| Background and objective Improper operation of facial rhytidectomy can lead to serious bleeding complications.The purpose of this study is to clarify the course of the branches of the transverse facial artery through anatomical research,and provide detailed measurement data on the location of the branches of the transverse facial artery,and to explore the anatomical characteristics of the branches of the transverse facial artery,so as to provide a certain anatomical basis for the design of the superficial fascia flap in facial rhytidectomy.Under the guidance of anatomic basis,the improvement of facial rhytidectomy should be carried out in clinical application.The location of transverse facial artery branches related to clinical facial rhytidectomy,the location of zygomatic arch and the relationship with superficial aponeurosis system should be objectively evaluated and analyzed.The safety of facial rhytidectomy and the effect achieved after operation should be optimized,so as to avoid bleeding and hematoma during and after operation.According to the experience of clinical application,it can help doctors avoid the occurrence of iatrogenic hemorrhage in facial rhytidectomy,and provide clinical reference guidance for rapid swelling reduction and shortening the recovery period.Materials and methods Basic part: Anatomic observation was carried out on 14 fixed head and neck specimens and 1 fresh adult head and neck specimen,11 of which were used for gross anatomy,2 of which were used for making arterial vascular cast specimens,1 of which was used for making P45 sectional plastic specimens,and the relationship between the start,stop,running position and distribution of the branches of the transverse facial artery,the location of the zygomatic arch and the superficial aponeurotic system was observed.Clinical part: From 2018 to 2019,there were 22 cases of face wrinkle removal in Anshan Qimin plastic and aesthetic hospital,all of them were female,38-67 years old,with an average age of 54 years.The main manifestations were facial skin relaxation,accompanied by upper eyelid skin relaxation and nasolabial groove deepening.The facial relaxation caused by myogenic,neurogenic and metabolic diseases is excluded.The location of the transverse facial artery branches through the zygomatic ligament was observed.The diameter of the branches of the transverse facial artery was measured.Result Basic part: 12 cases(24 sides)of the transverse facial artery with branches related to zygomatic arch were observed.The average number of branches was 1.17,the incidence of one branch was 83.3%,the incidence of more than two branches was1.67%,and the average diameter of branches was 1.02 ± 0.4mm.In the zygomatico buccal region,the branches start from the transverse facial artery and appear in the8 mm wide area below the zygomatic arch.The average distance between the starting point and the horizontal line of the epicanthus is 28.5 ± 3.5mm,and the average distance from the vertical line of the epicanthus is 38.9 ± 4.3mm.In the zygomatic arch area,all branches pass through the zygomatic arch ligament,and 14 cases pass through the lateral 1/3 of the zygomatic arch.The average distance between the crossing position and the horizontal line of the epicanthus point is 19.8 ± 5.1mm,and the average distance from the vertical line of the epicanthus point is 28.4 ± 5.6mm;4cases pass through the medial 1/3 of the zygomatic arch,and the average distance between the crossing position and the horizontal line of the epicanthus point is 20.4 ±3.1mm,and the distance from the epicanthus point to the vertical line of the epicanthus point is 20.4 ± 3.1mm The average distance of straight line is 10.3 ±8.6MM.In the zygomatic temporal region,the branches of the facial transverse artery passing through the zygomatic arch ligament go upward and inwards,and the average distance between the point passing through the SMAS layer and the horizontal line of the outer canthus point is 9.8 ± 7.6mm,and the average distance between the point passing through the SMAS layer and the vertical line of the outer canthus point is 13.7± 3.1mm.The subdermal vascular network was formed on the lateral side of the orbit,and the branches of the transverse facial artery were anastomosed with the adjacent subcutaneous artery: 17 of the 18 cases were accompanied by the superficial temporal artery,the branches of the transverse facial artery anastomosed with the zygomatic orbital artery(15 of the 18 cases)or the frontal branch of the superficial temporal artery(oblique ascending branch);6 cases showed 2 branches of the transverse facial artery;the recurrent branch was in the opposite direction to the main transverse facial artery The branches(100% of them)were in the lower layer of the skin in front of the ear,and the descending branches(3 of 6 cases)were in the lower layer of the skin in the cheek and anastomosed with the submental artery.Clinical part: 22 patients with flabby face were treated with facial lifting operation by preserving the transverse facial artery branches.All the operations were successful.After follow-up,the patients were satisfied with the effect of wrinkle removal after operation.The symptoms of the lower part of the patients were obviously improved.The angular pouch and nasolabial groove were significantly shallower.The contour of the mandible margin was clearer than that of the front.The wrinkles basically disappeared during the facial movement.After operation,only continuous skin texture could be seen at rest.There was no hematoma and other complications.There was no sensory abnormality in the skin of cheek.The function of facial muscles was normal.The patients were followed up for 6-8 months.During the operation,the branches of the transverse facial artery(oblique ascending branch)crossed the superior margin of the zygomatic arch in the third segment outside the zygomatic arch.It was observed that the incidence of one oblique ascending branch was 68.2%(15 / 22),and that of more than two oblique ascending branches was 31.8%(7 / 22).After passing through the ligaments of zygomatic arch and crossing over the upper edge of zygomatic arch,it goes up and down from the outside to the inside.On the zygomatic face,it goes under the SMAS layer and joins the zygomatic orbital artery on the outside of the orbit.In 22 patients with facial elevation,the ligaments of zygomatic arch were incisively dissected.The average diameter of the branches of the transverse facial artery crossing the zygomatic arch here was 0.9 ± 0.4mm.During the operation,the artery could not be disconnected,and the artery was kept or cauterized.During the operation,the patient had less bleeding,covered with a small amount of gauze,without hematoma,and the swelling recovery period was 1-3 days.Conclusion1.The branches of the transverse facial artery include the superior oblique ascending branch,the recurrent branch and the descending branch.The oblique ascending branch related to zygomatic arch is relatively constant,with single branch type as the main type,diameter of 1.02 ± 0.4mm,mostly crossing the posterior 1 / 3 segment of zygomatic arch and entering temporal area.The horizontal distance between branch point and outer canthus point is 28.5 ± 3.5mm,and the vertical distance is 38.9 ±4.3mm.2.It can effectively reduce intraoperative bleeding and shorten the postoperative recovery period if the transverse artery branches of the face not disconnected or the proximal part retained during the facial rhytidectomy. |
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