Morphologic studies of the venous drainage of the tongue

Summary The aim of this work was to study the role of the venous drainage of the tongue in tongue inspection in traditional Chinese medicine and tongue-flap surgery. Thirty-two adult cadavers were observed, including 7 venous corrosivecast specimens. The decreasing order of venous drainage of the tongue, based on the diameter of the vein and size of its drainage area, was the accompanying v. of the hypoglossal n., the epiglottic valleculate v., the accompanying v. of lingual n., the lingual root v. and the accompanying v. of the lingual a. The veins constituting the picture of the tongue seen in sublingual collateral inspection were the companion vv. of the hypoglossal and lingual nn. The pedicle of a tongue flap must maintain efficient venous drainage canal.This work was supported by the National Natural Science Fund     

Anatomic study of tongue architecture based on fetal histological sections

Tongue muscles are difficult to study by dissection and imaging methods because of the intermeshing of the muscular fibers. The study of the architecture of the tongue was based on 853 tongue sections of a fetus aged 32 weeks after conception. The analysis of the sections allowed demonstration of the different intrinsic and extrinsic muscles of the tongue, to determine their situation from the palatoglossus arch to the apex of the tongue. The tongue muscles are organized in different layers from cranial to caudal and from lateral to medial, one medial for the genioglossus muscle, one paramedial for the hyoglossus, the styloglossus and the inferior longitudinal muscles. In the anterior third of the tongue, the muscles presented a concentric organization.     

舌瓣设计的解剖学基础

目的：为外科舌瓣的设计提供解剖学基础。方法：解剖剥制２５具（５０例）成人舌动、静脉标本，制作７例（１４侧）舌血管铸型标本，观察舌动脉和静脉分布的规律性。结果：舌主要由２条舌动脉供血；舌的静脉每侧有５个流向，多数静脉不与动脉伴行。结论：根据需要舌瓣的蒂部可设在舌体周围的多个部位，多数舌瓣由动脉网供血，但每个舌瓣可获得一个自然的静脉引流渠道。     

旋髂深动脉嵌合组织瓣的解剖学基础

目的为旋髂深动脉嵌合组织瓣的设计提供解剖学依据.方法在40侧动脉内灌注红色乳胶的成人尸体标本上,以髂前上棘和腹股沟韧带为标志,解剖观测旋髂深动脉的起源、走行、分支与分布;1侧新鲜标本摹拟手术设计.结果根据旋髂深动脉的行程可将其分为腹股沟段、髂嵴内段和髂嵴上段.①腹股沟段沿途发出(2～4)支、外径为0.2～1.8mm的腹壁肌支至邻近肌肉,其中优势肌支长(9.0±0.5)cm,外径为(1.4±0.1)mm;②髂嵴内段沿途发出(2～8)支、外径为0.2～0.7mm肌骨支穿过肌肉附丽进入髂嵴前部;③髂嵴上段延续为肌皮穿支并穿过深筋膜支配11 cm×14 cm的皮肤.结论以旋髂深动脉蒂,可切取以腹股沟段的腹壁优势肌支肌瓣、髂嵴内段的肌骨支骨瓣和终末段的肌皮穿支皮瓣,从而形成嵌合组织瓣.临床可根据需要选择一种或多种嵌合组织瓣修复骨合并软组织缺损.     

A morphological study on human lingual venous valves

Summary This study deals with the appearance, function and pathophysiological action of the lingual venous valve in the design of surgical tongue flaps and in analyzing inspection of the tongue. Thirty two adult cadavers were studied, of which 7 were corrosive cast specimens. The lingual v. is well supplied with venous valves which may be divided into 3 types morphologically: hemispherical, spherical, and hanging spherical. Venous valves are classified according to their structures: bivalves, monovalves, and venous cristae. The abundant venous valves of the tongue effectively prevent reflux of blood. Various factors that influence venous blood reflux in the head and neck can be observed, analysed and judged by inspection of the tongue; the design of the pedicle and the anastomotic position of tongue flap should comply with the positions and orientations of its venous valves.This work was supported by the National Natural Science Fund     

舌血管构筑及计量学研究

目的：通过对舌血管的观察和计量，为舌下络脉诊，舌瓣提供形态学依据。方法：墨汁灌注，用手术放大镜、显微镜观察人舌血管的构筑，并用Ｑｕａｎｔｉｍｅｔ５２０＋型图像分析仪对舌各种乳头，舌粘膜肌层、舌肌的血管进行计量学研究。结果：单位面积内轮廓乳头的血管密度大于菌状和丝状乳头；舌肌的血管也明显丰富于舌粘膜肌层。结论：舌静脉的回流主要通过舌下神经伴行静脉，该静脉也是舌下络脉诊主要观察的对象。舌粘膜两侧血管吻合丰富，用舌粘膜肌瓣修复扁桃体窝，磨牙后区等特定的解剖部位有其他瓣无法代替的优点。     

Local blood flow and metabolism of the tongue before and during panting in the dog

Summary The effects of hyperthermia on blood flow and oxygen consumption of the tongue were investigated in anesthetized dogs. For comparison, blood flow through the skin and deep muscle of the hind leg was also measured in some animals. Increasing blood temperature revealed a biphasic response of lingual blood flow. At 41°C blood temperature respiratory frequency was twice that of control and there was a reduction of lingual blood flow, while resistance of the lingual bed was increased significantly. The arterio-venous oxygen difference (AVDO₂) of lingual blood was markedly increased at this level and the of the tongue was like-wise significantly greater than control. At 41.9°C, the steep increase of respiratory frequency was accompanied by a marked fall in lingual resistance as evidenced by a four-fold increase of lingual blood flow. The systemic AVDO₂ rose at this temperature, while the lingual AVDO₂ fell dramatically. There was no further increase of lingual . At both temperature levels the blood flow through the skin did not change substantially, while the deep muscle blood flow slightly increased. The mean arterial pressure showed a progressive fall during hyperthermia. It is assumed that the decrease of lingual blood flow at elevated blood temperature without panting is due to a redistribution of cardiac output to areas other than the tongue. The increase of lingual blood flow without an additional increase of lingual during panting may be explained solely as a mechanism for heat dissipation. The fact that the decrease of lingual resistance was demonstrated in immobilized animals concomitant with high frequency phrenic burst activity suggests that the decrease of lingual resistance and panting may be induced by a common central integrating mechanism.     

The intra-lingual course of the nerves of the tongue

The intra-lingual course of the nerves of tongue has never been studied in the human by the Sihler method. This technique was applied to six human tongues and allowed coloration of the nerves and illustration of the tongue. The course of the hypoglossal, glossopharyngeal, and lingual nerves was defined. Constant anastomoses between the lingual and hypoglossal nerves, between the glossopharyngeal nerve and the hypoglossal and lingual nerves, were demonstrated and may help explain the “neck–tongue” syndrome. This cartography of the nerves of the tongue allowed the definition of the motor and sensory consequences of tongue surgery.     

小腿前外侧和足背外侧岛状皮瓣的应用解剖

目的:为临床施行经小腿骨间膜前方游离腓动、静脉的小腿前外侧岛状皮瓣和足背外侧岛状皮瓣转位术提供解剖基础。方法:用46侧成尸下肢标本动脉灌注红色乳胶,观测腓动脉穿支及其外径,外踝前动脉弓和足背外侧动脉弓的外径及其皮支。结果:腓动脉下1/3段紧贴小腿骨间膜后方走行,发出2～5支穿支营养小腿前外侧皮肤,动脉外径(1.2±0.4)mm,穿支之间相距10～20mm不等。外踝前动脉弓外径(1.3±0.5)mm,两条伴行静脉外径分别为(1.7±0.5)mm和(1.3±0.4)mm。足背外侧动脉弓外径(1.1±0.5)mm,两条伴行静脉外径分别为(1.3±0.5)mm和(1.1±0.4)mm,发出皮支营养足背外侧皮肤。皮瓣切取范围为小腿外侧和足背外侧。结论:经小腿骨间膜前方游离腓动脉及其穿支与外踝前动脉和跗外侧动脉吻合形成的小腿前外侧和足背外侧串联岛状皮瓣,增加了血管蒂的长度,扩大了皮瓣的切取面积,增加了临床应用的灵活性。     

以腓动脉终末降支为蒂的外踝上皮瓣的解剖及临床应用

以腓动脉终未降支为血管蒂的外踝上皮瓣,修复足底跟骨外露1例,足背内踝肌腱骨质外露1例,单纯足背肌腱距骨外露2例,获得满意效果。此皮瓣较薄,有神经支配,血管蒂长,解剖位置恒定,切取容易,不损伤小腿外侧和后侧肌群的附着点,亦不牺牲腓动、静脉主干,临床有使用价值。     

骨间后动脉前臂逆行皮瓣的解剖学研究

目的:通过对骨间后动脉的解剖观测,为骨间后动脉逆行皮瓣的临床应用提供解剖学依据。方法:用30侧成人上肢标本,对骨间后动脉及其皮支、吻合支的起始、走行、分布进行解剖观测。结果:骨间后动脉发自骨间总动脉,穿过骨间膜上缘至前臂背侧,经旋后肌和拇长展肌之间在前臂深浅两层伸肌之间下行,沿途发出7~12条皮支营养前臂背侧的皮肤,其终末支(96.7%)在尺骨茎突近端(2.5±0.5)cm处与骨间前动脉的背侧支有弧形吻合支相连接。其皮支分布可达动脉主干两侧6cm范围,近侧达肘平面,远端至腕平面。结论:以骨间后动脉为蒂,可在前臂背侧设计大面积(10cm×8cm)逆行岛状皮瓣,用以修复手部皮肤组织缺损、瘢痕挛缩切除术后创面。     

弧形阴茎阴囊联合皮瓣设计的解剖学基础

目的：为弧形阴茎、阴囊联合皮瓣的设计提供解剖学基础。方法：采用显微解剖、皮瓣血管透明、Ｘ线造影等方法，对３６侧阴茎和阴囊外侧皮瓣的血供来源、动脉主干走行、分支分布及吻合进行观测。结果：阴茎和阴囊外侧皮瓣的血供分别来自阴茎背浅和阴囊前动脉，前者起点外径为０．８±０．２ｍｍ，行于阴茎浅筋膜的疏松组织层。在阴茎阴囊交界区，两动脉的分支相互吻合。阴茎皮瓣的静脉回流有二套，其中阴茎背浅静脉为血液回流的主要血管。结论：阴茎、阴囊交界区动脉间有吻合，可设计成阴茎阴囊弧形联合皮瓣。该型皮瓣较长，足以满足重度尿道下裂的修复。     

跨血供区阴囊“L”形皮瓣设计的解剖学基础

目的：为跨血供区阴囊“Ｌ”形皮瓣的设计提供解剖学依据。方法：用显微解剖、Ｘ线造影和血管透明方法，对３６侧阴囊皮瓣血供各来源动脉的分布区域大小、相邻区域之间的血管吻合进行观测。结果：阴囊前动脉布于阴囊外侧前１２～１３的皮肤。阴囊基底部和后外侧部分别由阴囊后动脉内、外侧支的皮支供养。缝区皮肤的血供来自阴囊中隔血管。上述血管在阴囊皮下和肉膜内相互吻合。结论：阴囊各血管的分布区域之间有吻合，可设计成跨血供区“Ｌ”形皮瓣修复阴囊型尿道下裂。     

Cribriform adenocarcinoma of the tongue: a hitherto unrecognized type of adenocarcinoma characteristically occurring in the tongue

AIMS: We report a review of our institutional and consultation files in order to select cases of hitherto unrecognized type of adenocarcinoma occurring in the tongue. MATERIALS AND RESULTS: Eight cases of a characteristic adenocarcinoma of the tongue resembled solid and follicular variants of the papillary carcinoma of the thyroid. All the tumours were unencapsulated and were divided by fibrous septa into lobules. Major parts of the lesions were composed of areas with solid and microcystic growth patterns. The most striking cytological feature was that the tumour nuclei were pale-staining with a 'ground glass' quality, and they often appeared to overlap. Immunohistochemically, the tumours expressed cytokeratin and S100 protein and, focally, actin; thyroglobulin was negative. Ultrastructurally the cells had clefted nuclei, and the cytoplasm contained a few mitochondria, lysosomes and Golgi apparatus. Many tumour cells had combined features of both myoepithelial and secretory differentiation-well formed microvilli on their apical borders and bundles of microfilaments. At first presentation, all eight patients had metastases in the regional neck lymph nodes, but all are alive 2-6 years after the initial excision and irradiation. CONCLUSION: We describe a distinctive type of adenocarcinoma of the tongue, for which we propose the name cribriform adenocarcinoma of the tongue (CAT). CAT usually presents with metastases in the neck lymph nodes at the time of presentation. We hypothesize that the tumour might arise from the thyroglossal duct anlage.     

Anatomic and magnetic resonance imaging bases for the naso-maxillo-cheek flap technique

Summary A transfacial approach to the deep cranio-maxillo-facial areas by the naso-maxillo-cheek flap technique (NMCF) is indicated for the treatment of some bulky tumors of the naso-pharynx. The procedure requires precise preoperative imaging. This study presents the morphologic bases of this surgical access and the reasonable limits of the excision preoperatively determined by magnetic resonance imaging (MRI). 18 facial and skull specimens were submitted to surgical facial dismantling by the NMCF technique according to Curioni's method. The clinical application in a 66-year-old patient suffering from a neuroblastoma of the olfactory nerve extended into the naso-pharynx is presented. Pre- and post-operative MRI correlations were made in transverse, sagittal and frontal acquisitions. Several structures were preserved in the procedure: facial reliefs, inferior orbital rim and orbital floor, posterior wall of the maxillary sinus covering the pterygopalatine fossa, lateral and medial pterygoid plates and pterygopalatine ganglion with its branches, lateral facial neurovascular pedicle, teeth and soft palate. Other structures were sacrificed: arteries and nerves located at the sites of skin and mucosal incision, and at the sites of osteotomies, ie the infraorbital nerve, the distal part of the greater palatine nerve, the nerves supplying the naso-pharynx, the nasal septum and the nasal conchae, nasolacrimal groove and lacrimal canal. The NMCF technique gives wide access to the deep nasal and nasopharyngeal areas. It is essential to preserve the lateral facial neurovascular pedicle to prevent necrosis of the midface structures. Preservation of the bony architecture surrounding the osteotomy sites is of great importance to allow precise final bone reassembly. Preoperative MRI appears of paramount importance to determine the borders of the lesion and the possibility of block resection.

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Bases anatomiques et d'imagerie en résonance magnétique de la technique du lambeau naso maxillo-jugal

Résumé L'accès transfacial aux régions crânio-maxillo-faciales par la technique du lambeau naso maxillojugal (NMCF) est indiqué pour le traitement de quelques tumeurs volumineuses de la partie nasale du pharynx. Le procédé nécessite un bilan d'imagerie pré-opératoire précis. Cette étude présente les bases morphologiques de cet accès chirurgical et les limites raisonnables à l'exérèse déterminée par l'imagerie en résonance magnétique (IRM) préopératoire. 18 spécimens du crâne et de la face étaient soumis à un « dismantling » facial par la technique NMCF selon la méthode de Curioni. L'application clinique chez un patient de 66 ans, souffrant d'un neuroblastome du nerf olfactif étendu à la partie nasale du pharynx, est présentée. Les corrélations en IRM pré et post-opératoires sont réalisées dans les plans transverse, sagittal et frontal. Plusieurs structures sont respectées dans toutes les procédures effectuées (n=19): les reliefs de la face, le rebord inférieur et le plancher de l'orbite, le mur postérieur du sinus maxillaire couvrant la fosse ptérygopalatine, les lames latérale et médiale des processus ptérygoides et le ganglion ptérygopalatin avec ses branches, le pédicule vasculo nerveux latéral de la face, les dents et le voile du palais. D'autres structures étaient sacrifiées, les artères et les nerfs localisés sur les sites d'incision cutanée et muqueuse et sur les sites d'ostéotomie i.e. le nerf infra-orbitaire, la partie distale du grand nerf palatin, les nerfs répondant à la partie nasale du pharynx, le septum nasal et les cornets nasaux, la gouttière lacrymonasale et le canal lacrymal. La technique NMCF donne large accès aux parties profondes et rhino-pharyngiennes de la face. Il apparaît d'une importance majeure de maintenir le pédicule vasculo-nerveux latéral de la face pour éviter toute nécrose des structures moyennes. Le respect de l'architecture osseuse entourant le site d'ostéotomie est d'une grande importance pour permettre une reconstruction osseuse finale précise. L'IRM pré-opératoire apparaît d'une importance capitale pour déterminer les limites de la lésion et les possibilités d'une résection carcinologique en bloc.

     

肩胛下血管蒂组织瓣的解剖及其临床应用

目的　研究肩钾下血管蒂组织瓣的血供解剖 ,解决肩钾下血管蒂的联合组织瓣的临床应用。方法　采用 6具新鲜尸体标本 ,从肩胛下血管起始处灌注中华墨汁 ,观察皮肤着色范围 ,于背阔肌上缘、前缘、肩胛岗、腋前线和髂嵴平面分别切取组织块做连续切片 ,应用Luzex F图像分析仪 ,观察皮瓣间微血管构筑。结果　肩胛皮瓣、背阔肌肌皮瓣、侧胸皮瓣间存在非常丰富的血管吻合网。临床上以肩胛下动静脉为血管蒂 ,包含肩胛皮瓣、背阔肌肌皮瓣、侧胸皮瓣联合移植修复巨大软组织缺损 ,吻合血管移植 6例 ,轴型皮瓣移植 5 0例 ,均获成功。结论　肩胛下血管蒂联合组织瓣是一个理想的供区 ,可用于移植修复大范围组织缺损。     

Anatomic basis of a fascio-cutaneous flap supplied by the perforating branch of the peroneal artery

Summary The length, caliber and course of the perforating branch of the peroneal artery are described following examination of both feet of 20 cadavers. This terminal branch of the peroneal artery has a constant, predictable course and may normally be sacrificed without any vascular compromise in the foot. It has great surgical potential at it is strategically situated so that it can act as a vascular pedicle for a large cutaneous flap situated on the lower lateral leg, with an axis of rotation centered at the midtarsal joint. This has been used by the senior author (AC Masquelet) as a pedicle flap and as an island flap for reconstruction of the foot and ankle with satisfying results.

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Bases anatomiques d'un lambeau cutanéo-aponévrotique vascularisé par la branche perforante de l'artère péronière

Résumé La longueur, le calibre et la direction de la branche perforante de l'artère péronière ont été décrites après examen des 2 pieds de 20 cadavres. Cette branche terminale de l'artère péronière a un trajet constant et prévisible. Elle peut être sacrifiée sans risque vasculaire pour le pied. Elle a un grand intérêt chirurgical du fait de sa situation, car elle représente le pédicule vasculaire d'un large lambeau cutané situé sur la face latérale de la partie basse de la jambe avec un axe de rotation centré au milieu de l'articulation du tarse. Ce lambeau a été initialement utilisé par AC Masquelet pour la reconstruction du pied et de la cheville comme lambeau pédiculé et un lambeau en îlot avec des résultats satisfaisants.