Vascularization of the facial bones by the facial artery: implications for full face allotransplantation.
BACKGROUND
The maxillary artery is recognized as the main vascular supply of the facial bones; nonetheless, clinical evidence supports a codominant role for the facial artery. This study explores the extent of the facial skeleton within a facial allograft that can be harvested based on the facial artery.


METHODS
Twenty-three cadaver heads were used in this study. In 12 heads, the facial, superficial temporal, and maxillary arteries were injected. In one head, facial artery angiography was performed. Ten facial allografts were raised. The soft tissues were dissected to show the arterial anastomotic connections. Radiographs and computed tomographic scans were obtained.


RESULTS
Constant anastomosis between the facial, inferior alveolar, and infraorbital arteries at the mental and infraorbital foramina were found. The facial artery vascularized the homolateral mandibular symphysis, body, and ramus. The condylar and coronoid processes were vascularized in 67 percent of the allografts. The homolateral maxilla was contrasted in all allografts. The alveolar and palatine processes contained the contrast in 83 percent of specimens. The maxillary process of the zygomatic bone was perfused in all allografts, followed by the body, frontal (83 percent), and temporal processes (67 percent). The nasal lateral wall and septum were vascularized in 83 percent of the allografts. The medial and lateral orbital walls and the orbital floor were stained in all specimens. The zygomatic process of the temporal bone was the least perfused bone.


CONCLUSIONS
A composite allograft containing 90 to 95 percent of the facial bones can be based on bilateral facial arteries.
Louisville, Ky. From the Christine Marie Kleinert Institute; and the Radiology Department, Jewish Hospital and St. Mary's Health Care.
Bahar Bassiri
BB
Gharb
Antonio
A
Rampazzo
Joseph E
JE
Kutz
Linda
L
Bright
Gaby
G
Doumit
Thomas B
TB
Harter
D000792:Angiography; D001158:Arteries / Q000033:anatomy & histology* / Q000601:surgery*; D002102:Cadaver; D004210:Dissection; D005147:Facial Bones / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D054445:Facial Transplantation / Q000379:methods*; D006801:Humans; D008334:Mandible / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D008437:Maxilla / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D009915:Orbit / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D013701:Temporal Bone / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D063986:Vascularized Composite Allotransplantation / Q000379:methods; D015050:Zygoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery