Dinámica contráctil espontánea del músculo liso vascular de la arteria carótida externa / Spontaneous contractile dynamics of the vascular smooth muscle of the external carotid artery

Introducción: La carótida externa es una arteria muscular que irriga todos los componentes del sistema masticatorio, por lo que la regulación de la dinámica contráctil de su músculo liso vascular es imprescindible para garantizar el tono y el flujo sanguíneo tisular y modular la respuesta inflamatoria. Objetivo: Describir la dinámica contráctil espontánea del musculo liso vascular de la arteria carótida externa. Métodos: Se realizó una investigación experimental en el Instituto de Fisiología Oscar Langerdorff de la Facultad de Medicina, en la Universidad de Rostock, Alemania, de octubre a diciembre del 2018, en la cual se utilizaron 60 anillos de arterias carótidas externas obtenidas de 10 ratas Wistar adultas de ambos sexos. A dichos anillos se les practicó un corte helicoidal y fueron colocados en un baño de órganos, para registrarles, luego, la tensión espontánea desarrollada por el músculo liso vascular contra una carga de 1 gramo, durante diferentes intervalos de tiempo. Resultados: Los registros de la actividad contracción-relajación espontánea del músculo liso vascular de la arteria carótida externa fluctuaron dentro de un rango estrecho de cifras de tensión, con valores máximos de 8,48 ± 0,03 y mínimos de 8,33 ± 0,03, y una diferencia de 0,08 mN/g de músculo. Los valores promedios de tensión en cada intervalo de tiempo fueron muy cercanos, con desviaciones estándar que evidenciaron muy poca dispersión de los datos respecto a la media. La tensión promedio general registrada fue de 8,40 ± 0,032 mN/g. Conclusiones: La dinámica contráctil espontánea desarrollada por el músculo liso vascular de la arteria carótida externa mostró una progresión irregular en el tiempo, con valores promedios de tensión que oscilaron entre 5-10 mN/g de músculo.

Introduction: The external carotid is a muscle artery irrigating all components of the masticatory system, so that the regulation of the contractile dynamics of its vascular smooth muscle is important. Objective: To describe the spontaneous contractile dynamics of the vascular smooth muscle of the external carotid artery. Methods: An experimental investigation was carried out in the Oscar Langerdorff Physiology Institute from the Medicine Faculty at Rostock University, Germany, from October to December 2018, in which 60 rings of the external carotid artery obtained from 10 adult Wistar rats from both sexes. An helical cut was made to each ring and they were placed in an organ bath, to be registered, then, the spontaneous strain developed by the vascular smooth muscle against a charge of 1 g, during different time intervals was registered. Results: The records from the spontaneous contraction-relaxation of the vascular smooth muscle in the external carotid artery fluctuated within a narrow range of strain figures, with maximum values of 8.48 ± 0.03 and minimum of 8.33 ± 0.03, and a difference of 0.08 mN/g of muscle. Average strain values in each time interval were very closed, with standard deviations which evidenced a very small data dispersion regarding the mean. The average general registered strain was 8.40 ± 0.032 mN/g. Conclusions: The spontaneous contractile dynamics developed by the vascular smooth muscle of the external carotid artery showed an irregular progression in time, with average strain values fluctuating between 5-10 mN/g of muscle.

An anatomical study of the facial artery / Un estudio anatómico de la arteria facial

The facial artery (a branch of the external carotid artery) is the main artery of the face. It gives rise to seven branches viz. inferior labial, superior labial, inferior alar, superior alar, lateral nasal and angular arteries, which are variable. This study included a dissection of twenty embalmed adult cadaveric head and neck specimens. The parameters of origin, branching patterns, termination and variations were analysed and compared with sex and laterality. The facial artery followed the standard anatomical description of origin in 84.62 % of the sample. Variations: (i) origin as a linguofacial trunk in 12.82 % and (ii) high origin in 2.56 % was observed. Male specimens displayed a higher number of linguofacial trunk origins (7.69 %). The branching patterns of the facial artery was classified into six types, with subtypes for Types 1 and 2. Subtype 1-A (standard anatomical description with early termination) occurred in most of the sample (46.15 %). Males were found to have more variations in branching patterns than females (48.72 % and 41.03 % respectively). Termination of the facial artery was as follows: inferior labial artery (5.13 %), superior labial artery (10.26 %), inferior alar artery (10.26 %), superior alar artery (46.15 %), lateral nasal artery (5.13 %), and angular artery (20.51 %). A single case (2.56 %) of an abortive artery was noted. Statistical analysis showed that sex was independent of each parameter observed in this study. Anatomical knowledge of the facial artery is of importance to clinicians and surgeons during procedures such as musculomucosal, island flaps and aesthetic dermatology.

La arteria facial (una rama de la arteria carótida externa) es la arteria principal de la cara. Da lugar a siete ramas: labial inferior, labial superior, alar inferior, alar superior, arterias nasales y angulares laterales, además de ramas pequeñas variables. Este estudio incluyó una disección de veinte muestras de cabeza y cuello de cadáveres adultos fijados. Los parámetros de origen, patrones de ramificación, terminación y variaciones fueron analizados y comparados con el sexo y la lateralidad. La arteria facial se originó de manera normal en el 84,62 % de la muestra. Variaciones: (i) origen como tronco linguofacial en 12.82 % y (ii) se observó un origen alto en 2,56 %. Las muestras en los hombres mostraron un mayor número de orígenes del tronco linguofacial (7,69 %). Los patrones de ramificación de la arteria facial se clasificaron en seis tipos, con subtipos para los Tipos 1 y 2. El subtipo 1-A (descripción anatómica normal con terminación temprana) se observó en (46,15 %) de la muestra. Las muestras de varones tenían una mayor variación en los patrones de ramificación que las muestras de mujeres, 48,72 % y 41,03 % respectivamente. La terminación de la arteria facial fue la siguiente: arteria labial inferior (5,13 %), arteria labial superior (10,26 %), arteria alar inferior (10,26 %), arteria alar superior (46,15 %), arteria nasal lateral (5,13 %) y arteria angular (20,51 %). Se observó un solo caso (2,56 %) de una arteria abortiva. El análisis estadístico mostró que el sexo era independiente de cada parámetro observado en este estudio. El conocimiento anatómico de la arteria facial es importante para los médicos y cirujanos durante procedimientos como colgajos musculomucosal y en la dermatología estética.

Lingual-facial trunk arising from the external carotid artery: a case report / Tronco linguo-facial como rama de la arteria carótida externa: reporte de un caso

The variations in the origin of the facial and lingual arteries are very important in maxillofacial, head and neck surgery procedures. This study is a case report in which the common origin is described in the facial and lingual artery in a lingual-facial trunk (LFT) on the left side of a female corpse from Spain. In the examination, a diameter of 2.17 mm and a length of 8.84 mm are shown. It was located 12.04 mm from the carotid bifurcation and 9.31 mm from the origin of the superior thyroid artery. The variation in biometric values shown, are anatomical findings in the neck dissection of a corpse. Moreover, taking into account the surgical procedures, which involve the origin of facial and lingual artery, because it is the most common variation and could cause complications.

Las variaciones del origen de la arteria facial y lingual son importantes en los procedimientos de cirugía maxilofacial y de cabeza y cuello. Reportamos un caso en el que se describe el origen común de las arterias facial y lingual en un tronco linguofacial en el lado izquierdo en el cadáver de una mujer de origen español. En la examinación, el tronco presentó un diámetro de 2,17 mm y una longitud de 8,84 mm. Se ubicó a 12,04 mm de la bifurcación carotidea y a 9,31 mm del origen de la arteria tiroidea superior. La variación en los valores biométricos presentados constituyen un hallazgo anatómico en una disección de cuello de un cadáver, además ser tomada en cuenta en los procedimientos quirúrgicos que involucren el origen de la arteria facial y lingual, pues al ser la variación más común podría generar complicaciones.

The morphometrical analysis of the external carotid artery and its branches with multidetector computerized tomography angiography technique / Análisis morfométrico de la arteria carótida externa y sus ramas mediante la técnica de angiografía por tomografía computarizada multidetector

The external carotid artery (ECA) is the main artery of the head and the neck region. Carotid bifurcation (CB), which is one of the place where the atherosclerotic plaques are most commonly seen. The surgical procedure of these plaques which causes cerebral vascular accident (CVA) is carotid endarterectomy. In this surgical procedure, the knowledge of the anatomical courses and variations of the carotid artery increased the surgery performance. In our study, we aimed to introduce the course, the location and the variation of the ECA's and their branches. This study is carried out on multidetector computerized tomography angiography of the ECA's of 50 men and 50 women, totally 200 ECA's (100 right, 100 left). The measurement of the inner diameter of the common carotid artery (CCA) and the ECA was evaluated. The location of the CB was determined and its vertical distance to the gonion measured. We found that the superior thyroid artery (STA) originated from the CCA, the CB and the ECA. The vertical distances between the CB and the STA, lingual (LA), facial (FA) occipital (OA) were measured. The ECA and its branches were recorded. We believe that the assessment of the ECA morphometrically may comprise control groups of diseases related to the vessel diameter and this data may be used as reference in clinic and surgery. Knowing the anatomical details and variations is vital to prevent unpredictable complications in surgery.

La arteria carótida externa (ACE) es la principal arteria de la cabeza y de la región del cuello. La bifurcación carotídea (BC) es uno de los lugares donde las placas ateroscleróticas son más frecuentes. El procedimiento quirúrgico para tratar estas placas que causan el accidente vascular cerebral (AVC) es la endarterectomía carotídea. En este procedimiento quirúrgico, el conocimiento de los cursos anatómicos y variaciones de la arteria carótida aumenta el rendimiento de la cirugía. El objetivo de nuestro estudio fue presentar el trayecto, localización y variación de la ACE y sus ramas. El estudio se realizó mediante angiografía multidetector por tomografía computarizada de la ACE de 50 hombres y 50 mujeres, totalizando 200 ACE (100 derechas y 100 izquierdas). Se evaluaron el diámetro interior de la arteria carótida común (ACC) y la ACE. Se determinó la ubicación de la BC y se midió la distancia vertical hasta el gonion. Se observó que la arteria tiroidea superior (ATS) se originó desde la ACC, la BC y la ACA. Las distancias verticales entre la BC, y las arterias tiroídea superior, lingual (AL), facial (AF) y occipital (AO) fueron medidas. La ACE y sus ramas se registraron. Creemos que la evaluación morfométrica de la ACE puede comprender grupos de control de las enfermedades relacionadas con el diámetro de los vasos, y estos datos pueden ser utilizados como referencia clínica y quirúrgica. El conocimiento de los detalles anatómicos y variaciones es de vital importancia para evitar complicaciones imprevisibles en la cirugía.

Anatomia microcirúrgica da artéria carótida externa: um estudo estereoscópico / Microsurgical anatomy of the external carotid artery: a stereoscopic study

CONTEXTO: O conhecimento das estruturas anatômicas da artéria carótida externa por meio do estudo estereoscópico pode determinar melhores resultados em microcirurgias da artéria carótida externa. OBJETIVO: Descrever as estruturas da artéria carótida externa sob a visão estereoscópica, identificando seus múltiplos aspectos. MÉTODOS: Doze regiões cervicais foram dissecadas, utilizando-se microscópico cirúrgico com 3 a 40x de aumento. As dissecções anatômicas foram documentadas utilizando-se a técnica para obtenção de imagens tridimensionais (3D), objetivando a produção de impressões estereoscópicas. RESULTADOS: O uso da técnica estereoscópica possibilitou a abordagem da circulação arterial extracraniana, sendo realizados estudos cirúrgicos do tipo combinado fossa posterior e fossa infratemporal, tornando as microcirurgias e os procedimentos neurocirúrgicos vasculares mais precisos. CONCLUSÃO: O uso das imagens obtidas pela técnica estereoscópica produziu um resultado mais assertivo em relação ao estudo da anatomia para a microcirurgia e procedimentos neurocirúrgicos, facilitando melhor aprendizado previamente à realização de procedimentos complexos em neurocirurgia.

BACKGROUND: The knowledge on the anatomical structures of the external carotid artery through the stereoscopic study may provide better results in microsurgical treatment of the external carotid artery. OBJECTIVE: To describe the structures of the external carotid artery under stereoscopic vision, identifying its multiple aspects. METHODS: Twelve cervical regions were dissected using a surgical microscope with 3 to 40x magnification. The anatomical dissections were documented using the technique to obtain three-dimensional images (3D), aiming at producing stereoscopic prints. RESULTS: The use of the stereoscopic technique enabled the stereoscopic approach to extracranial arterial circulation, and it was followed by a combined posterior fossa and infratemporal approach, making microvascular surgery and neurosurgical procedures more precise. CONCLUSION: The use of images obtained through the stereoscopic technique produced a more assertive result in relation to the anatomy study for microsurgical or neurosurgical procedures, facilitating a better learning before performing complex procedures in neurosurgery.

Aneurisma de carótida interna extracraniano mimetizando tumor glômico / Extracranial internal carotid artery aneurysm presenting as glomus tumor

Aneurismas de carótida interna extracranianos (ACIE) são raros e o diagnóstico pode ser feito com ultrassonografia, tomografia computadorizada com contraste, ressonância nuclear magnética e angiografia. Este último é fundamental para definir a anatomia vascular e a melhor estratégia para o acesso operatório. O objetivo deste trabalho é apresentar e discutir um caso de aneurisma de artéria carótida interna extracraniano cujo diagnóstico definitivo foi realizado no intraoperatório, uma vez que, embora este diagnóstico tenha sido sugerido pela ultrassonografia pré-operatória, a tomografia computadorizada e a ressonância nuclear magnética com reconstrução arterial indicaram tratar-se de um tumor glômico.

Extracranial internal carotid artery aneurysm is rare and the diagnosis is made by ultrasonography, computed tomography scan with contrast, magnetic resonance imaging and carotid angiography. The latter is important to define the vascular anatomy and best surgical approach. The aim of this study is to present and discuss a case of extracranial internal carotid artery aneurysm diagnosed intraoperatively. Ultrasonography suggested a carotid artery aneurysm but CT and angiographic nuclear scanning erroneously indicated a glomus tumor.

Unilateral variations of vessels and nerves in the neck / Variación unilateral de vasos y nervios en el cuello

Variations of vessels and nerves in the left neck side, of 65 year old male cadaver, during the routine dissections, were detected. It was observed that the linguofacial trunk originated from external carotid artery and that the ascending pharyngeal artery originated from the occipital artery. It was determined that after the laryngeopharyngeales rami originated from the superior cervical ganglion, the branch wound around the origin of the superior thyroid artery. As an additional variation, the internal jugular vein divided. The cervical ansa and the inferior belly of the omohyoid muscle passed through the parts of the vein. We think that these type of variation can entail important difficulties during radiologic and surgical procedures of the neck region. To know these anatomical variations, is important for the anatomist and surgeons.

Durante una disección de rutina, fue observada en el lado izquierdo del cuello de un cadáver de sexo masculino de 65 años de edad variaciones anatómicas vasculares y nerviosas. Se observó que el tronco linguofacial se originaba de la arteria carótida externa y que la arteria faríngea ascendente se origina en la arteria occipital. Se determinó que los ramos laringofaríngeos originadas desde el ganglio cervical superior, giraban en torno al origen de la arteria tiroidea superior. Como una variación adicional, la vena jugular interna se encontró dividida. El asa cervical y el vientre inferior del músculo omohioideo pasaban a través de las partes de la división de la vena. Creemos que este tipo de variaciones supone dificultades importantes durante procedimientos radiológicos y quirúrgicos de la región del cuello, y por tanto, es importante que los cirujanos conozcan estas variaciones.

Aneurisma da artéria carótida externa: uma condição rara diagnosticada durante uma consulta cosmética / External carotid artery aneurysm: a rare condition diagnosed in cosmetic consultation

O objetivo deste relato é mostrar a importância e alertar os dermatologistas que praticam a cosmiatria sobre a necessidade de se realizar um exame completo e minucioso de qualquer paciente, mesmo que ele só esteja interessado em tratamentos e/ou procedimentos cosméticos. Atualmente, essa é uma preocupação importante, pois muitas pessoas e alguns médicos estão envolvidos em uma busca exagerada pela beleza eterna. Essa é uma prática muito lucrativa para dermatologistas e cirurgiões plásticos. No entanto, não devemos nos esquecer que uma consulta dermatológica pode ser uma oportunidade para diagnosticar uma dermatose que passou despercebida ou identifi car sinais relacionados a desordens sistêmicas.

The aim of this report is to highlight and warn cosmetic dermatologists about the need of a full body complete examination regardless of the complain of any patient that seeks our evaluation, even when they ask only for cosmetic treatments and/or procedures. This is nowadays a very important concern as people and some physicians are involved in an exaggerated search for eternal beauty. This represents a very profi table practice for dermatologists and plastic surgeons. But we should never forget that a dermatologic consultation can be an opportunity to discover an unnoticed dermatosis or signs related to systemic diseases.