Sheth Nishita T, Hauck Erik F, Bibawy Joseph M, Lee Irene T, Dermarkarian Christopher R, Saadat David, Woodward Julie A
University of North Carolina School of Medicine, Chapel Hill.
Department of Ophthalmology, Duke University, Durham.
Ophthalmic Plast Reconstr Surg. 2025;41(4):465-470. doi: 10.1097/IOP.0000000000002897. Epub 2025 Jan 3.
Soft-tissue filler injections, particularly hyaluronic acid, are popular for temple volume restoration. Although uncommon, this area poses risk for vision loss from embolic occlusion. Guidelines recommend injecting into the supraperiosteal plane for safety; however, the deep temporal arteries (DTAs) in this plane pose a risk. This study investigates potential pathways from the DTA to the ophthalmic artery (OA) and mechanisms of filler travel.
Retrospective analysis of carotid angiograms from patients with marked carotid artery stenosis or vascular malformations, given that collaterals are more visible in the presence of vascular blockages. Select cases were identified by the neurosurgery team.
Four anastomotic pathways between the DTA and OA were identified, displaying a combination of anterograde and retrograde flow. Case 1 shows direct DTA-lacrimal artery anastomosis. In cases 2 to 4, the DTA is shown originating from the internal maxillary artery (IMAX) following its anatomical course. Retrograde flow from the DTA into the IMAX can then lead to anterograde flow into branches connecting to the IMAX including the superficial temporal artery, infraorbital artery, and middle meningeal artery. These arteries then form collaterals with the OA.
This study is the first to elucidate 4 potential routes for filler-induced OA occlusion originating from DTAs in the supraperiosteal plane. These pathways involve retrograde flow, a mechanism previously suggested for filler-induced occlusion. Notably, the likelihood of these pathways being traversed may be low due to their length and amount of filler volume required; however, it is not impossible.
软组织填充剂注射，尤其是透明质酸注射，在颞部容积恢复中很受欢迎。尽管这种情况不常见，但该区域存在因栓塞性闭塞导致视力丧失的风险。指南建议为安全起见应在骨膜上平面进行注射；然而，该平面内的颞深动脉（DTA）存在风险。本研究调查了从DTA到眼动脉（OA）的潜在途径以及填充剂的游走机制。
对患有明显颈动脉狭窄或血管畸形患者的颈动脉血管造影进行回顾性分析，因为在血管阻塞的情况下侧支循环更明显。神经外科团队确定了部分病例。
确定了DTA与OA之间的四条吻合途径，显示出顺行和逆行血流的组合。病例1显示DTA与泪腺动脉直接吻合。在病例2至4中，DTA显示沿其解剖路径发自上颌内动脉（IMAX）。从DTA到IMAX的逆行血流随后可导致顺行血流进入与IMAX相连的分支，包括颞浅动脉、眶下动脉和脑膜中动脉。这些动脉随后与OA形成侧支循环。
本研究首次阐明了骨膜上平面内源自DTA的填充剂诱导OA闭塞的4条潜在途径。这些途径涉及逆行血流，这是先前提出的填充剂诱导闭塞的一种机制。值得注意的是，由于这些途径的长度和所需填充剂的量，其被穿行的可能性可能较低；然而，并非不可能。
