Angiographic measurement of the superficial temporal artery for potential use in cerebral bypass surgery: a combined radiological and cadaveric study.

PURPOSE: This study aims to investigate the microsurgical anatomy of the superficial temporal artery (STA), explore the relationship between STA length and lumen diameter, and develop a reliable radiologic method for selecting STA segments for bypass surgery. METHODS: This study used 10 cadaveric dissections (20 STAs, both sides) and 20 retrospective radiological examinations (40 STAs, both sides), employing curved multiplanar reformation and flow color lookup table (CLUT) DICOM processing. Measurements included vessel lumen diameters and luminal cross-sectional thicknesses 3 mm proximal to the STA bifurcation, 3 mm distal to the frontal branch, 5 cm distal to the frontal branch, 3 mm distal to the parietal branch, and 5 cm distal to the parietal branch. The distance between the STA bifurcation and the superior zygomatic border (SZB) was also measured. In our analysis, descriptive statistics encompassed mean, standard deviation (SD), standard error, minimum and maximum values, and distributions. Comparative statistics were performed using Student's t-test, with statistical significance set at p < 0.05. RESULTS: There were no statistically significant differences between STA measurements of bifurcation distances (p = 0.88) and lumen diameters (p = 0.46) between cadavers and radiological measures. However, lumen thicknesses were larger in frontal branches than parietal branches at the seventh and eighth centimeter (p = 0.012, p = 0.039). Branches became thinner distally from the zygoma in both cadavers and radiological image measurements. CONCLUSION: The CLUT DICOM processing radiological measures provided the high-precision required to enable pre-surgical vessel selection for extracranial-intracranial bypass. The results show that STA vessel luminal diameters are sufficient (> 1 mm) for bypass surgery in the first 9 cm but gradually decrease after that. Also shown is that the choice of frontal versus parietal branches depends on individual anatomical features; therefore, careful preoperative radiological examination is critical.

Anatomic variations of the superficial temporal artery.

The superficial temporal artery (STA) is a terminal branch of the external carotid artery. It is commonly described as coursing posterior to the mandibular condyle and over the posterior zygomatic root (PZR) and then dividing terminally into parietal and frontal branches. However, possible variations of the main trunk of the STA have seemingly been overlooked. This study retrospectively examined the archived head tomography angiograms of 43 patients to determine the morphology and topography of the STA prior to its terminal bifurcation. In 79% of patients, the STA topography related to the mandibular condyle was bilaterally symmetrical, either retrocondylar (65.1%) or laterocondylar (13.6%). The parietal branch was sometimes absent unilaterally (16.3%) or bilaterally (9.3%). In 2/43 cases, the frontal branch of the STA was unilaterally absent. When both terminal branches were present, the bifurcation was retrocondylar or immediately above the PZR when on the PZR, or the terminal division of the STA was high above the PZR. In 88.4% of the STAs, different patterns of kinking and coiling were documented, including retrocondylar kinks (27.9%), laterocondylar kinks (20.9%), kinks placed on the PZR (81.4%) and variably oriented suprazygomatic kinks (32.6%). Five of the 86 STAs were coiled, one retrocondylar, one laterocondylar, and three other placed on the PZR. Two cases showed unilateral pseudoaneurysms of the STA, one above the PZR and the other on the temporomandibular joint. The STA is surgically important; therefore, the number of anatomical studies of the STA should increase.

Anatomy and external landmarks of the superficial temporal artery using 3-dimensional computed tomography.

PURPOSE: The purpose of this study was to analyze the anatomical variability of the superficial temporal artery (STA) and to provide an easy visual landmark to find the STA and its branches to facilitate its surgical access. METHODS: A retrospective study was conducted on 57 patients who underwent a head and neck computed tomography with contrast injection. A visual landmark running from the tragus to the corner of the eye was used: the "eye-tragus-line" (ETL). On the ETL, the distance between the tragus and the STA was measured. The length of the STA main branch, its parietal and frontal branch and the angle of the STA and its branches with the ETL were measured. The division of the STA was studied as above/at the same level/below the zygomatic arch (ZA) and the ETL. RESULTS: The STA division was located above the ZA in 61.54% of cases, at the same level in 26.92% of cases and below in 11.54% of cases. Regarding the ETL, 93.27% of the STA divisions were located above the ETL, 5.77% at the same level and 0.96% below. On the ETL, the STA was located 15.55 ± 4.5 mm in front of the tragus. CONCLUSION: This study allowed to define an easy visual landmark: the ETL running from the tragus to the corner of the eye. The STA main branch was located 15.55 ± 4.5 mm of front of the tragus on the ETL. The STA division was nearly always located above the ETL (99.04%). Furthermore, this study provides a statistical representation of the anatomy of the STA and its branches.

Tomography of the Forehead Arteries and Tailored Filler Injection for Forehead Volumizing and Contouring.

BACKGROUND: The forehead is a challenging area for filler injection because of the risk of serious complications. Anatomy-based filler injection techniques help to avoid severe vascular complications. MATERIALS AND METHODS: Sixty-six cadaver heads were infused with adequate lead oxide contrast through the external carotid arteries, internal carotid arteries, facial artery, and superficial temporal artery. Three-dimensional computed tomography scans were reconstructed using validated algorithms. We measured the length and arc length of "beautiful" foreheads evaluated by 3 skilled surgeons. RESULTS: The frontal branch of the superficial temporal artery (FBSTA) was classified based on the main trunk as follows: Type I FBSTA (89.72%) took a sudden turn (89.56° ± 11.76°) once passing through the temporal crest, whereas Type II FBSTA (10.28%) barely turned (52.26° ± 6.81°) at the temporal crest. A total of 319 arteries passed through the midline in 48 cadaver heads. There were more superficial arteries (292 of 319) than deep arteries (27 of 319). The difference in the length and arc length of the forehead was 19.66 ± 4.35 mm. CONCLUSION: This study introduces an effective technique for forehead filler injection that minimizes the risk of filler injection and improves patient satisfaction.

The superficial temporal artery: A meta-analysis of its prevalence and morphology.

INTRODUCTION: The superficial temporal artery (STA) is a terminal branch of the external carotid artery. It supplies the regions of scalp and face. The morphometrical data concerning STAs are not consistent; therefore, in this systemic review and meta-analysis, we aimed in this to provide an up-to-date data on its anatomic features. MATERIAL AND METHODS: In order to do this, PubMed, Embase, ScienceDirect, and Web of Science were searched. We followed the Preferred Reporting Items and Review and Meta-Analyses guidelines for the meta-analysis. Studies that reported the prevalence and anatomical data regarding STA were included in further analyses. RESULTS: Out of 1,446 studies initially evaluated, 21 were included in the meta-analysis (874 patients/donors). The STA diameter was 1.5 mm (95% confidence interval [CI]: 1.47-1.53 mm). The frontal and parietal branches of the STA were present in 97.6% (95% CIs: 94.6-99.5%) and 96.4% (95% CIs: 93.5-98.5%) of the cases, respectively. The STA bifurcation point was located above the zygomatic arch in 79.1% (95% CI: 68.0-84.3), below the zygomatic arch in 6.7% (95% CI: 2.4-12.1), and on the zygomatic arch in 11.1% of the cases (95% CI: 5.4-17.5). There was no bifurcation of the STA in 3.1% of the cases (95% CI: 0.4-7.3). CONCLUSION: The most comprehensive analysis of STA morphological features is presented. The results from this evidence-based anatomical study will improve understanding of the clinical STA anatomy, which in turn has major implications for understanding the STA in clinical practice.

Changes in the Layers of the Temple During Pinch Manipulation: Implications for Thread Lifting.

BACKGROUND: During minimally invasive aesthetic procedures, the skin is often pinched to facilitate filler injection or thread insertion into the desired layer. However, little is known about changes in the facial layers during pinch manipulation. OBJECTIVE: To determine which layer of the temple is lifted during pinching and whether the artery and the nerve are affected by pinching. MATERIALS AND METHODS: At 11 sites on 3 fresh Korean cadavers, the skin of the temple was pinched gently or deeply, and the skin pulled up was cut at the bottom. The exposed areas were grossly and histologically examined. RESULTS: With gentle pinching, the subcutaneous fat and superficial temporal fascia (STF) layer were separated, and the fat was removed with the skin. The superficial temporal artery and temporal branches of the facial nerve were intact. With deep pinching, the STF was separated from the deep temporal fascia and lifted with the skin. CONCLUSION: When thread lifting is performed, deep pinching is helpful for anchoring thread to the temporal fascia, whereas gentle pinching helps to insert thread into the safe subcutaneous fat layer, where no significant blood vessels or nerves are present.

Trifurcated external carotid artery and complete gamma-loop of its maxillary branch.

The external carotid artery (ECA) normally bifurcates terminally with the superficial temporal artery (STA) and the maxillary artery (MA). From the horizontally coursing, mandibular segment of the MA leaves the middle meningeal artery (MMA). We hereby report a previously unknown anatomic possibility, incidentally found during an angio-CT scan in an adult female patient. Unilaterally, the ECA was terminally trifurcated, sending off the MA, STA, and MMA. On that side, the mandibular segment of the MA had a gamma-loop and the contralateral one had a U-loop; both these loops were inferior to the lateral pterygoid muscle, closely approaching the respective lingula of the mandible. These findings are relevant during surgery of the parotid gland and infratemporal fossa, approaches of the MMA, and inferior alveolar nerve blocks. The modified origin of the MMA could be explained by an altered development of the primitive stapedial artery.

The Superficial Temporal Artery: Anatomical Map for Facial Reconstruction and Aesthetic Procedures.

BACKGROUND: The superficial temporal artery (STA), a terminal branch of the external carotid artery, supplies multiple regions of the scalp and face. Knowledge of the STA is important for reconstructive and aesthetic procedures of the head and face. OBJECTIVES: The aim of this study was to map the STA in relation to anatomical landmarks. METHODS: Computed tomographic head angiographies of 215 patients were included in this study; the final analysis comprised 419 STAs. The STA's main branches and variants were identified. The diameters of the STA and its frontal and occipital branches were measured, and the distance between the STA tree and anatomical landmarks was delineated. RESULTS: Frontal and parietal branches were recorded in 98.1% and 90.7% of patients, respectively. The mean diameters, measured 1 and 7 cm from the STA bifurcation for the frontal branch, were 0.97 ± 0.32 and 0.81 ± 0.26 mm, respectively, and for the parietal branch, the diameters were 0.96 ± 0.28 and 0.76 ± 0.23 mm, respectively. The STA bifurcation point was located above the zygomatic arch (ZA) in 75.6%, below in 14.7%, and on the ZA in 9.7% of patients. The mean distance from the ZA center to the STA bifurcation was 16.8 ± 16.0 mm. CONCLUSIONS: The STA artery and its main branches follow a conservative course, and serious anatomical variations are relatively rare. The STA and its main branches may be localized using simple anatomical landmarks. An anatomical map showing artery-free zones in the lateral forehead region was presented, which may prove useful for plastic, reconstructive, and aesthetic surgeons.Level of Evidence: 4.

Landmarks for the preservation of the middle temporal artery during mastoid surgery: Cadaveric dissection study.

IMPORTANCE: The middle temporal artery flap is a vascularized periosteal flap that is highly useful for otologic reconstruction including the middle cranial fossa, mastoidectomy defect, and external auditory canal. The course of the artery is close to the external auditory canal and is easily injured during preliminary exposure and elevation of flaps. OBJECTIVES: To describe the course of the middle temporal artery in relation to the external auditory canal and the superficial temporal artery in order to enhance preservation and use in otologic reconstruction. DESIGN: Dissection of preserved, injected cadaveric temporal bones. SETTING: Anatomical laboratory. PARTICIPANTS: Seven cadaveric temporal bones. INTERVENTION: Temporal bones were dissected in a planar manner to identify the middle temporal artery along the squamous temporal bone to its origin. The superior border of the external auditory canal was divided, horizontally, into thirds to create three measurement points. Distances between the middle temporal artery and the bony portion of the external auditory canal were then determined. MAIN OUTCOMES AND MEASURES: Horizontal diameter of the external auditory canal, distance from the superior-most border of the external auditory canal to the middle temporal artery, various patterns of the middle temporal artery. RESULTS: The middle temporal artery branched from the superficial temporal artery in all specimens. Mean horizontal diameter of the external auditory canal was 9.97mm. Mean distances between the bony portion of the external auditory canal and middle temporal artery for the first, second, and third points along the horizontal diameter of the external auditory canal were 1.57, 2.96, and 4.02mm, respectively. In at least one specimen, the artery dipped into the external auditory canal. CONCLUSIONS AND RELEVANCE: The middle temporal artery runs closest to the external auditory canal at the anterosuperior border. To preserve the middle temporal artery for use in reconstruction after otologic surgery, the surgeon should avoid dissection superior to the external auditory canal until the artery is positively identified.

Surgical anatomy of the superficial temporal artery to prevent facial nerve injury during arterial biopsy.

To investigate the topographical relationship between the frontal branch of the superficial temporal artery (FSTA) and the temporal branch of the facial nerve (TFN) with the aim of preventing nerve injury during FSTA biopsy. Fifty-seven hemifaces of 33 cadavers were dissected. Vertical lines drawn to the lateral orbital margin (LOM) and the superior root of the helix were used as the anterior and posterior reference positions, respectively. Horizontal lines drawn through the supraorbital margin and lateral canthus were used as the superior and inferior reference points, respectively. The depth and course relationships of the FSTA and TFN were examined. Midpoints between the FSTA and TFN are situated approximately 6.0 and 4.5 cm posterior to the lateral orbital margin at the levels of the lateral canthus and supraorbital margin, respectively. The TFN is generally situated 1-2 cm anteriorly and inferiorly to the FSTA in the temporal region. However, in two cases (3.6%), the TFN ran just underneath the FSTA with only a very small safe distance, making it highly vulnerable to iatrogenic injury. In conclusion, when performing an FSTA biopsy, the surgeon should not dissect below the superficial temporal fascia because there is an overlap between the course of the FSTA and the TFN in a minority of cases. Also, surgical incisions should be made outside the area delineated by an oblique line passing through the points 6.0 and 4.5 cm posterior to the lateral orbital margin at the levels of the lateral canthus and the supraorbital margin, respectively. Clin. Anat. 31:608-613, 2018. © 2017 Wiley Periodicals, Inc.

Anatomical recommendations for safe botulinum toxin injection into temporalis muscle: a simplified reproducible approach.

PURPOSE: The objective of this study was to simplify the anatomically safe and reproducible approach for BoNT injection and to generate a detailed topographic map of the important anatomical structures of the temporal region by dividing the temporalis into nine equally sized compartments. METHODS: Nineteen sides of temporalis muscle were used. The topographies of the superficial temporal artery, middle temporal vein, temporalis tendon, and the temporalis muscle were evaluated. Also evaluated was the postural relations among the foregoing anatomical structures in the temporalis muscle, pivoted upon a total of nine compartments. RESULTS: The temporalis above the zygomatic arch exhibited an oblique quadrangular shape with rounded upper right and left corners. The distance between the anterior and posterior margins of the temporalis muscle was equal to the width of the temporalis rectangle, and the distance between the reference line and the superior temporalis margin was equal to its height. The mean ratio of width to height was 5:4. CONCLUSIONS: We recommend compartments Am, Mu, and Pm (coordinates of the rectangular outline) as areas in the temporal region for BoNT injection, because using these sites will avoid large blood vessels and tendons, thus improving the safety and reproducibility of the injection.

Bilateral comparison of the vascular pattern of the superficial temporal artery based on digital subtraction angiography.

PURPOSE: This study was performed to investigate any bilateral differences in the vascular pattern and microsurgical relevant parameters of the superficial temporal artery (STA) in vivo. METHODS: Digital subtraction angiographies of the STA of 38 individuals were retrospectively analyzed. A bilateral comparison of the branching pattern as well as of surgically relevant diameters and lengths of the main branches of the STA was performed. Moreover, gender-specific differences were assessed. RESULTS: Only 10 cases (26%) demonstrated an identical type and subtype of the STA pattern bilaterally. The diameters of the STA at its origin and bifurcation level as well as of its parietal branch were statistically significant wider on the right than on the left side (p(o) = 0.0009, p(b) = 0.006, p(p) = 0.030). Moreover, the diameters of the STA at its origin level on the right side, at its bifurcation level on both sides and of the frontal branch on both sides were statistically significant wider in males than females. No statistically significant differences of the lengths of the STA and its main branches between the right and the left side were identified. CONCLUSION: The occurrence of the vascular pattern of the STA in vivo is random for each side of the same person and cannot be predicted by the vascular pattern of the opposite side. The calibers of the main branches of the STA are gender specific and commonly larger on the right than on the left side.

Superficial temporal artery: the "C" shape half-buttonhole configuration as it courses over the zygomatic arch.

PURPOSE: To describe the course and configuration of the superficial temporal artery (STA) around the zygomatic arch. METHODS: Volume rendered 3D reconstructions of computed tomography angiography of 25 healthy patients were performed and analyzed at Duke University Hospitals. RESULTS: The STA coursed over the zygomatic arch or over the condylar process of the mandible in all cases (25/25 pts, 100 %). The STA courses over the posterior zygomatic arch in 23/25 pts (92 %), creating a characteristic "C" shape half-buttonhole configuration as it embraces the arch. When the STA travels posterior to the zygomatic arch, there is no C shape configuration (2/25 pts, 8 %). The STA bifurcates distal to the zygomatic arch in 24/25 pts (96 %). CONCLUSIONS: The "C" shape half-buttonhole configuration is a useful identifying characteristic of the most common course of the STA-over the posterior zygomatic arch before it bifurcates.

In vivo analysis of the vascular pattern of the superficial temporal artery based on digital subtraction angiography.

BACKGROUND: Existing anatomic descriptions of the superficial temporal artery (STA) are mainly based on cadaver studies and do not accurately reflect the in vivo situation. In this study, the anatomical course and branching pattern of the STA were analyzed with digital subtraction angiographies (DSAs). METHODS: DSAs of 93 Caucasian individuals between 16- and 79-years old were retrospectively analyzed regarding the course and branching pattern of the STA as well as surgically relevant inner diameters and lengths of its main branches. RESULTS: In total, 11 variations in the branching pattern of the terminal STA were found. About 89% of the examined individuals demonstrated the classic variation in which the main trunk of the STA bifurcates into a single frontal and parietal branch. In 60% of cases with an existing bifurcation, the division of the main trunk of the STA was located above the zygoma. The mean inner diameters of the STA main trunk, the frontal branch and the parietal branch were 2.4 ± 0.6 mm, 1.3 ± 0.6 mm and 1.2 ± 0.4 mm, respectively. The surgically relevant "working lengths" of the frontal and parietal branches above the upper margin of the zygoma up to an inner diameter of 1 mm were 106.4 ± 62.1mm and 99.7 ± 40.9 mm, respectively. CONCLUSIONS: The common variations of the branching pattern of the STA are described in this study. Furthermore, surgically relevant inner diameters and lengths of the main branches of the STA are determined. These findings should improve our understanding of the suitability and usefulness of the STA for various surgical procedures.

Cadaveric dissection and clinical experience with 20 consecutive tunneled pedicled superficial temporal artery perforator (STAP) flaps for ear reconstruction.

INTRODUCTION: Reconstruction of anterior ear defects is poorly described, but using "like" tissue provides the optimal reconstruction. We present a cadaveric dissection and our experience with the pedicled superficial temporal artery perforator (STAP) flap for reconstruction of partial ear defects. MATERIALS AND METHODS: Two cadavers were dissected bilaterally (n = 4) following injection of latex and barium sulfate. A retrospective review of 20 consecutive patients undergoing reconstruction with the STAP flap from 2009 to 2012 was performed. Twenty patients underwent reconstruction of anterior ear defects following resection for non-melanoma skin malignancies using a tunneled pedicled STAP flap (scapha: 5, triangular fossa: 2, scapha and triangular fossa: 13). RESULTS: Two perforators were identified in all dissections with one perforator at the level of the tragus, and the second perforator within 1 cm cephalad to the tragus. Thirteen patients underwent reconstruction following basal cell carcinoma excision and seven patients were reconstructed following excision of squamous cell carcinoma. There were no flap losses, but four flaps (20%) developed congestion at the tip of the flap that resolved without need for flap delay, leeching, or vasodilators. No patients developed complications with the donor site, and no patients underwent revisions. With a mean follow-up of 27.3 months (range: 19-38 months), all patients were pleased with their aesthetic outcomes and alive without recurrent disease. CONCLUSION: The STAP flap is a pedicled perforator flap providing local "like" tissue that can be utilized for resurfacing of defects involving the anterior upper external ear with minimal donor site morbidity.

Transparotid Approach for the Treatment of Condylar Osteochondroma and Ankylosis of the Temporomandibular Joint.

Among the methods to treat temporomandibular joint (TMJ), preauricular, submandibular, retromandibular, and intraoral approaches have been described. These approaches, however, occasionally offer inadequate access, owing to the oblique course of the facial nerve, and access can be limited, especially to the medial and anterior part of the infratemporal fossa. The use of the transparotid approach can offer direct visualization of the facial nerves to prevent severe damage, and a wide work field can be achieved from the medial-anterior part of the infratemporal fossa to subcondylar region by retracting the mobilized facial nerves in either the superior or inferior direction. The 2 patients reported herein illustrate the addition of a transparotid approach to the standard procedures for the removal of an osteochondroma and condylectomy with displaced bone fragment for ankyloses of TMJ from the infratemporal fossa.

Frontal branch of the superficial temporal artery: anatomical study and clinical implications regarding injectable treatments.

BACKGROUND: The frontal branch of the superficial temporal artery (Fbr) is vulnerable to damage triggered by iatrogenic manipulation by both dermal filler and BoNT-A injection. The purpose of this study was to elucidate the branching pattern of Fbr and to determine its location and course on the lateral border of the frontal belly of the occipitofrontalis muscle (FB). METHODS: Sixty-four hemifaces from 38 Korean cadavers (26 males and 12 females; mean age 71.9 years) were dissected, and the location and course of the Fbr were identified with reference to the lateral border of the FB. RESULTS: The ramification of the frontal branch from the superficial temporal artery (STA) occurred 36.9 ± 14.24 mm (mean ± SD) superior and 17.2 ± 8.2 mm anterior to the posterior-most point of the tragus [i.e., tragion (Tg)]. The Fbr was observed as a single branch in 96.9% of cases and reached its destination at a single point in 71.9%. It reached the Fbr 14.8 ± 7.7 mm superior to the uppermost point of the eyebrow and 15.8 ± 9.1 mm from the lateral epicanthus. The Fbr bifurcated into superior and inferior branches before reaching the FB in 25.0% of cases. In two cases (3%), the Fbr ramified from the STA within 1 mm of the Tg. The diameter of the superior division of Fbr was 1.6 ± 0.5 mm at the lateral border of the FB and 1.8 ± 0.6 mm at other locations. CONCLUSION: Physicians performing injection treatments such as botulinum toxin type A and dermal filler injection to the posterior frontal area should be aware of the various distributions of the Fbr.

[Clinico-morphological substantiation of feasibility of angiosomic adipose-cutaneous flaps from temporal and parietal regions application].

Actuality of the problem, consisting of restoration of defects and deformity zones on head and neck, is caused by great quantity of patients, surgical treatment of which constitute important medico-social problem. The flaps, raised from temporal and parietal regions, are considered perspective for replacement of defects and the deformity zones on head and neck. But, for their correct isolation and mobilization it is necessary to know the topographoanatomical peculiarities of superficial temporal artery, localization of which differs, depending on the head form. The methods of isolation and mobilization of angiosomic preauricular, postauricular and fascial temporal-parietal flaps were optimized in the clinic, basing on analysis of results of the investigations performed and computeric modeling of the superficial temporal artery branches.

Split temporalis muscle flap anatomy, vascularization and clinical applications.

INTRODUCTION: For more than a century, the temporalis muscle has been used for facial reconstructions. More recently, a split temporalis muscle flap elevated on the superficial temporal pedicle has been described, for which the resulting gain of length makes crossing of the midline possible, as well as reconstruction of substance losses exceeding the midline. MATERIALS AND METHODS: Fourteen fresh cadaveric dissections were performed to study the different techniques for splitting the temporalis muscle. Dissections with catheterization and injection of radio-opaque contrasting agent in the external carotid artery were then performed to specify the vascularization of the flap split on the superficial temporal pedicle. RESULTS: The duplication of the superficial temporal pedicle grants greater length compared to that of the deep pedicles, 57 mm versus 40 (p = 0.036). The middle temporal artery is capable of ensuring the vascularization, and therefore the viability, of the split flap. From these results, we spoke about the limitations of this study and we have inferred the main indications.

The Middle Temporal Vein on Computed Tomographic Angiography: Implications for Filler Injection and Reconstructive Surgery.

BACKGROUND: Detailed knowledge of middle temporal vein (MTV) anatomy would benefit health care professionals when performing filler injection and reconstructive surgery. The purpose of this study was to assess the variation and course of the MTV using computed tomographic angiography. METHODS: Computed tomographic angiography images of 300 MTVs from 150 Asian patients were evaluated in this study. The course and branching pattern of the MTVs were evaluated, as well as the relationship between the location of the MTV and the frontal branch of the superficial temporal artery. The diameter of the MTV and the distances between anatomic landmarks and temporal vessels were measured. RESULTS: The MTV was identified in all images, with an average diameter of 2.98 ± 0.80 mm. All MTVs had at least one major trunk; 12.3% had two major trunks. According to the landmarks, the MTV ran 16.3 ± 8.1 mm, 24.8 ± 4.5 mm, and 24.2 ± 4.6 mm above bony lateral canthus, jugale, and zygion point, respectively. Regarding the relationship between the MTV and the frontal branch of the superficial temporal artery, most of the superficial temporal arteries (81.7%) were located above the MTVs, whereas only 9.0% of the superficial temporal arteries crossed the MTVs. The superficial temporal artery was located 43.5 ± 9.6 mm, 44.3 ± 11.9 mm, and 37.0 ± 11.9 mm above the bony lateral canthus, jugale, and zygion point, respectively. CONCLUSION: Detailed knowledge of MTV anatomy will provide a valuable reference for safe filler injection and reconstructive surgery in the temporal region. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.