Anatomía topográfica del nervio laríngeo superior: importancia quirúrgica en las tiroidectomías / Topographic anatomy of the upper laryngeal nerve: surgical importance in thyroidectomies

En las cirugías sobre la glándula tiroides se ha prestado mucha atención al manejo del nervio laríngeo inferior y de las glándulas paratiroides, no así del ramo lateral del nervio laríngeo superior, el cual es satélite del pedículo vascular superior de la glándula tiroides. El manejo del polo superior de la glándula tiroides requiere de un conocimiento acabado de su anatomía topográfica del área y está determinada por sus relaciones más importantes, dadas por el citado nervio y la arteria tiroidea superior principalmente. En este trabajo se pretende estudiar estas relaciones en base a la disección meticulosa del triángulo laringo-esternotiroideo ("Triángulo de Joll") de 25 cadáveres adultos formolizados. Como hallazgo relevante se informa que los "nervios en riesgo", según la clasificación de Cernea, que se basa en una distancia menor a un centímetro en el entrecruzamiento del nervio con la arteria tiroidea superior con respecto al polo superior de la glándula tiroides, es del 52 % para el lado derecho y 44 % para el lado izquierdo del cuello. El origen bajo de la arteria a nivel de la bifurcación carotídea se presenta asociada a un mayor número de "nervios en riesgo" en el lado izquierdo. Según el punto de penetración del ramo lateral del nervio laríngeo superior en el músculo constrictor inferior de la faringe se establece la clasificación de Friedman, muy útil sobre todo en cirugías ayudadas por la neuroestimulación. En esta clasifiacción los "nervios en riesgo" son aquellos que transcurrren superficial al músculo, mientras que los "nervios protegidos" serían aquellos que perforan el músculo en su porción superior. En este trabajo los "nervios en riesgo" se presentaron del lado izquierdo en el 56 % de los casos y del derecho en el 60 %, mientras que los "nervios protegidos" en el 24 % y 16 %, respectivamente.

In surgeries on the thyroid gland, much attention has been given to the management of the inferior laryngeal nerve and parathyroid glands, but not the external branch of the given by the aforementioned nerve and the superior thyroid artery. This paper intends to study these relationships based on the meticulous dissection of the larynx-sternothyroid triangle ("Joll triangle") of 25 formolized adult corpses. As a relevant finding, it is reported that the " nerves at risk" according to the Cernea classification, which is based on the distance less than one centimeter at the intersection of the nerve with the superior thyroid artery with respect to the upper pole of the gland, is 52 % for the right side and 44 % for the left side of the neck. The low origin of the artery at the level of the carotid bifurcation is associated with a greater number of "nerves at risk" on the left side. According to the penetration point of the external branch of the superior laryngeal nerve in the inferior pharyngeal constrictor muscle, the Friedman classification is established, very useful especially in surgeries aided by neurostimulation. In this classification the "nerves at risk" are those that run superficially to the muscle, while the protected nerves would be those that pierce the muscle in its upper part. In tis work, the "nerves at risk" presented on the left side in 56 % of the cases and the right side in 60 %, while those "protected" in 24 % and 16 % respectively.

Ligadura segregada de la arteria tiroidea superior. Minimizar la lesión posterior a la tiroidectomía en el rama externa del nervio laríngeo superior. Un nuevo enfoque práctico / Segregated ligation of the superior thyroid artery minimize post-thyroidectomy injury to the external branch of superior laryngeal nerve, a novel practical approach

External division of the superior laryngeal nerve supplies the crico-thyroid muscle to excite length and thickness of the vocal fold. Thus, increasing voice tone. The vicinity with the superior thyroid vessels sets the external branch of the superior laryngeal nerve in danger every time the superior end of the thyroid is dissected. Thus, the aim of present study is to assess the rate and complication of external branch of the superior laryngeal nerve injury post- thyroidectomy when segregated ligation of superior thyroid vessels closes to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuro-monitoring. The presented study is a prospective, non- randomized clinical study included 1450 patients who underwent thyroidectomy which either (total thyroidectomies, near total thyroidectomies or lobectomy and isthmectomy) in the Department of Surgery/AL-Diawania Teaching Hospital in Diawania City, Iraq, between January 2000 and February 2018. All patients underwent thyroidectomy through segregated ligation of superior thyroid artery very closely to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuromonitoring. Postoperative indirect laryngoscopy vocal cord examination with long term follow up through physical examination and clinical history to evaluate nerve integrity. In present study, the total cases with EBSLN injury were 38 (2.6%), in which the transient EBSLN injury occurred in 28 (1.9%) of patients and permanent injury occurred in 10 (0.7%) of patients and majority of cases with EBSLN injury were occur in patients with large size goiter 29 (2%) more than small size goiter 9 (0.6%) And these differences were statistically significant differences, (P<0.005). In addition to, the majority of cases with EBSLN injury were occur in male {25(1.7%)} more than female patients {13(0.9%)} And these differences were statistically significant differences, (P<0.005). Segregated ligation of superior thyroid artery is a safe technical option, cost effective, time preserved and need surgical skills to minimized risk of injury to the external laryngeal nerve

Superior Thyroid Artery Arising From the Common Carotid Artery- Potential Source for Unpredicted Intraoperative Bleeding- A Cadaveric Case Report

Superior thyroid artery usually arises from the anterior surface of external carotid artery as its first branch. Superior thyroid artery forms an important collateral circulation in case of unilateral occlusion of common carotid artery. Due to the close relation with superior thyroid artery, external laryngeal nerve is prone to injury during thyroid surgery. Superior thyroid artery occasionally arises from the bifurcation of common carotid artery or from the common carotid artery. In the present cadaveric case, during the routine neck dissection of the cadaver in department of anatomy, anomalous origin of the left superior thyroid artery was found. It was originating from the left common carotid artery at a distance of 1.8 cm proximal to the bifurcation of common carotid artery. The length of left superior thyroid artery was 3.2 cm. left Inferior thyroid artery was present and no anomaly was found. Right superior and inferior thyroid arteries were present and no variations were found. Knowledge about these variations in the origin of superior thyroid artery is extremely important in head and neck surgeries to prevent inadvertant injury and avoid torrential bleeding

Variation in the Origin of Superior Thyroid Artery and it’s Relation with External Laryngeal Nerve: A Cadaveric Study

Introduction: The Thyroid gland is a highly vascular gland placed anteriorly in the neck, extending from the level of fifth cervical vertebra to first thoracic vertebra.The lobes of gland are conical. Their apices diverge laterally to the oblique line on the lamina of thyroid cartilage, and their bases are at the level of 4th or 5th tracheal ring. The relationship of the superior thyroid artery to the external laryngeal nerve is important to the surgeon during thyroid surgery.The artery and nerve are close to each other higher up but diverge near the gland. Thus in order to avoid injury to the external laryngeal nerve, the superior thyroid artery is ligated as near to the gland as possible. Subjects and Methods: This study was conducted on 50 cadavers of known age and sex in the dissection laboratory, department of anatomy. The cadavers were embalmed through carotid arterial perfusion or femoral arterial perfusion. Results: The site of the origin of the superior thyroid artery (STA) was evaluated as it arose from external carotid artery in 66% cases, from carotid bifurcation in 33% cases and from common carotid artery in 1% cases.The site of the origin of the superior thyroid artery (STA) was evaluated as it arose from external carotid artery in 66% cases, from carotid bifurcation in 33% cases and from common carotid artery in 1% cases.The evaluation of distance from upper pole of the thyroid gland to the level where External superior laryngeal nerve turns medially from Superior thyroid artery was found More than 1 cm in 73% cases & Less than 1 cm in 27% cases. Conclusion: The relationship of superior thyroid artery to external superior laryngeal nerve is very important for surgeons during thyroid surgeries to avoid injuries to above nerves while ligating STA.

A Study Of Anatomical Variations Of The Origin Of Superior Thyroid Artery And Its Relationship With The External Branch Of Superior Laryngeal Nerve

AIMS: To examine the variations of the origin of superior thyroid artery and its relationship with the external anch of the superior laryngeal nerve. MATERIALS AND METHODS: 43 embalmed cadavers were studied in this descriptive study. The anterior triangle of the neck region was dissected bilaterally. The presence or absence of STA and its origin, anching pattern, relationship with the external anch of the superior laryngeal nerve, level of origin in relation to the lamina of the thyroid cartilage and level of carotid bifurcation were observed and recorded. OBSERVATION AND RESULTS: The superior thyroid artery arises from the external carotid artery in 44.2%, common carotid bifurcation in 27.9% and common carotid artery in 26.7% of cadavers.

Variations In The Origin Of Superior Laryngeal Artery: A Cadaveric Study

Background: The superior laryngeal artery (SLA) is the dominant arterial supply of the laryngeal muscles, mucosaand glands. Knowledge of variations in the origin of superior laryngeal artery will be very useful duringreconstructive surgeries of the larynx, partial laryngectomy, laryngeal transplantation, and also during procedureslike super-selective intra-arterial chemotherapy for laryngeal and hypolaryngeal cancers. However, relativelyfew studies have been done on the superior laryngeal artery in comparison to its clinical importance. Thepresent study was aimed at documenting the prevalence of variable origin of the superior laryngeal artery withinthe carotid triangle.Materials and methods: Seventy hemi-necks obtained from 35 cadavers were dissected and studied for variationsin the origin of superior laryngeal artery. Dissection method was employed for this study. The infrahyoid groupof muscles were identified and reflected. The sternocleidomastoid muscle and superior belly of omohyoid weredisplaced laterally. The fascia was removed from the lobes of the thyroid gland exposing its arteries and veins,studied the origin of STA and its branches, especially superior laryngeal artery.Results: It was observed that the superior laryngeal artery took origin from superior thyroid in 92.8% cases.Variable origin from the bifurcation of common carotid artery was noted in 4.28% cases. SLA was found to arisefrom the external carotid artery in 2.85% cases. All the variations that were observed were unilateral.Conclusion: These findings may provide further insight to the anatomists, radiologists and surgeons and canhelp improve performances during surgical manipulations of the larynx.

Branches Of External Carotid Artery: A Descriptive Study

Background: The common carotid artery (CCA) divides at the level of superior border of thyroid cartilage. Theexternal carotid artery (ECA) is one of the terminal branches of CCA. ECA gives three anterior branches, Superiorthyroid (STA), Lingual (LA) and Facial arteries (FA). Therefore the present study was carried out to describe thelevel of bifurcation of CCA, its relations with anatomical landmarks and the morphometry of anterior branchesof ECA in relation to bifurcation of CCA.Methods: The present study was carried on 30 sagittal head and neck sections. The level of bifurcation of CCAwas noted. The distances from CCA bifurcation to the superior border of thyroid cartilage (SBTC), angle ofmandible, ear lobule were measured. The ddistances of STA, LA & FA from CCA bifurcation were also measured.Results: In 16 (53.33%) cases the bifurcation of CCA was observed at the level of SBTC, 2 (6.67%)It was between SBTC and hyoid bone, in 5 (16.67%) below SBTC and in 6 (20%) at the level of hyoid bone. The meandistances from the bifurcation of CCA to the SBTC was 24 ± 0.95mm, to the angle of the mandible was 31 ± 0.86mmand to the ear lobule was 54.8 ± 0.96mm. The mean distances of STA, LA and FA from CCA bifurcation were 7.2 ± 0.2,12 ± 0.45 and 17.6 ± 0.48 cm respectively.Conclusion: The anatomical study of CCA is useful for angiographies, thyroid and head and neck surgeries. Incase of common trunks, stenosis or occlusion may cause severe ischemic consequences and prone toatherosclerosis.

Progressive hematoma in anterior neck after endovascular treatment of middle cerebral artery aneurysm / Hematoma progressivo na região anterior do pescoço após tratamento endovascular de aneurisma da artéria cerebral média

Abstract Background: Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm. Case report: A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started. Following standard monitoring and anesthesia induction, the patient's trachea was intubated with a 7.5 mm endotracheal tube and the procedure was completed without any complications. Three hours later, dyspnea developed and physical examination revealed progressive swelling and stiffness in the neck. Endotracheal intubation was performed with a 6 mm diameter uncuffed tube with the aid of sedation. The vocal cords were completely closed due to compression. There was no leak around the endotracheal tube. The rapidly performed computerized tomography scans showed an enormous hematoma around the neck and extravasation of contrast medium through superior thyroid artery. After coil embolization of superior thyroid artery, she was taken to the intensive care unit as intubated and sedated. Surgical exploration of the hematoma was not recommended by the surgeons, because she was on clopidogrel. After two days, the patient's trachea was extubated safely ensuring that the swelling was sufficiently ceased and leak detected around the endotracheal tube. Conclusions: Securing the airway rapidly by endotracheal intubation is the most crucial point in the management of cervical hematomas. Diagnostic and therapeutic procedures should be performed only afterwards.

Resumo Justificativa: Hematomas cervicais podem levar ao comprometimento das vias aéreas, uma condição de risco para a vida, independentemente da causa. O presente caso é a primeira apresentação de hematoma cervical como uma complicação do tratamento endovascular de aneurisma da artéria cerebral média. Relato de caso: Uma mulher de 49 anos foi agendada para a colocação do stent sob anestesia geral para aneurisma da artéria cerebral média. Poucos dias antes da intervenção, um tratamento com ácido acetilsalicílico e clopidogrel foi iniciado. Após a indução da anestesia e o monitoramento padrão, a traqueia da paciente foi intubada com um tubo endotraqueal de 7,5 mm e o procedimento foi concluído sem quaisquer complicações. Três horas mais tarde, a paciente desenvolveu dispneia e o exame físico revelou edema progressivo e rigidez do pescoço. A intubação endotraqueal foi feita com um tubo de calibre 6 mm sem balonete com o auxílio de sedação. As pregas vocais estavam completamente fechadas devido à compressão. Não houve vazamento ao redor do tubo endotraqueal. Tomografias computadorizadas feitas rapidamente mostraram um enorme hematoma no pescoço e extravasamento do meio de contraste através da artéria tireoidiana superior (ATS). Após embolização com molas da ATS, a paciente foi levada para a unidade de terapia intensiva intubada e sedada. A exploração cirúrgica do hematoma não foi recomendada pelos cirurgiões porque a paciente tomava clopidogrel. Depois de dois dias, a traqueia da paciente foi extubada com segurança. Isso garantiu que o edema havia cessado o suficiente e o vazamento detectado ao redor do tubo endotraqueal também. Conclusões: Proteger as vias aéreas rapidamente por meio de intubação endotraqueal é a conduta mais crucial no manejo de hematomas cervicais. Os procedimentos diagnósticos e terapêuticos devem ser feitos somente após essa conduta.

Morphological Variations In The Arterial & Nerve Supply Of Thyroid Gland – A Cadaveric Study

Introduction: The arteries and nerves related to the thyroid gland are very important as they are the potentialsource of bleeding and palsy during thyroidectomies and other head and neck surgeries. Thus a thoroughknowledge of relation between them is a prerequisite for the surgeons and other interventionists.Materials and Methods: The study was done in the Department of Anatomy, Government Medical College, Patiala,Punjab among 30 adult human cadavers from May 2015 to Nov 2015. The origin, course, terminal branches andthe relation of superior and inferior thyroid arteries to external and recurrent laryngeal nerves respectively werenoted and the results were evaluated. The complete pattern of morphology of the thyroid gland in relation to thearterial and nerve supply was labelled as standard or variant. Bilateral symmetry of pattern was noted anddetails of the variations were enumerated. A detailed inference was obtained in the light of present observationsand the findings of earlier workers.Results: In 29 cases we found the superior and inferior thyroid arteries were originating from the externalcarotid artery and thyrocervical trunk respectively while in 1 case there was thyroidea ima artery originatingfrom right common carotid artery with absent right inferior thyroid artery. The external and recurrent laryngealnerves were related to superior and inferior thyroid arteries as described by most of the standard textbooks butthe detail percentages of the relationship is given below.Conclusion: The study is an attempt to establish a relation between the variations that we generally encounter inthyroid glands related to its arteries and nerves. Proper identification of thyroid gland vessels is very importantin order to avoid major complications during and after neck surgeries. Thyroid anatomy and its associatedanatomical variations are very essential to know for Endocrinologist and Surgeons, so that these anomalies arenot overlooked while arriving at a diagnosis

A Case of Pseudoaneurysm of the Superior Thyroid Artery after Core Needle Biopsy

A pseudoaneurysm is a collection of blood that locates between the two outer layers of an artery, the muscularis propria and the adventitia. It is resulted from disruption of a portion of the arterial wall. A pseudoaneurysm can be caused by trauma, blood vessel intervention, intravenous drug use, vasculitis, infectious aneurysm, and postoperative anastomotic leakage. The pseudoaneurysm of superior thyroid artery after core needle biopsy is rare. We report a case of pseudoaneurysm caused by thyroid core needle biopsy and treated by surgical treatment.

Variations in the origin of superior laryngeal artery / 대한해부학회지

The superior laryngeal artery is the principal artery supplying the laryngeal mucosa, musculature, and glands. Knowledge of variations in the origin of superior laryngeal artery could prove to be very useful during reconstructive surgeries of the larynx, partial laryngectomy, laryngeal transplantation, and also during procedures like super-selective intra-arterial chemotherapy for laryngeal and hypolaryngeal cancers. However, relatively few studies have been done on the superior laryngeal artery in comparison to its clinical importance. The present study was aimed at documenting the prevalence of variable origin of the superior laryngeal artery within the carotid triangle. Sixty hemi-necks obtained from 30 South Indian cadavers were dissected and studied for variations in the origin of superior laryngeal artery. It was observed that the superior laryngeal artery took origin from superior thyroid in 91.7% cases. Variable origin from the external carotid artery was noted in 5% cases. The superior laryngeal artery was found to arise from the lingual artery in one case alone (1.7%). In addition to the above findings, a very rare variation of superior laryngeal artery arising from the ascending pharyngeal (1.7%) was also observed in the hemi-neck of one cadaver. All the variations that were observed were unilateral and on the left side. These findings may help provide further insight to the anatomists, radiologists and surgeons and can help improve performances during surgical manipulations of the larynx.

Surgical Management of Bleeding from the Superior Thyroid Artery after Core Needle Biopsy / 대한내분비외과학회지

Thyroid core needle biopsy (CNB) is commonly used in diagnosis of thyroid neoplasia, and despite its low complication rate, the complications can be fatal. Here, we report on the surgical management of thyroid artery bleeding after core needle biopsy of a thyroid nodule. A 58-year-old woman who underwent core needle biopsy presented with neck bulging and pain that developed two hours after biopsy. A large hematoma surrounding her right superior thyroid artery was detected.

Anatomical considerations of the superior thyroid artery: its origins, variations, and position relative to the hyoid bone and thyroid cartilage / 대한해부학회지

The aim of this study was to provide accurate anatomical descriptions of the overall anatomy of the superior thyroid artery (STA), its relationship to other structures, and its driving patterns. Detailed dissection was performed on thirty specimens of adult's cadaveric neck specimens and each dissected specimen was carefully measured the following patterns and distances using digital and ruler. The superior thyroid, lingual, and facial arteries arise independently from the external carotid artery (ECA), but can also arise together, as the thyrolingual or linguofacial trunk. We observed that 83.3% of STAs arose independently from the major artery, while 16.7% of the cases arose from thyrolingual or linguofacial trunk. We also measured the distance of STA from its major artery. The origin of the STA from the ECA was 0.9±0.4 mm below the hyoid bone. The STA was 4.4±0.5 mm distal to the midline at the level of the laryngeal prominence and 3.1±0.6 mm distal to the midline at the level of the inferior border of thyroid cartilage. The distance between STA and the midline was similar at the level of the hyoid bone and the thyroid cartilage. Also, when the STA is near the inferior border of the thyroid cartilage, it travels at a steep angle to the midline. This latter point may be particularly important in thyroidectomies. We hope that anatomical information provided here will enhance the success of, and minimize complications in, surgeries that involve STA.

Protection of the external branch of the superior laryngeal nerve in carotid endarterectomy / 中国脑血管病杂志

Objectives To investigate the methods of protecting external branch of the superior laryngeal nerve (EBSLN)in carotid endarterectomy and to observe the effect of using these methods in clinical surgery. Methods EBSLN (20 sides)of 10 heads of corpse were studied by using microanatomy from January 2013 to December 2013. The occurrence probability of EBSLN on the lower edge of posterior belly of digastric muscle,medial edge of external carotid artery and upper edge of superior thyroid artery in anatomy triangle was analyzed. The distances from the midpoint of the EBSLN to carotid bifurcation, mandibular angle and mastoid tip were measured. Sixty-five patients with carotid endarterectomy in Tianjin Huanhu Hospital from December 2013 to November 2014 were treated with the protective methods of the relevant EBSLN by using anatomy triangle as a mark. Whether the patients had injury symptoms of EBSLN were followed up after procedure. Results (1)The occurrence probability of 20-side EBSLN in anatomy triangle was 95%(19 sides). The midpoint of EBSLN in the anatomy triangle at the posterior mandibular angle was median 0. 34 (-1. 62 to 2. 43)cm,at the inferior mandibular angle was 1. 28 (-1. 33 to 3. 42) cm,at anterior mastoid tip was 2. 84 (0. 51 to 5. 14)cm,at inferior was 4. 51 (2. 82 to 6. 39)cm,and at anterior superior of the carotid bifurcation was 1. 64 (0. 57 to 3. 78)cm. (2)65 patients who underwent carotid endarterectomy used the protective methods of intraoperative EBSLN. There was no manifestation of EBSLN injury at 3 weeks to 9 months after procedure. Conclusion In carotid endarterectomy,taking an anatomic triangle as a symbol,it is no more than 2 cm of the anterior superior of carotid bifurcation during the separation process. As for the patients with higher or lower position of carotid bifurcation,in the range of crossing rear mandibular angle 0. 50 cm or below the mastoid tip 4. 50 cm for arterial separation should be avoided,and this can effectively protect EBSLN.

A Case of Massive Oropharyngeal Bleeding from Pseudoaneurysm of Superior Thyroid Artery Associated with Parapharyngeal Abscess / 대한이비인후과학회지

Parapharyngeal abscess is relatively common but it can cause life-threatening complications like internal jugular vein thrombophlebitis, septic shock, airway obstruction, and mediastinitis. The diagnosis is dependent on physical examination, endoscopic view, and CT and MR imaging. The treatment is antibiotics but sometimes incision and drainage are necessary. Pseudoaneurysm in deep neck space is very rare and mainly caused by trauma, postoperative state of head and neck surgery and radiation therapy. We herein report a case of massive oropharyngeal bleeding from pseudoaneurysm of the superior thyroid artery associated with parapharyngeal abscess with a review of related literature.

Unusual branching pattern of external carotid artery in the left carotid triangle.

During the routine dissection of the neck for the first MBBS students, we have found the abnormal branching of the external carotid artery in the carotid triangle. The external carotid artery is a terminal branch of the common carotid artery arises at the level of superior border of the thyroid cartilage in the carotid triangle. It supplies the structures of head and neck regions by its eight branches. The knowledge of variations is very important for the general, head & neck, ENT and oncosurgeons, to avoid unforeseen complication in the form of bleeding by injuring the abnormal arteries. It is also important for the vascular surgeons and radiologists while performing the procedures on the arteries.

Clinical evaluation of superior thyroid artery hemodynamic characteristics by color Doppler ultrasound on 131I treated Graves'hyperthyroidism / 中华超声影像学杂志

Objective To investigate the hemodynamic characteristics of superior thyroid artery and its corresponding clinical significance with patients of Graves'hyperthyroidism.Methods Thirty patients with Graves'hyperthyroidism received Doppler ultrasonography.Patients were grouped with different serologic indices at 4 month after radioiodine therapy as relief(R),uncured(U)and hypothyroidism(H).The relationships between thyroid volume(V),superior thyroid artery peak systolic velocity(PSV),end diastolic velocity(EDV),RI,PI and systolic accelerating time(SAT)and the 4-month outcome were analyzed respectively.Results Besides the effect of 24 h-131I uptake rate on patients'short-term outcome,V,PSV and RI were of predominate prognosis value(P＜0.01).PSV and V of group R were positively correlated with 131I dose respectively(r1=0.825,r2=0.697;P＜0.001),while SAT of group R was negatively correlated with 131I dose(r=-0.489,P＜0.05).Conclusions Patients with high V,PSV and RI maybe still suffering hyperthyroidism after regular dosage of 131I therapy.Doses of 131I should be added appropriately for patients with high PSV and V,but short SAT to achieve complete remission,while it should be reduced for patients in opposite condition to avoid occurrence of hypothyroidism.

Topographic Anatomy of the Arteries Supplying Sternocleidomastoid Muscle for Osseomusculocutaneous Flap Surgery / 체질인류학회지

In reconstructing a defect of the mandible after removing tumor of an oral cavity or facial region, various musculocutaneous flaps are used. Among those, SCM musculocutaneous flaps are clinically frequently used due to its near donor site and it can be done without an additional operation. Because the SCM muscle is supplied by many vessels of the external carotid artery and subclavian artery, it is essential to the figure out its distribution to the SCM muscle, clavicle and the skin before making an osseomusculocutaneous flap including the clavicle. Especially, understanding the distribution status of the origin of superior thyroid artery and SCM branch is very important in making a SCM musculocutaneous flap including the clavicle and deciding the rotation arc of the musculocutaneous flap. The authors have dissected SCM muscles and arteries distributed to the SCM muscle of 50 cadavers and found the following results. The average distance from the origin of superior thyroid artery to SCM branch entering to SCM muscle was 30.1 mm (16.0 ~37.7 mm), and some were to have 2 ~3 branches inserted simultaneously into the SCM muscle. The average distance from the origin of superior thyroid artery to clavicular head of SCM muscle was 87.6 mm (57.7 ~123.8 mm), and to sternal head of SCM muscle was 131.2 mm(99.7 ~166.8 mm). After the SCM branch of superior thyroid artery distributed to the SCM muscle, the bifurcation point into clavicular branch and sternal branch is located at an average 58.8 mm(28.4 ~130.4 mm) above the clavicle. All of the nutrition artery distributed to the clavicle were branches of the thoracoacromial artery, and the SCM branch of superior thyroid artery distributed throughout the SCM muscle and downwards to the periosteal artery of the clavicle. The pattern of the superior thyroid artery was divided into 6 types. Among the branches of superior thyroid artery such as laryngeal, SCM and thyroid branch, The type I (36%) that the laryngeal branch arised first was most common. Next, the incidence of type II that all three branches arised at one point was 16%. In addition, the incidence of the case that SCM branch arised directly from the external carotid artery was 26%. In conclusion, because the origin of superior thyroid artery from the external carotid artery is located relatively close to the mandible above the neck, the length of SCM musculocutaneous flap including the SCM branch of superior thyroid artery is sufficient to reconstructing the mandible and the SCM osseomusculocutaneous flap including the clavicle is useful in reconstruction of the mandible.