Exploring the efficacy of laser speckle contrast imaging in the stratified diagnosis of rosacea: a quantitative analysis of facial blood flow dynamics across varied regions.

Background: Rosacea has a high incidence, significantly impacts quality of life, and lacks sufficient diagnostic techniques. This study aimed to investigate the feasibility of laser speckle contrast imaging (LSCI) for measuring facial blood perfusion in patients with rosacea and to identify differences in blood flow among various facial regions associated with different rosacea subtypes. Methods: From June to December 2023, 45 patients were recruited, with 9 excluded, leaving 36 subjects: 12 with erythematotelangiectatic rosacea (ETR), 12 with papulopustular rosacea (PPR), and 12 healthy controls. The Think View multispectral imaging analyzer assessed inflammation via gray reading values across the full face and five facial areas: forehead, nose, cheeks, and chin. LSCI measured and analyzed blood perfusion in the same areas. Plasma biomarkers interleukin-6 (IL-6), IL-1ß, and tumor necrosis factor-α (TNF-α) were tested in different groups. Results: Both ETR and PPR groups showed increased average blood perfusion and facial inflammation intensity by gray values compared to controls, with statistically significant differences. Average blood perfusion of ETR and PPR groups showed increased values in the forehead, cheeks, and nose, compared to controls, and the values in the cheeks were statistically different between ETR and PPR. The facial inflammation intensity of the ETR group showed increased values in the forehead and cheeks, and the PPR group showed increased gray values in the forehead, cheeks, nose, and chin compared to controls, and the values for the cheeks, nose, and chin were statistically significantly different between ETR and PPR. Plasma biomarkers IL-6, IL-1ß, and TNF-α were significantly elevated in both ETR and PPR groups compared to controls. Conclusion: LSCI is a valuable, non-invasive tool for assessing blood flow dynamics in rosacea, providing a data foundation for clinical research. Different rosacea subtypes exhibit distinct lesion distribution and blood flow patterns, and both ETR and PPR could affect all facial areas, particularly the cheeks in ETR and the forehead, nose, and chin in PPR.

Leveraging 3D convolutional neural network and 3D visible-near-infrared multimodal imaging for enhanced contactless oximetry.

Significance: Monitoring oxygen saturation ( SpO 2 ) is important in healthcare, especially for diagnosing and managing pulmonary diseases. Non-contact approaches broaden the potential applications of SpO 2 measurement by better hygiene, comfort, and capability for long-term monitoring. However, existing studies often encounter challenges such as lower signal-to-noise ratios and stringent environmental conditions. Aim: We aim to develop and validate a contactless SpO 2 measurement approach using 3D convolutional neural networks (3D CNN) and 3D visible-near-infrared (VIS-NIR) multimodal imaging, to offer a convenient, accurate, and robust alternative for SpO 2 monitoring. Approach: We propose an approach that utilizes a 3D VIS-NIR multimodal camera system to capture facial videos, in which SpO 2 is estimated through 3D CNN by simultaneously extracting spatial and temporal features. Our approach includes registration of multimodal images, tracking of the 3D region of interest, spatial and temporal preprocessing, and 3D CNN-based feature extraction and SpO 2 regression. Results: In a breath-holding experiment involving 23 healthy participants, we obtained multimodal video data with reference SpO 2 values ranging from 80% to 99% measured by pulse oximeter on the fingertip. The approach achieved a mean absolute error (MAE) of 2.31% and a Pearson correlation coefficient of 0.64 in the experiment, demonstrating good agreement with traditional pulse oximetry. The discrepancy of estimated SpO 2 values was within 3% of the reference SpO 2 for ∼ 80 % of all 1-s time points. Besides, in clinical trials involving patients with sleep apnea syndrome, our approach demonstrated robust performance, with an MAE of less than 2% in SpO 2 estimations compared to gold-standard polysomnography. Conclusions: The proposed approach offers a promising alternative for non-contact oxygen saturation measurement with good sensitivity to desaturation, showing potential for applications in clinical settings.

Facial vascular visualization enhancement based on optical detection technology.

OBJECTIVE: This study aims to develop a facial vascular enhancement imaging system and analyze vascular distribution in the facial region to assess its potential in preventing unintended intravascular injections during cosmetic facial filling procedures. METHODS: A facial vascular enhancement imaging system based on optical detection technology was designed, and volunteers were recruited. The system was utilized to detect and analyze vascular distribution in various anatomical regions of the faces. The vascular visualization-enhanced (VVE) images generated by the system were compared with visible light images to validate the vascular visualization capability of the system. Additionally, the reliability of vascular visualization was assessed by comparing the observed vascular patterns in the VVE images with those in near-infrared light images. RESULTS: Thirty volunteers were recruited. The VVE images produced by the system demonstrated a significant capacity to identify vascular morphology and yielded a higher vessel count compared to visible light images, particularly in the frontal, orbital, perioral, mental, temporal, cheek, and parotid masseter regions (P < .05). The temporal region exhibited the highest vascular density, followed by the cheek region and then the frontal region. Reliability analysis of vascular visualization enhancement indicated that the system's imaging of facial vasculature not only demonstrated reliability but also enhanced physicians' visual perception. CONCLUSION: Blood vessel distribution varies across facial regions. The facial vascular enhancement imaging system facilitates real-time and clear visualization of facial vasculature, offering immediate visual feedback to surgeons. This innovation holds promise for enhancing the safety and effectiveness of facial filling procedures.

Submental Artery Perforator Flap Drained Solely With the Vena Comitans of Facial Artery.

BACKGROUND: The submental artery perforator flap (SMAPF) is an alternative to reconstruct oral and maxillofacial defects secondary to oral cancers. However, vascular anomalies or surgical damage often lead to vascular crises or harvest failure. Our clinical findings suggest that the vena comitans of the facial artery (cFA) very commonly exist. This study aimed to investigate the reliability of the cFA as a sole venous reflux route for the SMAPF. METHOD: The patients were from the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Jilin University. All patients were treated for oral cancer between January 2016 and September 2022. Seventeen SMAPFs were successfully raised to reconstruct the postoperative defects, of which 7 had cFA as the sole reflux route. RESULTS: The size of the flaps varied from 4.0×3.0 cm to 12.0×3.0 cm. All flaps survived. Patients were followed from 1 month to 5 years. Satisfactory restoration of contour and functional outcomes were achieved at the recipient sites. The scars were well camouflaged in the submental region. No local or regional recurrence was detected during follow-up. Patients had an overall 2-year survival rate of 100% with no suspected flaps-related recurrence. CONCLUSIONS: The cFA as the sole venous reflux route for SMAPF is reliable for flap harvesting and is applicable for immediate defect reconstruction secondary to cancer resection.

Course and Relation of the Facial Vessels-An Anatomical Study.

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.

Cervicofacial Subcutaneous Emphysema and Pneumomediastinum Following Class V Resin Restoration: A Case Report.

Air can become trapped within the subcutaneous layer of the cervicofacial area, a condition known as subcutaneous emphysema (SE), unexpectedly after routine dental procedures. SE can worsen by extending superiorly to the peri-orbital region and inferiorly to the thorax and abdomen along the fascial planes. Upward progression can result in cavernous sinus thrombosis. Conversely, downward progression can cause a variety of complications such as pneumothorax, mediastinitis, and compression of the venous trunks. The presence of these conditions highlights the significance of prompt identification, precise diagnosis to ascertain the need for immediate intervention, and suitable management to prevent additional unfavorable consequences.

The Safety of Injections in the Infraorbital Region.

BACKGROUND:  Infraorbital filler injection is a commonly used minimally invasive cosmetic procedure on the face, which can cause vascular complications. OBJECTIVE:  In this study, we aimed to explore the anatomical structure of the infraorbital vasculature and to establish an accurate protocol for infraorbital filler injection. METHODS:  The vascular structure of the infraorbital region was evaluated in 84 hemifacial specimens using computed tomography. Four segments (P1-P4) and five sections (C1-C5) were considered. We recorded the number of identified arteries in each slice and at each location and the number of deep arteries. Furthermore, we also measured the infraorbital artery (IOA) distribution. RESULTS:  At P1-P4, the lowest number of arteries was detected in segment P4, with a 317/1727 (18.4%) and 65/338 (2.3%) probability of total and deep arterial identification, respectively. The probabilities of encountering an identified artery at the five designated locations (C1-C5) were 277/1727 (16%), 318/1727 (18.4%), 410/1727 (23.7%), 397/1727 (23%), and 325/1727 (18.8%), respectively. The probability of an IOA being identified at C2 was 68/84 (81%). CONCLUSION:  We described an effective filler injection technique in the infraorbital region to minimize the associated risks. LEVEL OF EVIDENCE IV: 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 .

Reticulated livedoid skin patterns after soft-tissue filler-related vascular adverse events.

BACKGROUND: For the treatment of vascular adverse events caused by filler injections, duplex ultrasound imaging may be used. The findings of duplex ultrasound examination and the clinical features of reticulated livedoid skin patterns were compared with the hemifaces anatomy. OBJECTIVE: The objective of this study was to link the reticulated livedoid skin patterns to the corresponding duplex ultrasound findings and the facial perforasomes. METHODS: Duplex ultrasound imaging was used for the diagnosis and treatment of vascular adverse events. The clinical features and duplex ultrasound findings of 125 patients were investigated. Six cadaver hemifaces were examined to compare the typical livedo skin patterns with the vasculature of the face. RESULTS: Clinically, the affected skin showed a similar reticulated pattern in each facial area corresponding with arterial anatomy and their perforators in the cadaver hemifaces. With duplex ultrasound, a disturbed microvascularization in the superficial fatty layer was visualized. After hyaluronidase injection, clinical improvement of the skin pattern was seen. Normalization of blood flow was noted accompanied by restoration of flow in the corresponding perforator artery. The skin patterns could be linked to the perforators of the superficial fat compartments. CONCLUSION: The livedo skin patterns seen in vascular adverse events may reflect the involvement of the perforators.

Ultrasonographic Evaluation of Facial Artery in the Nasolabial Fold for Gender Differences and Symmetry Between Hemifaces.

OBJECTIVES: The aim of this study was to establish the relationship of facial artery with nasolabial fold by color Doppler sonography and to determine facial artery variations and their relationship with age, gender, or hemifaces. METHODS: The study included 188 patients (94 women, 94 men) aged 18-60 years. Overall, 376 facial arteries in both hemifaces were evaluated for the course within nasolabial fold, symmetry, and relationship with gender. RESULTS: The mean age of the patients was 39.29 ± 12.81 years. Type A (55.7%) was the most common type in both hemifaces. There was no significant relationship between the course of facial artery and age (P > .05). Asymmetrical course of facial artery was more common in females (54.3%). In both genders, type A was the type with highest symmetry detected. CONCLUSIONS: Nasolabial fold is one of the important facial regions for filler injection. To prevent vascular injection, course of facial artery should be identified within the nasolabial fold. Type A was the most common type in both hemifaces and genders. Although the rates were close to each other, asymmetry in the course of the facial artery was observed in most of the patients. Ultrasonographic examination which is non-invasive and non-ionizing imaging method can be performed carefully before filler injection to determine vascular tissues.

Nicolau Syndrome with Severe Facial Ischemic Necrosis after Endodontic Treatment: A Case Report.

Nicolau syndrome (NS) is a rare complication resulting from intramuscular injections. It is characterized by severe pain at the injection site and the development of purplish discoloration. Only a limited number of case reports have been published documenting the adverse effects associated with the injection of calcium hydroxide (CH) beyond the apex during endodontic treatment. Here, we present the case of a 16-year-old female with NS after the injection of CH during the root canal treatment. The radiography examination revealed distal occlusion of the right maxillary and facial arteries. This caused a substantial area of skin necrosis to develop on the patient's face, resulting in permanent scarring. NS is associated with the displacement of CH beyond the apex. To minimize the risk of NS, dentists should exercise caution by avoiding forced injection of CH during treatment, particularly when the root canal is actively bleeding.

Hotspots of facial artery perforators and perforasomes for easier flap guidance: An anatomical study.

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. CONCLUSION: 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.

A roadmap for safety during facial filler injections: A fresh frozen cadaver study.

BACKGROUND: Filler injections are commonly applied to reshape facial contouring. However, cadaveric injections of filler for facial contouring on the whole face, followed by anatomic analysis and measurement, have rarely been reported. This study aimed to provide comprehensive anatomical information, including topographies and roadmap of injection point entry, penetration depth, filler location, the hierarchy of facial structure, and vital vascular course. METHODS: Thirty faces on fresh frozen cadaver heads were used for this anatomic study. The whole face was divided into seven facial zones and 14 injection points for penetration depth measurement and cadaveric injection. Static periosteum injections with a sharp-needle technique were performed. Specimens were then dissected to observe the precise locations of fillers and their relationships with surrounding anatomic structures. RESULTS: The topography of penetration depth gradually increased from the upper face to the middle face, lower face, and temporal region. Most of the injected hyaluronic acid filler flowed backward to the loose areolar tissue layer between the superficial musculoaponeurotic system and periosteum or deep fascia. Multilevel layer distributions and anastomosis of the vessels were found in the face, especially in the glabella, dorsum nasi, and temporal regions. CONCLUSIONS: This study can provide clinicians with a comprehensive reference for facial contouring injections: topographies of the injection point and penetration depth and the vascular anatomical structure in high-risk facial zones. The static periosteum injection with effective aspiration is recommended as a relatively safe technique. Clinicians are supposed to grasp the anatomy and injection technique to achieve maximum safety during filler injections.

Analysis of facial vascular pattern characteristics in the Korean population.

BACKGROUND: Facial erythema is a common problem among patients visiting dermatologists. However, data on the clinical characteristics of facial erythema in healthy people are lacking. We aimed to compare and analyze the severity and pattern of facial vascularity in healthy subjects based on their age and gender. MATERIALS AND METHODS: This study included 198 Korean volunteers (126 females and 72 males) with Fitzpatrick skin types II, III, or IV. Fourteen different anatomical areas on the face were divided into facial erythema units. Each unit was scored from one (least erythematous) to five (most erythematous) according to the observed level of erythema on the red images implemented as hemoglobin content. We also evaluated the presence of facial telangiectatic macules. RESULTS: On average, the perinasal, nasal, and cheek units were the most hypervascular regions. In contrast, the degree of facial erythema was lowest in the labial (perioral), neck, and temporal regions. The average value of erythema was higher in males than in females. Additionally, the severity of erythema tended to increase with age. In both males and females, the number of telangiectatic macules increased with age. CONCLUSIONS: We analyzed the clinical characteristics of erythema in healthy subjects with Fitzpatrick skin types II, III, or IV in the Korean population. This study is expected to be used to identify the neurovascular pathogenesis of the most common regions of facial dermatosis in the future.

A Computed Tomographic Investigation of the Ophthalmic Artery Volume and Its Relevance to Soft Tissue Filler Injections.

BACKGROUND: The measured intraarterial volume of cadaveric ophthalmic arteries was utilized for safety recommendations during facial soft tissue filler injections. However, its clinical practicability and model applicability have become questionable. OBJECTIVES: To measure the volume of the ophthalmic artery in living individuals by utilizing computed tomography (CT) imaging technology. METHODS: A total of 40 Chinese patients (23 males, 17 females) were included in this study with a mean age of 61.0 (14.2) years and a mean body mass index of 23.7 (3.3) kg/m2. Patients were investigated with CT imaging technology to evaluate the length, diameter, and volume of the bilateral ophthalmic arteries as well as the length of the bony orbits, resulting in a total of 80 investigated ophthalmic arteries and orbits. RESULTS: Independent of gender, the average length of the ophthalmic artery was 80.6 (18.7) mm, the calculated volume of the ophthalmic artery was 0.16 (0.05) mL and the minimal and maximal internal diameter of the ophthalmic artery were 0.50 (0.05) mm and 1.06 (0.1) mm, respectively. CONCLUSIONS: Based on the results obtained from the investigation of 80 ophthalmic arteries it must be concluded that current safety recommendations should be reevaluated. The volume of the ophthalmic artery appears to be 0.2 mL rather than 0.1 mL as previously reported. In addition, it appears impractical to limit the volume of soft tissue filler bolus injections to 0.1 mL due to the aesthetic requirements of each individual patient and treatment plan.

Lower Nose Arterial Plexus and Implications for Safe Filler Injections.

BACKGROUND: The lower nose has abundant blood supply; however, nasal tip necrosis still occurs following filler injections. This study revealed the complicated pattern of the arterial supply of the lower nose. METHODS: The arterial pattern of the lower nose was studied in 40 cadavers using conventional dissections and translucent modified Sihler staining. RESULTS: Two arterial rings were connected in a figure of eight. The upper ring (nasal arterial circle) consisted of the lateral nasal and the subalar arteries encircling the nasal tip and alae. The lower ring (arterial plexus of the upper lip) was more important because of the contribution of the facial and superior labial arteries. This specific feature had not been mentioned elsewhere. CONCLUSION: Understanding this specific feature of the blood supply of the lower nose is essential for aesthetic physicians to perform the appropriate techniques during filler injection procedures in the nasal and perioral regions.

Lateral branches of the facial artery and its clinical implications.

The facial artery is the main artery supplying blood to the face and is known to have facial branches of the inferior labial, superior labial, lateral nasal and angular arteries. These known major branches of facial artery run medially, however, there are sometimes branches of the facial artery heading laterally. The purpose of the present study was to investigate the lateral branches of the facial artery in face. We dissected facial branches of the facial artery in 74 cadaveric hemifaces. We investigated the presence of the lateral branches of the facial artery. Following parameters were investigated: lateral branch presence, the location of its origin, and the lateral branch diameter. Among the lateral branches, we evaluated the prevalence and diameter of the premasseteric branch. Lateral branches were observed in 48 of the 74 hemifaces (64.9%). The total number was 81 in the 48 hemifaces. The most common origin was between the inferior border of the mandible and inferior labial artery origin (42 of 81, 51.9%). The mean diameter of all lateral branches of the facial artery was 0.7 mm. Among the lateral branches, the premasseteric branches were present in 38 of 74 specimen (51.4%) and the mean diameter was 0.8 mm. The lateral branches of the facial artery may be registered in Terminologia Anatomica based on their prevalence. Accurate knowledge of the anatomy of the lateral branches of the facial artery is helpful for clinicians to avoid complications during facial procedures or maxillofacial surgeries.

Upper Facial Anastomoses Between the External and Internal Carotid Vascular Territories - A 3D Computed Tomographic Investigation.

BACKGROUND: Facial regions with a high risk for causing injection-related visual comprise are dual-supply vascular areas such as the nose, glabella, and forehead. These regions have in common that they receive arterial blood supply both by branches of the internal (ICA) and the external carotid artery (ECA). OBJECTIVE: The authors sought to investigate the anastomotic pathways between ICA and ECA branches in the upper face. METHODS: Postmortem computed tomographic angiographic scans of n = 38 Chinese non-embalmed hemifaces (25 males, 13 females; mean age, 37.79 [11.8] years; mean BMI, 21.90 [2.3] kg/m2) were conducted. Data analysis relied on the calculation of depth, distances, and pathways of forehead and temporal arteries to investigate the number of anastomotic connections, the connecting branches, and the layer of connection between ICA and ECA territories. RESULTS: Between ICA and ECA territories, only 1 connection in 57.9%, 2 connections in 31.6%, 3 connections in 5.3%, and 4 and 5 connections in 2.6% each were identified. A superficial connection was observed in 15.8% whereas in 84.2% the anastomotic connection was identified to be both superficial and deep. CONCLUSIONS: Adverse events following facial minimally invasive soft-tissue filler injections for aesthetic purposes are not frequent but devastating if they occur. Anatomic knowledge as presented in this study can help to increase awareness of 3-dimensional vascular anastomotic pathways and identify safer injection zones and safer fascial planes. Evidence-based injection techniques should be followed, and safety aspects should be placed over the aesthetic outcome.

Descriptive Study on Vascular Anatomy of the Upper Lip.

INTRODUCTION: 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. METHOD: 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. CONCLUSION: 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. LEVEL OF EVIDENCE IV: 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 .