The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection

Background The knowledge of the anatomy of the facial vein (FV) is essential for plastic surgery and filler injection. Objectives The purpose of this study was to investigate the variation and three-dimensional course of FV using computed tomographic angiography (CTA). Methods The CTA images of 300 FVs from 150 Asian patients were included in this study. The distance between each anatomical landmark and FV was measured to position the course. The depth of FV beneath the skin and the height of FV above the periosteum were measured at five anatomical planes. Results The facial vein showed a relatively constant course with a frequency of 7.0% variation. The average diameter of FVs was 2.42 ± 0.58 mm. The vertical distance between medial canthus, the midpoint of inferior orbital rim or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm, or 53.04 ± 6.56 mm. The mean depth of FV beneath the skin at the plane of medial canthus, infraorbital, nasal ala, oral commissure, and mandible was 1.16 ± 0.99 mm, 5.83 ± 1.64 mm, 16.07 ± 4.56 mm, 14.92 ± 2.49 mm, and 9.67 ± 2.88 mm, respectively. The mean height of FV above the periosteum at the plane of medial canthus, infraorbital, nasal ala, and mandible was 1.17 ± 1.32 mm, 3.59 ± 1.48 mm, 3.92 ± 1.95 mm, and 3.50 ± 2.03 mm, respectively. Conclusions This study revealed the three-dimensional course of the facial vein with reference to the anatomical landmarks. The detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

Launay’s External Carotid Vein

Background and Objectives: Launay’s external carotid vein (ECV) is poorly represented in the anatomical literature, although it is an occasional satellite of the external carotid artery (ECA). We aimed to establish the incidence and morphology of the ECV. Materials and Methods: One hundred computed tomography angiograms were investigated, and ECVs were documented anatomically, when found. Results: Launay’s vein was found in 3/200 sides (1.5%) in a male and two female cases. In two of these cases, the ECV was a replaced variant of the anterior division of the retromandibular vein (RMV), and the facial vein (FV) ended in the external jugular vein. In the third case with the ECV, the RMV was absent and the common FV that resulted from that ECV and the FV drained into the internal jugular vein. The ECV could also appear as an accessory RMV, not just as a replaced one. Additional variants were found, such as fenestration of the external jugular vein (EJV), the extracondylar vein draining the deep temporal veins and an arterial occipitoauricular trunk. Conclusions: Surgical dissections of the ECA in the retromandibular space should carefully observe an ECV to avoid unwanted haemorrhagic events. Approaches of the neck of the mandible should also carefully distinguish the consistent extracondylar veins.