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• W4313204078 abstract "We read with great interest the article entitled “Investigation of the Orbital Arterial Distribution Using Image Superimposition to Determine Safe Zones for Retrobulbar Injection and to Prevent Filler Complications,”1 and we wish to congratulate the authors. A total of 27 Korean cadaveric orbital dissections were completed by the authors. Considering the subtlety of orbital arteries and the damage to the original structure caused by formalin immersion, which dramatically increases the difficulty of dissection, we highly admire the authors’ painstaking effort and believe this work is of much significance. Our team recently published a review on cerebral embolism after facial filler injections.2 When applying retrobulbar injection, the fillers may intravasate into the abundant vascular branches and anastomoses of orbit. Under high injection pressure, the central retinal or posterior ciliary artery can be blocked retrogradely by the fillers, causing blindness. If the filler particles are smaller, they may even trace back to the internal carotid artery and embolize the middle cerebral or anterior cerebral artery, causing cerebral infarction. Two related articles were retrieved from the literature.3,4 Both patients were injected with fat during reconstructive eye surgery, and hemiplegia occurred after the operation. Magnetic resonance imaging demonstrated embolism of the middle cerebral artery and/or anterior cerebral artery.3,4 The findings of this article promote the understanding of orbital arterial distribution and provide a solid anatomical basis for optimizing retrobulbar injection strategy for reducing the occurrence of embolism. Image superimposition was innovatively applied in integrating the 27 orbital arterial distributions. We are curious about how the authors located the objective positions of arteries in one fixed image while taking into account the different sizes and shapes of different orbits. Were some anatomical landmarks used to help localization? The orbital region is also rich with nerve branches. We would ask the authors whether they have some additional findings regarding orbital nerve distribution during dissection. In view of the three-dimensional topological structure of orbits, we agree with the authors that three-dimensional reconstruction is a promising way to further sharpen the injection strategy, such as the depth of needle insertion and the degree of needle rotation. Finally, we find ultrasound to be exceptionally useful in facial injections for guidance during our clinical practice, because muscle layers and blood flow can be shown in real time. Whether ultrasound can also be helpful in retrobulbar injection deserves further exploration. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. There was no funding for this work. Yixin Sun, MDXiao Long, MDDepartment of Plastic SurgeryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, People’s Republic of China" @default.
• W4313204078 created "2023-01-06" @default.
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• W4313204078 date "2022-10-20" @default.
• W4313204078 modified "2023-09-25" @default.
• W4313204078 title "Investigation of the Orbital Arterial Distribution Using Image Superimposition to Determine Safe Zones for Retrobulbar Injection and to Prevent Filler Complications" @default.
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• W4313204078 doi "https://doi.org/10.1097/prs.0000000000009791" @default.
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