锁骨上动脉岛状瓣的应用解剖

目的:为临床应用锁骨上动脉岛状瓣提供解剖学依据。方法:在10例20侧经锁骨下动脉灌注氧化铅-明胶溶液的成人尸体标本上,对颈横动脉和锁骨上动脉的分支情况、起始位置、行程、长度和管径进行观测,观察其回流静脉情况,并在尸体标本上模拟皮瓣制备。结果:颈横动脉由甲状颈干或锁骨下动脉分支而来,在锁骨中1/3上方分为深支和浅支。锁骨上动脉由颈横动脉浅支发出后行向后外,越过斜方肌浅面和锁骨的肩峰端,走行于三角肌筋膜的浅面,并逐渐发出细小分支穿过深筋膜,进入锁骨上和肩部的皮肤和皮下组织。颈横动脉起点至锁骨上动脉起点距离平均为(4.31±0.64)cm,锁骨上动脉起点至其发出分支穿深筋膜点的距离平均为(3.62±0.42)cm。颈横动脉起点处外径平均为(2.71±0.33)mm,锁骨上动脉起点处外径平均为(1.10±0.17)mm。2条锁骨上动脉伴行静脉分别回流入颈横静脉和颈外静脉。结论:以锁骨上动脉为营养血管的锁骨上动脉岛状瓣,适于转移修复口腔颌面颈部组织缺损,也可以颈横动脉为吻合血管,制作游离皮瓣。     

颈外动脉结扎与甲状腺上动脉起始部位的临床研究

本文对５５例成年男性头颈部标本的甲状腺上动脉起始部位进行观测，结果表明：甲状腺上动脉可起自颈总动脉（４０％）、颈外动脉（３６．３６％）和平颈总动脉分叉处（２３．６４％），并就颈外动脉结扎与甲状腺上动脉起始部位的临床意义进行了研究。     

植入式颈动脉压迫训练器的研制及初步应用性研究

目的：研制出一种准确、可靠、高效的颈动脉压迫训练仪器,并通过动物实验证实其可行性和有效性。方法：利用现有的皮肤扩张器生产工艺,结合人体颈动脉的具体解剖特点设计生产了植入式颈动脉压迫训练器;然后对其进行理化性能测定以及动物实验研究：①对植入式颈动脉压迫训练器各部件的机械强度进行了测量;②对该仪器注水压与犬颈动脉内血流通通畅率之间关系进行了测量;③利用影像学手段观察证实了犬颈动脉被该仪器阻断情况。结果：①植入式颈动脉压迫训练器对颈动脉断流可以提供足够的压力;②从注水压与犬颈动脉内血流畅率之间关系曲线观察到了颈动脉血流阻特点;③以颈动脉造影的手段证实该仪器可以对颈动脉进行断流。结论：植入式颈动脉压迫训练器能准确、可靠、安全的阻断颈动脉血流,达到颈动脉压迫训练的目的。     

Blood supply to the maxillary sinus relevant to sinus floor elevation procedures

The maxillary blood supply is essential for preserving the vitality of the affected maxillary region, integration of the grafting material, and wound healing such as following sinus floor elevation. Although it is well established that edentulous maxillae demonstrate a decreasing vascularity as bone resorption progresses, the vascular conditions relevant to sinus floor elevation procedures have not been investigated yet. This study deals with maxillary arteries relevant to sinus floor elevation surgery and examines the vascularization of the lateral maxilla after tooth loss. The vessels of the lateral maxilla of 18 maxillary specimens (10 male, 8 female, mean age 67 years) were prepared anatomically and the local main arteries, the number of macroscopically discernible branches and anastomoses, their calibers, and the distance between the caudal main branches and the alveolar ridge recorded. The lateral maxilla is supplied by branches of the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) that form an anastomosis in the bony lateral antral wall, which also supplies the Schneiderian membrane. This intraosseous anastomosis was found in all of the specimens. Eight of 18 also showed an extraosseous anastomosis between PSAA and IOA, vestibular to the antral wall, giving off an average of 3 branches cranially and 5 branches caudally. The two anastomoses form a double arterial arcade to supply the lateral antral wall and, partly, the alveolar process. The PSAA had a mean caliber of 1.6 mm and exhibited an average of 2 endosseous and 1 extraosseous branches. The IOA had a mean diameter of 1.6 mm and showed an average of 1 endosseous and 3 extraosseous branches. The mean distance between the intraosseous anastomosis and the alveolar ridge was 19 mm in 2 defined measuring sites. Its mean length was 44.6 mm. The epiperiosteal vestibular anastomosis was situated further cranially at a mean distance of 23 to 26 mm from the alveolar ridge and had a mean length of 46 mm. The rather large caliber of the vessels supplying the lateral antral wall seems to be crucial to the fact that the periosteal blood supply is maintained even in severe maxillary atrophy and after complete disappearance of the centro-medullary vessels.     

去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌术后缺损

目的：探讨去上皮逆行面动脉-颏下动脉颏下岛状瓣对上颌骨术后缺损的修复效果。方法：回顾性研究我科自2007年3月-2009年1月应用去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌骨术后缺损病例13例。其中男9例。女4例。所有病例均经病理学检查确诊,其中10例诊断为上颌牙龈鳞状细胞癌,其余3例诊断为硬腭鳞状细胞癌。依据Brown等提出的上颌骨缺损分类法,术后缺损为2a型．用以同期修复的面动脉-颏下动脉岛状瓣长度约8～10cm．宽度约4～5cm。结果：面动脉-颏下动脉岛状瓣的存活率为92.3％（12／13）,未见供区并发症及面神经下颌缘支损伤。随访8～24个月．1例原发灶复发后死亡,2例颈淋巴结复发。结论：去上皮逆行面动脉-颏下动脉颏下岛状瓣具有安全、简单、易于改良等优点,适用于无区域性淋巴结转移的恶性肿瘤术后上颌骨缺损修复。     

Duplication of the internal carotid artery and segmental aplasia of the vertebral arteries

The internal carotid artery mainly supplies the brain. As the internal carotid artery contributes to the formation of the cerebral arterial circle, its variations are relevant in imaging, interventional radiology, and surgery. Knowledge of these variations is important for vascular anastomosis in free flap reconstruction and in arterial ligatures for haemostasis. During a cadaveric cervical dissection, a duplicated left internal carotid artery was incidentally observed in the carotid triangle of the neck. The internal carotid branches were dissected up to their distribution to the brain. The two branches of the left internal carotid artery penetrated into the base of the skull by the carotid canal and the foramen magnum, respectively. With the right internal carotid artery, they formed the cerebral arterial circle. The basilar artery was formed by the branch of the left internal carotid artery entering the skull by the foramen magnum. The right internal carotid artery and the two branches of the left internal carotid gave rise to all of the arteries of the cerebral arterial circle. The vertebral arteries did not contribute to its formation. This duplication of the internal carotid arteries is rare, as the literature does not describe any case of vertebral artery aplasia replaced by an internal carotid artery.     

Incidence of the occipital artery arising from the internal carotid artery identified by three-dimensional computed tomographic angiography

Variants of the branches of the external carotid artery are common, but it is extremely rare that the occipital artery arises from the internal carotid artery. We investigated the incidence using three-dimensional computed tomographic (CT) angiography. In 265 patients with cancer of the head and neck, we did CT angiography for vascular mapping of the external carotid artery and its branches before reconstruction or superselective intra-arterial chemotherapy. The origin of the occipital artery was detected in 514 of 530 carotid arteries (97%); the incidence of it arising from the internal carotid artery was 0.2%.     

A new method for displaying the lingual artery using high-resolution three-dimensional phase-contrast magnetic resonance angiography

The aim of this study was to display the lingual artery superimposed on the anatomical image and to confirm its course and relation to the adjacent structures, noninvasively. Nineteen volunteers participated in the magnetic resonance imaging (MRI) study and one was excluded for excessive movement during scanning. A three-dimensional phase-contrast sequence (3D-PC) of magnetic resonance angiography (MRA) was used for vessel images, and a 3D-T1 high-resolution volume examination (THRIVE) was used for anatomical images. Colour-coded vessel images from 3D-PC MRA were superimposed on the 3D volume anatomical images, and the arterial course and relation to the adjacent structures were confirmed with multiplanar reconstructed cross-sectional (MPR) images. 3D-PC MRA images visualized the lingual artery in all 18 subjects and the sublingual artery in 14 subjects. In seven of 18 cases the bilateral sublingual arteries were shown to run side by side but had no contact with the sublingual veins. They ran together with the sublingual veins in four cases. Three cases showed irregular patterns. The bilateral sublingual arteries could not be identified in four cases. 3D-PC MRA images of the lingual artery superimposed on the anatomical images may be clinically useful to confirm its course and relationship to the adjacent structures before surgery, in order to prevent haemorrhage.     

应用面动脉-颏下动脉岛状肌皮瓣修复舌癌术后缺损

目的：探讨面动脉-颏下动脉岛状肌皮瓣同期修复舌癌术后缺损的效果。方法：2005年1月—2006年1月收治舌癌患者11例,其中男6例,女5例,全部采用面动脉-颏下动脉岛状皮瓣对舌癌根治性切除后半舌缺损进行同期整复,皮瓣最小8cm×3cm,最大12cm×4.5cm。结果：11例皮瓣全部存活,术后随访1a,未发现复发和转移。全部皮瓣形态、质地良好,面部外形满意。结论：面动脉-颏下动脉岛状皮瓣具有可靠血供,操作简便安全,适合同期修复T2期舌癌术后半舌缺损。     

Dealing with vascular anomalies during radial forearm free flap harvest: report of two cases and review of the literature

Radial forearm free flap reconstruction for head and neck cancer is very common, and it is widely considered a workhorse flap. Although this flap has a relatively reliable anatomy, surgeons need to be aware of possible anatomical variations and how to deal with them. This paper presents the cases of two patients who underwent oral reconstruction, in whom anomalies of the radial artery were identified while raising a radial forearm free flap. Case 1 demonstrates the dominant branch of the radial artery joining the common interosseous artery approximately 9 cm from the first wrist crease. Case 2 demonstrates abnormal distal branching of the radial artery approximately 4 cm from the first wrist crease. Reconstruction with the flap was successful in both cases. A literature review of reported anomalies of the radial artery is presented, and how to deal with such vascular anomalies is discussed.     

Reverse facial artery-submental artery deepithelialised submental island flap to reconstruct maxillary defects following cancer ablation

Objective

The present study assessed the reliability of the reverse facial artery-submental artery deepithelialised submental island technique to reconstruct maxillary defects.

Methods

The study included 13 patients (9 men and 4 women; 43–62 years) with maxillary defects resulting from cancer ablation. Ten patients presented with maxillary gingival squamous cell carcinoma and the remaining 3 cases were hard palate squamous cell carcinomas. The maxilla was resected and the remaining defects were classified as Class 2a. Reverse facial artery-submental artery deepithelialised submental island flaps measuring 8–10 cm in length and 4–5 cm in width were used to reconstruct the defects.

Results

Twelve of the 13 flaps survived. No donor-site problems or palsy of the marginal mandibular branch of the facial nerve occurred. The follow-up period ranged from 8 to 24 months, 1 patient died as a result of local tumour recurrence and 2patients developed cervical recurrence.

Conclusion

The reverse facial artery-submental artery deepithelialised submental island flap is safe, quick and simple to use or elevate. The flap is a reliable technique for reconstructing maxillary defects following cancer ablation.     

Facial artery pseudoaneurysm without evidence of trauma

False aneurysm or pseudoaneurysm is usually a result of blunt trauma causing laceration of part of the vessel wall and extravasation of blood into surrounding tissue, followed by tamponade and clot formation. The wall of the pseudoaneurysm consists of perivascular fibrous tissue. Extracranial carotid artery pseudoaneurysms are relatively rare because trauma to external carotid artery branches usually results in total transection rather then partial laceration of blood vessel. Most affected branches are the superficial temporal artery, internal maxillary artery and distal facial artery, usually where they pass over the bone (zygoma or mandible). The authors present the case of a 78-year-old male patient with facial artery pseudoaneurysm in its proximal part in the submandibular region with no known evidence of trauma. To the authors’ knowledge this is the first case in the literature of facial artery pseudoaneurysm without traumatic origin and the third case of proximal facial artery pseudoaneurysm. Although formation of pseudoaneurysm in the region of face and neck is rare, the authors consider that inclusion of pseudoaneurysm in the differential diagnosis of a neck mass is important.     

Calibre-persistent labial artery: often misdiagnosed as a mucocoele

The authors present five cases of calibre-persistent labial artery (CPLA) all of which were diagnosed clinically as a labial mucocoele. The purpose of this article is to bring this rarely reported lesion to the attention of clinicians.     

Vascularization of the peroneal muscles. Critical evaluation in fibular free flap harvesting

This anatomical study was carried out in order to discover the etiology of partial necrosis of the peroneus longus and brevis muscles after fibular osteocutaneous flap harvest. The vascular supply to the lateral compartment peroneal muscles was investigated in 10 fresh cadaveric lower limbs. The peroneal muscles are supplied by two principal sources arteries, the anterior tibial artery (ATA) and the peroneal artery (PA). The ATA is the dominant artery and supplies the proximal and middle thirds of these muscles. The PA is considered to be a supplementary vascular source and supplies the distal thirds of these muscles. After harvesting the PA in a fibular flap, regions of the peroneal muscles preoperatively vascularized by its branches become supplied through the anastomotic "choke" vessels between the ATA and the PA. Primary closure of the cutaneous defect increases the possibility of developing a pseudo-compartment syndrome with necrosis of the more precariously vascularized portions of the peroneal muscles. This complication is difficult to diagnosis early and the reason why we advocate that direct skin closure following composite harvest must be avoided. Moreover, conservation of the inferior and superior lateral branches of the ATA is imperative in order to preserve the peroneal muscles vascularization.     

上颌窦口扩大手术与蝶腭动脉分支关系的外科解剖研究

目的：了解人体上颌窦口扩大手术与蝶腭动脉分支的解剖关系。方法：30侧动脉灌注乳胶10%福尔马林固定的成人头部标本,不计性别和年龄,在立体放大镜下观察鼻中隔,中鼻道的结构和血管分布。结果：上颌动脉在蝶腭孔处分为蝶腭动脉一终支,经蝶腭孔到鼻腔。其分支供应鼻腔外侧壁,鼻窦及鼻中隔。蝶腭动脉的分支,鼻后外侧动脉的外径为（1.05±0.09）mm,其分支至中鼻甲动脉和下鼻甲动脉,其外径分别为（0.91±0.09）mm和（0.96±0.09）mm。蝶腭动脉的下鼻甲分支在下鼻腔后端前方的距离约为（11±3）mm。在行上颌窦口开放手术时,若距中鼻甲后约1.5cm的距离,不易伤及鼻后外侧动脉。结论：上颌窦口扩大手术中不能单纯以上颌窦开口位置,作为向后上扩大的自然标志,在中鼻甲后端1～1.5mm处,开放上颌窦口较为安全,同时应避免伤及蝶腭动脉的分支及鼻后外侧动脉。     

Calibre Persistent Labial Artery: Clinical Features and Immunohistochemistry Diagnosis

Calibre persistent labial artery (CPLA) usually presents as an asymptomatic papule on the lower lip and can be easily misdiagnosed as a mucocele, haemangioma, venous lake, varix or fibroma. When it is ulcerated, squamous cell carcinoma is the most usual differential diagnosis. Here, we report a case of a 25-year-old woman with no previous relevant medical history who presented with a complaint of an asymptomatic, non-ulcerated, progressively growing nodule (over the last 5 months) on the upper lip. In this case, the diagnosis was made clinically and confirmed by immunohistochemical analysis. We conclude that clinicians should be aware of CPLA and it should be included in the differential diagnosis of labial mucosal papules. Sometimes, the immunohistochemical analysis is necessary to make a correct diagnosis.     

DIAGNOSTIC AGREEMENT BETWEEN PANORAMIC RADIOGRAPHS AND COLOR DOPPLER IMAGES OF CAROTID ATHEROMA

The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.     

自动监控式颈动脉压迫训练的效果研究

目的：对自动监控式颈动脉压迫训练器进行颈动脉压迫训练的效果进行研究。方法：将实验犬分为低血压状态下训练组６只，低血压状态下直接结扎组６ 只，对照组３ 只。训练组在降低其血压后，利用压迫训练器进行压迫训练，１ 天１ 次，开始为压迫３０ｍ ｉｎ，以后每天延长１０ｍ ｉｎ，直至第８天处死。结扎组除压迫训练经过与训练组相同的处理过程后结扎其颈动脉，结扎组训练组进行单光子发射计算机断层扫描（ＳＰＥＣＴ）检查及病理检查。结果：ＳＰＥＣＴ值：在α＝ ０．０１时，训练组与结扎组相比有显著提高，与其自身正常值相比，皆有显著差异。病理结果：结扎组组织学改变同前两组，训练组有４ 只狗右侧出现了一些不可逆缺血改变的组织学变化，左侧未见异常，其余２ 只未发现明显组织学异常。结论：经过颈动脉压迫训练后，训练组狗都不同程度提高了对缺血的耐受力，肯定了训练法的作用，但训练的时间及持续时间还需进一步研究。ＳＰＥＣＴ值与病理结果相符，可以很好反映大脑侧支循环建立情况。