Transverse mesocolic hernia with intestinal obstruction as a rare cause of acute abdomen in adults: A case report.

BACKGROUND: Internal hernia is a rare cause of acute abdomen and intestinal obstruction in adults. Internal abdominal hernias include paraduodenal, perigastric, foramen of Winslow, intersigmoid, and post-anastomotic hernias and can be congenital or acquired. Internal hernias occur in 1%-2% of patients, and transmesocolic hernias are extremely rare. This report presents a patient with a transverse mesocolic hernia with a preoperative diagnosis of small intestinal obstruction. CASE SUMMARY: A 45-year-old Chinese woman was admitted to the hospital with middle and upper abdominal pain for 2 d, abdominal distension, and vomiting. After abdominal computed tomography, she was diagnosed with an internal abdominal hernia complicated by small intestinal obstruction and underwent emergency laparoscopic surgery. The patient recovered well and was discharged 6 d postoperatively. CONCLUSION: Transmesocolic hernias must be considered in adult patients with signs and symptoms of intestinal obstruction, even without a history of abdominal trauma or surgery.

New Insight into Glabellar Arteries: A Three-Dimensional Computed Tomography and Dissection Study.

BACKGROUND: Vascular complications from glabellar intravascular filler injections are major safety concerns. Filler injection into the glabella without precise knowledge of its vascular topography poses a risk of severe complications. METHODS: Computed tomography was used to study 90 cadaveric heads after contrast agent and filler injection, and 15 cadaveric heads were dissected. RESULTS: Central (CAs), paracentral (PCAs), and reverse dorsal nasal arteries (rDNAs) were found in 70 (38.9%), 58 (32.2%), and 16 (8.9%) of the 180 hemifaces, respectively. Based on the presence of CAs, PCAs, and rDNAs between the bilateral supratrochlear arteries (STAs), glabellar arteries were categorized into two main patterns: in type 1 [without named arteries between bilateral STAs; 22 of 90 (24.4%)], the glabella was supplied by bilateral STAs and their branches; in type 2 [with named arteries between bilateral STAs; 68 of 90 (75.6%)], the glabella was supplied by bilateral STAs and CAs, PCAs, and rDNAs. Type 2 could be further divided into three subtypes: in type 2a [45 of 90 (50.0%)], the glabella was supplied by bilateral STAs and one of the named arteries; in type 2b [21 of 90 (23.3%)], the glabella was supplied by bilateral STAs and two of the named arteries; and in type 2c [two of 90 (2.3%)], the glabella was supplied by bilateral STAs and unilateral CA, PCA, and rDNA. CONCLUSION: This study elucidated novel arterial systems and proposed considerations for glabellar filler injection.

Positions of the Glabellar Arteries: Implications for Glabellar Injection.

BACKGROUND: Glabellar filler injection is linked to an increased risk of blindness. A thorough understanding of vascular changes in the glabellar area is critical for safety. The study's goal was to precisely determine the three-dimensional placements of the arteries in the glabellar area. METHODS: In 117 cadavers, the vascular structures in the glabellar area were examined. There were four segments (S1/S1'-S4/S4') and five points (P1-P5) specified. The number of identified arteries found in each section and at each position was tallied. Additionally, the depth of the underlying identified artery under each site was measured. RESULTS: One to three named arteries per glabellar segment were found. Each segment had at least one named artery, and the number of named arteries detected between S1/S1' and S4/S4' decreased. The chance of encountering identified arteries at the 5 designated locations, P1-P5, was 7/117 (6.0%), 6/117 (5.1%), 7/117 (6.0%), 6/117 (5.1%), and 16/117 (13.7%), respectively. At P1-P5, the major artery trunk was 1.8 ± 0.3 mm, 1.6 ± 0.3 mm, 1.4 ± 0.2 mm, 1.3 ± 0.3 mm, and 1.1 ± 0.2 mm below the skin. CONCLUSIONS: The site of the glabellar arteries was clearly shown in this investigation; these arteries were met at a rate of 14% from P1 to P5. We demonstrated that a single entry site through the glabella via cannula could readily keep the needle deep enough for safe glabellar filler injection. LEVEL OF EVIDENCE V: 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 .

Vasculature of the Nasal Cartilage Region Related to Filler Injection.

BACKGROUND: A filler injection in the nose can be essential but is also dangerous, especially in the nasal cartilage region. To safely and accurately perform a filler injection, surgeons must have detailed knowledge of nasal anatomy. OBJECTIVES: Associated the vessel branches and the characteristics of different nasal regions to provide suggestions for more suitable injection sites. METHODS: Fifty specimens underwent computed tomography (CT) after contrast infusion. Qualified specimens were selected for 3D CT reconstruction. Dissection was performed to confirm the accuracy of the CT data. RESULTS: The branches of arteries with large diameters, the dorsal nasal artery (DNA) and the lateral nasal artery (LNA) were distributed within the superficial musculoaponeurotic system layer. The DNA was seen in only 58% of specimens. The artery crossed the midline over the upper lateral cartilage in 16% of specimens. The LNA was a constant branch that traversed the nasal tip. The LNA crossed the midline to the contralateral side in 18% of patients. We divided the nasal cartilage dorsum into two regions for easy handling: the supratip region (STR) and the nasal tip region (NTR). The branches distributed in the STR mostly originated from the DNA (81.6%, 40/49), while those in the NTR mostly originated from the LNA. CONCLUSIONS: The vasculature of the nasal cartilage region observed in this study is similar to that observed in previous studies. However, we found that the STR was an advantageous area for filler injection. At the same time, we provided suggestions for more suitable injection methods. 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 .

Deployment of the Ophthalmic and Facial Angiosomes in the Upper Nose Overlaying the Nasal Bones.

BACKGROUND: Nasal filler placement is associated with a high risk of blindness. The arterial supply to the upper nose overlaying the nasal bones is poorly understood. OBJECTIVES: The aim of this study was to visualize and analyze the deployment of the ophthalmic and facial angiosomes in the upper nose to help prevent blindness following nasal filler injections. METHODS: The arterial systems of 62 cadaveric heads were filled with lead oxide contrast agent, and computed tomography (CT) images were acquired and reconstructed in 3 dimensions. RESULTS: Twenty-six of the cadaveric noses examined demonstrated clear CT images of the facial and ophthalmic angiosomes in the upper nose. The Type 1 upper nose (15.4%) is supplied by 2 independent ophthalmic angiosomes that communicate indirectly through a choke anastomosis. The Type 2 upper nose (38.5%) is supplied by 2 ophthalmic angiosomes with a true anastomosis between them. The Type 3 upper nose (46.1%) is supplied by both ophthalmic and facial angiosomes with true anastomoses across the dorsal midline. These true anastomoses are mediated by the radix arcade in 46% of the noses and involve the dorsal nasal artery in 65% of the cases. The anastomoses all cross the upper dorsal midline and are directly linked to the ophthalmic angiosome. CONCLUSIONS: The deployment and anastomosis of the facial and ophthalmic angiosomes in the upper nose fall into 3 major patterns. About 85% of the noses have true anastomotic arteries that cross the upper dorsal midline and are directly linked to the ophthalmic circulation. Dorsum filler injection poses a significant risk of blindness.

Three-Dimensional Computed Tomographic Study on the Vessels of the Zygomatic Region: Arterial Variations and Clinical Relevance.

BACKGROUND: Injection-based techniques for "cheek augmentation" have gained popularity in recent years. The aim of this study was to perform a topographic analysis of the depth and distribution of the vessels in the zygomatic region to facilitate clinical procedures. METHODS: The external carotid arteries of seven cadaveric heads were infused with lead oxide contrast medium. The facial and superficial temporal arteries of another 12 cadaveric heads were injected sequentially with the same medium. Computed tomographic scanning was then performed, and three-dimensional computed tomographic scans were reconstructed using validated algorithms. RESULTS: The vessels on the zygomatic arch received a double blood supply from across the upper and lower borders of the arch, and the number of the vessels varied from one to four. Ninety percent of the vessels on the zygomatic arch were at a depth of 1 to 2.5 mm, and 75 percent were at a depth of 10 to 30 percent of the soft-tissue thickness. The vessels were concentrated on the midline of the zygomatic arch and the lateral margin of the frontal process. All samples showed a vessel travel along the lateral margin of the frontal process that eventually merged into the superior marginal arcades. CONCLUSIONS: This study reported a topographic analysis of the depth and distribution of the vessels in the zygomatic region based on three-dimensional scanning. The results indicated that injection on the zygomatic arch should be performed deep to the bone, and the vascular zones anterior or posterior to the midline of the zygomatic arch were relatively safe injection areas.

Three-Dimensional Analysis of Age-Related Orbital and Midfacial Bone Remodeling in Asians.

BACKGROUND: Facial bony changes vary among races, yet few studies have been conducted in Asians. OBJECTIVE: To analyze the aging of orbital and midfacial bones in Asians. METHODS: Based on the two-dimensional data obtained from the computed tomography scanner of imaging department, 3D reconstructions were conducted to take measurements (orbital diagonal diameter, orbital width, orbital area, maxillary angle, midfacial height, pyriform angle, pyriform width, and pyriform area). RESULTS: In this retrospective study of 261 subjects, a significant decrease in the orbital diagonal diameter, orbital width, and midfacial height was found in men, whereas women displayed a significant increase in the pyriform width and a significant decrease in maxillary angle and midfacial height by three-dimensional analysis. CONCLUSION: This study verifies the minor female changes in the orbital region and less dramatic male changes in the midfacial region compared with that in Caucasians. Individualized treatment should be performed according to different genders and races. Further exploration of facial bone metabolism may have valuable implications for Asians.

Three-Dimensional Computed Tomographic Study on the Periorbital Branches of the Ophthalmic Artery: Arterial Variations and Clinical Relevance.

BACKGROUND: Filler injection is a popular cosmetic procedure, but it can entail vascular complications. Periorbital injections have the highest risk within the entire injection area. OBJECTIVES: The authors sought to systematically screen for periorbital arterial variations prior to treatment. METHODS: The external carotid arteries of 10 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 11 cadaveric heads were injected with the contrast in sequential order. Computed tomography (CT) scanning was performed after injection of contrast, and 3-dimensional (3D) CT scans were reconstructed using validated algorithms. RESULTS: Three types of periorbital blood vessels were found to derive from the ophthalmic artery, including 30% directly originating from the ophthalmic artery, 65% originating from its trochlear branch, and 5% originating from its supraorbital branch. In the forehead, the ophthalmic artery, originating from the internal carotid arteries, formed anastomoses between the frontal branch of the superficial temporal artery, originating from the external carotid artery, with the deep and superficial branches of the supratrochlear and supraorbital arteries, respectively. The lateral orbit and malar plexus can be classified into 4 types based on the trunk artery: the zygomatic orbital artery (27%), the transverse facial artery (23%), the premasseteric branch of the facial artery (19%), and all 3 contributing equally (31%). CONCLUSIONS: Postmortem 3D CT can map periorbital arterial variations. The branching pattern of the ophthalmic artery, the ophthalmic angiosome in the forehead, and the distribution of the lateral orbit and malar plexus were identified at high resolution to guide clinical practice.

High-Throughput Screening of Full-Face Clinically Relevant Arterial Variations Using Three-Dimensional Postmortem Computed Tomography.

BACKGROUND: Vascular complications resulting from intravascular filler injection and embolism are major safety concerns for facial filler injection. It is essential to systematically screen full-face arterial variations and help design evidence-based safe filler injection protocols. METHODS: The carotid arteries of 22 cadaveric heads were infused with adequate lead oxide contrast. The facial and superficial temporal arteries of another 12 cadaveric heads were injected with the contrast in a sequential order. A computed tomographic scan was acquired after each contrast injection, and each three-dimensional computed tomographic scan was reconstructed using validated algorithms. RESULTS: Three-dimensional computed tomography clearly demonstrated the course, relative depth, and anastomosis of all major arteries in 63 qualified hemifaces. The ophthalmic angiosome consistently deploys two distinctive layers of branch arteries to the forehead. The superficial temporal and superior palpebral arteries run along the preauricular and superior palpebral creases, respectively. The study found that 74.6 percent of the hemifaces had nasolabial trunks coursing along the nasolabial crease, and that 50.8 percent of the hemifaces had infraorbital trunks that ran through the infraorbital region. Fifty percent of the angular arteries were the direct anastomotic channels between the facial and ophthalmic angiosomes, and 29.2 percent of the angular arteries were members of the ophthalmic angiosomes. CONCLUSIONS: Full-face arterial variations were mapped using postmortem three-dimensional computed tomography. Facial creases were in general correlated with underlying deep arteries. Facial and angular artery variations were identified at high resolution, and reclassified into clinically relevant types to guide medical practice.

Primary haemangiopericytoma outside muscle cone in fossa orbitalis: a case report and review.

PURPOSE: Orbital haemangiopericytoma (HPC) is a rare tumor with great histological variability and unpredictable clinical and biological behavior. The precise cell type origin is uncertain. METHOD: A case report is provided. RESULTS: A 24-year-old male patient visited an ophthalmologist because of proptosis, strabismus, and movement limitation of the right eye one year ago. These symptoms worsened rapidly. Histopathology, MRI methods and microscopy coil were applied to study the features of HPC. The tumor was removed and the histological examination revealed that it was a primary HPC of the orbit. CONCLUSION: MRI determined the size, location, circumscription, morphological detail, growth pattern, and relationship between masses and surrounding tissues. The genesis location of this HPC was rare, and its internal morphological characters were different from cases reported in the literature. The new type of microscope showed more details of tumor MR image characters objectively.