Arterial variations within the lateral cervical region: a multidetector CT angiography study / Variaciones arteriales en la región cervical lateral: estudio angiográfico por tomografía computarizada multidetector

It is important to know the arterial anatomy within the lateral cervical region before the flap-planning. We evaluated the arterial anatomy in this area using multidetector computed tomography (CT) angiography and our aim was to establish the arterial variations. Both sides of individuals in a total number of 155 carotid CT angiographies are reviewed by using 64-detector CT, retrospectively. The variations of suprascapular artery, superficial cervical artery, dorsal scapular artery that are inclusive of the lateral cervical region were assessed. Three arteries originated individually in 67 (23.8 %) sides. They arose by trunk formation in 214 (76.2 %) sides. The most common type of trunk formation was cervicodorsal trunk (107; 38 %). The others were cervicoscapular trunk, cervicodorsoscapular trunk, dorsoscapular trunk and detected in 66 (23.4 %), 40 (14.3 %), 1 (0.3 %) sides, respectively. The origins of arteries within the lateral cervical region may show variations and they may originate from subclavian artery or its branches individually or by trunk formations. It may be beneficial to know these variations before the reconstructive surgical procedures in head and neck. CT angiography is a non-invasive method that enables to evaluate the arterial anatomy and variations in this area.

Es importante conocer la anatomía arterial de la región cervical lateral antes de la planificación de un colgajo. Evaluamos la anatomía arterial en esta área mediante angiografía con tomografía computarizada (TC) multidetector con el objetivo de establecer las variaciones arteriales. Se revisaron retrospectivamente un total de 155 angiografías de ambos lados de la región cervical lateral por tomografía computarizada multidetector. Se evaluaron las variaciones anatómicas de las arterias supraescapular, cervical superficial y escapular dorsal. Las tres arterias se originaron individualmente en 67 casos (23,8 %). Surgieron por formación de un tronco en 214 casos (76,2 %). El tipo más común de formación del tronco fue el tronco cervicodorsal (107 casos; 38 %). Los otros troncos hallados fueron: el tronco cervicoescapular, el tronco cervicodorsoescapular, el tronco dorsoescapular, en 66 casos (23,4 %), 40 casos (14,3 %) y 1 caso (0,3 %), respectivamente. Los orígenes de las arterias en la región cervical lateral pueden mostrar variaciones y las arterias pueden originarse desde la arteria subclavia o sus ramas, individualmente o por formaciones de tronco. Puede ser beneficioso conocer estas variaciones antes de los procedimientos quirúrgicos reconstructivos en cabeza y cuello. La angiografía por TC es un método no invasivo que permite evaluar la anatomía arterial y las variaciones en esta área.

Ethanol sclerotherapy of head and neck venous malformations / Escleroterapia com etanol em malformações venosas da cabeça e pescoço

Objective This retrospective study evaluated the results of sclerotherapy with low doses of ethanol for treatment of head and neck venous malformations. Methods We treated 51 patients, 37 females. Median age was 23 years. Patients were treated with percutaneous intralesional injection of alcohol every two weeks and followed up prospectively for a median period of 18 months. Most lesions affected the face and cosmetic disfigurement was the most frequent complaint. Results We performed a median of 7 sessions of sclerotherapy. Complete resolution or improvement was observed in 48 patients presented. Five cases of small skin ulceration, two cases of hyperpigmentation and two of paresthesia were documented; all of them were treated conservatively. Conclusion Percutaneous sclerotherapy with low doses of ethanol is a safe and effective treatment modality for venous malformations affecting the head and neck. .

Objetivo Estudo retrospectivo que analisou os resultados da escleroterapia, com doses baixas de etanol, realizada sob anestesia local para tratamento de malformações venosas na cabeça e pescoço. Métodos Foram tratados 51 pacientes, sendo 37 do gênero feminino. A mediana de idade foi de 23 anos. Os pacientes foram tratados com injeções alcoólicas nas lesões, por via percutânea, em sessões quinzenais, e acompanhados prospectivamente por um período mediano de 18 meses. A maioria das lesões acometia a face e a queixa principal mais frequente foi deformidade estética. Resultados Foram realizadas, em média, sete sessões de escleroterapia. Resolução completa ou melhora foi observada em 48 pacientes. Cinco pacientes apresentaram pequena úlcera cutânea, dois hiperpigmentação e dois parestesia, sendo todos tratados conservadoramente. Conclusão A escleroterapia percutânea com doses baixas de etanol é um método seguro e eficaz para tratar malformações venosas na cabeça e pescoço. .

Two rare anatomical variations of external jugular vein: an embryological overview / Dos raras variaciones anatómicas de la vena yugular externa: una visión embriológica

Human anatomy is an ocean of unending variations and its mysteries are being unravelled since ages. Knowledge of variations in the superficial veins of head and neck is essential to carry out successful surgical procedures. During routine dissection of head and neck of two middle aged male cadavers, in the Department of Anatomy, Calcutta National Medical College, Kolkata, India, we came out with some interesting venous architecture. The retromandibular vein on the left side of both the cadavers was found to be undivided and joined with the facial vein in the neck at an acute angle to form a common venous trunk at variable distances from the angle of the mandible. That trunk ultimately drained into the left subclavian vein. This might be the result of disappearance of the cephalic part of the external jugular vein and formation of an additional communication between common facial vein and the external jugular vein in foetal life. In one case, we also came across an extra transverse communication between that common trunk and the internal jugular vein. A detail of those cases with embryological explanation is attempted...

La anatomía humana tiene un sin fin de variaciones y sus misterios se han develado desde el inicio de los tiempos. El conocimiento de las variaciones anatómicas de las venas superficiales de la cabeza y del cuello es fundamental para llevar a cabo con éxito los procedimientos quirúrgicos. Durante una disección de rutina de cabeza y cuello encontramos una arquitectura venosa interesante en dos cadáveres de hombres de mediana edad en el Departamento de Anatomía de la Facultad de Medicina Nacional Calcuta, Calcuta, India. En el lado izquierdo del cuello de ambos cadáveres, la vena retromandibular no se encontraba dividida, y se unía a la vena facial en un ángulo agudo, para formar un tronco venoso común a una distancia variable desde el ángulo de la mandíbula. Ese tronco finalmente drenaba en la vena subclavia izquierda. Esto podría ser el resultado de la desaparición de la parte cefálica de la vena yugular externa y la formación de una comunicación adicional entre la vena facial común y la vena yugular externa en la vida fetal. En un caso, también se encontró con una comunicación adicional transversal entre ese tronco común y la vena yugular interna. Se realiza una descripción en detalle de los casos junto a una explicación embriológica...

Gasless Transaxillary Robot-Assisted Neck Dissection: A Preclinical Feasibility Study in Four Cadavers

PURPOSE: We hypothesized that comprehensive neck dissection could be achieved via a gasless transaxillary approach using a robotic system. We intended to evaluate the accessibility of level I, IIB and VA nodes with transaxillary robot-assisted neck dissection of four cadavers. MATERIALS AND METHODS: Transaxillary robotic neck dissection was performed in four cadavers through a 7-cm longitudinal incision at the anterior axilla and a 0.8-cm-sized incision in the chest wall. RESULTS: We successfully performed neck dissection from level II to V in all four cadavers. However, dissection of levels IIB and VA, which lie on the cephalic portion of the spinal accessory nerve, was difficult. Vital structures, including the internal jugular vein, carotid artery, vagus nerve, phrenic nerve, superior thyroid artery and hypoglossal nerve, were successfully identified and preserved. CONCLUSION: Our results demonstrate the feasibility of robot-assisted neck dissection using a transaxillary approach. We suggest that gasless, transaxillary robotic neck dissection is a promising technique for treating nodal metastasis in thyroid cancers or in selected squamous cell carcinomas of the head and neck. However, some modification of the approach might be needed when performing comprehensive neck dissections of all levels of the neck.

A Case of Central Retinal Artery Occlusion after Chiropractic Manipulation of the Neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.

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.

Head and Neck Vascular Lesions: Characterization of the Flow Pattern by the Use of Three-Phase CT

OBJECTIVE: This study was designed to evaluate the usefulness of three-phase CT to characterize the hemodynamics of vascular lesions in the head and neck area. MATERIALS AND METHODS:We analyzed vascular malformations of head and neck regions in 21 patients with the use of three-phase CT, including pre-contrast phase, vascular phase (scan delay: 20-35 seconds after intravenous contrast material injection) and equilibrium phase (scan delay: 3-5 minutes) imaging. The flow characteristic of each lesion was determined and categorized as either a high- or a low-flow lesion according to findings on selective arteriography and/or direct puncture venography. The CT number was acquired from two areas in a vascular lesion, sorted by the enhancement pattern: area 1, a highly enhanced area seen on the vascular phase; area 2, a delayedly enhanced area seen on the equilibrium phase. The CT numbers of each phase were compared between high- and low-flow lesions with use of the unpaired t-test. The flow patterns of high- and low-flow lesions were analyzed by assessment of time-density curves of three phase CT. RESULTS: High-flow lesions were detected in nine patients and low-flow lesions were detected in 12 patients. On the vascular phase, the CT number of areas 1 and 2 of high-flow lesions was significantly higher than for low-flow lesions (p < 0.05). Contrary to early peaks seen in time-density curves of high-flow lesions, low-flow lesions showed a delayed peak. CONCLUSION: Three-phase CT seems to be a valuable non-invasive method to differentiate a high-flow lesion from a low flow lesion of head and neck vascular lesions.

An anomalous left external jugular vein draining into right subclavian vein: a case report

Knowledge of the varying drainage patterns of superficial veins of head & neck, in particular, jugular veins are not only important for anatomists but also for the surgeons operating at this level and to clinicians in general. The variations are important for interventional radiologists too who perform transjugular procedures, such as port implantations and the transjugular intrahepatic portosystemic shunt or selective venous samplings. Results of recent studies report that the superficial veins, especially the external jugular vein (EJV), is been increasingly utilized for cannulation to conduct diagnostic and therapeutic procedures. We report a very unusual presentation of external jugular vein on left side of an embalmed male cadáver. Embryological evaluations of the anomaly was done and compared with available literature which showed that the observed variation is rare.

El conocimiento de los diferentes patrones de drenaje de las venas superficiales de la cabeza y cuello, en particular, las venas yugulares no sólo son importantes para anatomistas, sino también para los cirujanos que operan a este nivel y para los médicos en general. Las variaciones son importantes también para los radiólogos intervencionistas, quienes realizan procedimientos transyugulares, así como implantaciones portales y portosistémicas transyugulares intrahepáticas o derivación venosa selectiva. Resultados de estudios recientes informan que la venas superficiales, especialmente la vena yugular externa, es cada vez más utilizada para la canulación en diagnósticos y procedimientos terapéuticos. Se reporta una muy inusual variación anatómica de la vena yugular externa del lado izquierdo, presente en un cadáver embalsamado de sexo masculino. Fueron realizadas evaluaciones embriológicas de la anomalía y se compararon con la literatura mostrando que se trata de una variación rara.

Circuito venoso cervical de la llama (Lama glama) / Cervical venous circuit of the llama (Lama glama)

La particular estructura de la región cervical de la llama (Lama glama) se traduce en numerosas diferencias anátomo-funcionales respecto de otros mamíferos domésticos. Entre ellas merece destacarse un distintivo circuito venoso, cuya descripción es el objetivo de este trabajo. Para el presente estudio, se utilizaron diez llamas, machos, adultos y de aptitud lanera. Para resaltar las venas del cuello se procedió a la repleción de las mismas y, posteriormente, se disecaron los vasos utilizando técnicas e instrumental convencional. Se describe la morfología particular de un circuito venoso, en el cual las venas yugular externa, vertebral e intervertebrales son las principales protagonistas. El hecho destacado radica en las anastomosis establecidas entre las citadas venas, uniones dispuestas en forma metamérica, formando un circuito o by pass yugular-vertebral. La existencia de comunicaciones o shunts venosos, permite definir un circuito de circulación colateral derivando la sangre principalmente hacia la vena yugular externa. La longitud del cuello y los hábitos de pastoreo indican que esta disposición vascular es un hecho facilitador del retorno venoso, en cuanto a su dinámica y al control regional del flujo sanguíneo.

The neck region of the Llama (Lama glama) has several structural and functional particularities in comparison to the same region of other domestic mammals. Among them, it is noticeable a distinctive venous circuit whose description is the purpose of this study. In order to perform the study, the veins of the neck of ten adult, male, wool type llamas were dissected with conventional technique. Previously to dissection, the veins were filled with a repletive substance. The authors describe the morphology of a venous circuit in which external jugular vein (v. jugularis externa), vertebral vein (v. vertebralis), and intervertebral veins (vv. Intervertebrales) are the main participating vessels. The distinctive feature is the fact that the metameric anastomoses between the forenamed veins leads to a jugular-vertebral by pass. The existence of venous shunts provides a circuit of collateral circulation, diverting the blood mainly towards the external jugular vein. Grazing habits and the length of the neck suggest that the vascular structure previously described facilitates the venous return, contributing to the regional blood stream control.

A unilateral anomaly of the superior laryngeal artery passing through the thyroid cartilage lamina

The superior laryngeal artery supplies blood to the larynx and has important implications for neck surgery. We report a unilateral, anomalous continuation of this superior laryngeal artery in an elderly male cadaver. The superior laryngeal artery was enlarged from its origin down to the lateral lamina of the thyroid cartilage. At this point, the artery passed through the lamina and continued as an internal branch that supplied the larynx. No other vascular anomalies were noted. Although this anatomical variation is uncommon, the possibility of its occurrence should be kept in mind by clinicians and surgeons who manipulate this anatomical area.

The contribution of the aortic branches in the vascularization of cervical regions, during the development of the nine banded armadillo (Dasypus Novemcinctus, L. 1758)

El trabajo describe el origen, ramificación y distribución de las ramas aórticas, durante el desarrollo del tatu gallina, modelo experimental en el estudio de la hanseniasis humana. Aplicando inyección de contraste, se identificaron las ramas de las aa. subclavia, carótida común y omocervical, y su contribución en la irrigación de las regiones cervicales ventral, lateral, dorsal, encefalica y de la glandula tiroide.

Conceptos básicos en anatomía de cabeza y cuello para el cirujano dermatólogo / Mejor concepts of face and neck surgical anatomy for the dermatologic surgeon

Los autores integran en forma concisa los puntos de mayor interés en anatomía quirúrgica práctica de cabeza y cuello para el cirujano dermatólogo