective trial on SMG surgery was conducted between 2016 and 2019. Patients were assigned into one of two main groups: surgical drain (+) (n=20) and surgical drain (-) (n=17). All surgical procedures were done via a standardized surgical technique. Facial vessels were dissected and only glandular branches were ligated. Also, non-identification method was applied for marginal mandibular nerve (MMN) protecting. In surgical drain (-) group, before the wound closure, oxidized regenerated cellulose (ORC) was placed in the surgical field. Moreover, a closed suction drain was inserted in surgical drain (+) group.
RESULTS: A total of 37 SMG resections were performed: 15 patients had sialolithiasis, 14 patients had pleomorphic adenoma and 8 patients had chronic sialadenitis. There were 20 women (54%) and 17 men (46%), with an age range of 23-70 years. No major complications were observed in surgical drain (-) group. There were two cases with minor complications. One patient (5.8%) occurred transient paralysis of the MMN. Other patient developed seroma and it was easily managed with repeated punctures. ORC related allergic reaction or adverse incident were not detected in any of the patients. On the other hand, in surgical drain (+) group, 2 patients (10%) developed a hematoma on the first postoperative day and local wound infection was detected in 4 patients (20%). We found that the surgical drain usage was related to prolonged hospitalization, worse wound healing and problems with scarring.
CONCLUSIONS: Our findings provide evidence for the safe drainless resection of the SMG using ORC. It may be possible to prevent all of these undesirable conditions by a surgery which performed without drain insertion.

OBJECTIVE: Blood supply of the skin of the face is mainly provided by 3 branches of the external carotid artery: facial artery (FA), superficial temporal artery (STA) and transverse facial artery (TFA) which is a branch of the STA. The aim of the study was to describe the arterial territories of the skin of the face depending on the external carotid branches.
METHODS: After dissection of the first two centimeters of these arteries on one side, we performed an injection of India ink of different colors in the arteries in order to describe the arterial territories (angiosomes) of the face on 24 embalmed cadavers.
RESULTS: The lips and the tip of the nose were vascularized in most cases by the FA. The STA vascularizes the temporal and frontal areas and a part of the auricle. The buccal area blood supply is coming from the FA with a participation of the TFA which is variable (10/24 cases), and the zygomatic area blood supply is coming from the STA with a participation of the TFA (9/24 cases).
CONCLUSIONS: Variations in the angiosomes of the face have to be considered in reconstructive surgery, and in face transplantation.

Hemorrhage remains a major potential risk when performing any form of transoral surgery. This is the first study to focus on the location of the facial artery \"bulb\" (FaB) and its tonsillar branches within the parapharyngeal space (PPS) from the perspective of the transoral surgeon.
A total of 44 hemi-sections were dissected via the transoral approach with endoscopic assistance: 26 from fresh-frozen specimens and 18 formalin-fixed hemi-sections. The distance from the superior apex of the FaB to the pterygoid hamulus (PH) was recorded, and the arterial branching variations described.
The average distance from the PH to the FaB was 4.17 ± 0.4 cm. In 90.9% of cases, the two tonsillar artery branches passed between styloglossus muscle (SGM) and stylopharyngeus muscle (SPM).
Understanding the FaB location and its branching patterns offers the surgeon confidence dissecting in the PPS transorally.