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Anatomy of the Pharynx and Oesophagus
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The pharynx has a rich vascular supply from a number of branches of the external carotid artery. Much of the superior pharynx is supplied by the ascending pharyngeal artery. This artery arises from the medial external carotid and passes superiorly, giving off branches to the pharynx. A palatine branch passes over the edge of the superior constrictor to supply the soft palate and internal pharynx as well as the pharyngotympanic tube. There are additional supplies from the tonsillar artery and ascending palatine branch of the facial artery as well as, more inferiorly, from the superior and inferior laryngeal arteries.
The Adenoid and Adenoidectomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Secondary haemorrhage after adenoidectomy is rare. It may be due to bleeding from an aberrant ascending pharyngeal artery.70 Unusual reactionary or secondary bleeding should raise the possibility of a clotting or coagulation defect. This requires specialist haematological investigation to confirm or exclude.
Treatment of intractable epistaxis in patients with nasopharyngeal cancer
Published in Annals of Medicine, 2023
Xiaojing Yang, Hanru Ren, Minghua Li, Yueqi Zhu, Weitian Zhang, Jie Fu
The primary blood supply to the posterior wall of the nasopharynx and pharyngeal recess area is provided by the ascending pharyngeal artery. This artery arises from the external carotid artery, with some branches originating from the ICA or occipital artery [37]. The pterygoid artery, a secondary branch of the pharyngeal artery from the internal maxillary artery, supplies blood to the front of the nasopharynx, front of the pharyngeal crypt, and cartilage of the Eustachian tube. If the ascending iliac artery is absent, it can be replaced by a descending branch of the ascending pharyngeal artery. The branches of the maxillary artery from the external carotid artery are distributed on the top and posterior walls of the nasopharynx, the side walls of the nasopharynx, and the nasal floor near the posterior nostril of the nasal cavity [38]. The superficial blood supply of the pharyngeal recess of the nasopharynx is primarily through the branches of the external carotid artery and ascending pharyngeal artery. Nasopharyngeal bleeding can occur due to rupture of the ascending pharyngeal recess.
Resolution of hypoglossal nerve palsy after coil embolization of an anterior condylar confluence fistula
Published in British Journal of Neurosurgery, 2021
Donald K. E. Detchou, Gregory Glauser, Omar A. Choudhri
Here, we present the case of a 69-year-old female with a 2-year history of slurred speech, left-sided pulsatile tinnitus, and a left-sided hypoglossal nerve palsy, with tongue deviation and atrophy (Figure 1(A)). MRI and CT Angiography imaging demonstrated increased vascularity at the left hypoglossal canal. Cerebral angiography showed a left anterior condylar confluence fistula, supplied bilaterally by the ascending pharyngeal artery, as well as the posterior meningeal artery (Figure 1(B,C)). For this patient, the treatment plan included a transvenous coil embolization of the left condylar fistula pocket (Figure 2). Subsequent to receiving therapeutic endovascular treatment, the patient had complete resolution of her symptoms (Figure 3).
Outcome of carotid and subclavian blowout syndrome in patients with pharynx- and larynx carcinoma passing a standardized multidisciplinary treatment
Published in Acta Oto-Laryngologica, 2018
Constanze Gahleitner, Benedikt Hofauer, Katharina Storck, Andreas Knopf
The mean age at bleeding was 63 ± 12 years. The average time from primary diagnosis to first bleeding was 15 ± 17 months. Eighty-six percent of patients presented with manifest carcinoma at the time of acute arterial haemorrhage. In the rest of the patients, CT scan or histological sampling found no recurrent or residual tumour (Table 2). Analysis of affected vessels demonstrated external carotid artery (ECA, 24%), common carotid artery (ACC, 10%), lingual artery (LA, 10%) and maxillary artery (MA, 10%) as the most affected vessels (Figure 2). Blow out of the subclavian artery (SCA), inferior thyroid artery (ITA), internal carotid artery (ICA), superior thyroid artery, facial artery (FA) and ascending pharyngeal artery occurred infrequently. The vessels affected by CBS were further divided into four groups according to their anatomical localisation. The superior vessel group consisted of ICA and MA, the central vessel group of ECA and its branches (except MA) and the inferior group of SCA, CCA and ITA, respectively. Lastly, there was a group of 12 patients (24%) who suffered from bleeding of unknown primary causes. Four patients were shown to have bleeding which was likely to have occurred from multiple vessels (Table 2). There were significant differences in the distribution of previous cancer localisation for the central and inferior vessel groups. Post hoc analysis illustrated that the central vessel group was more affected in cases of oropharyngeal- and oral cavity cancer than in cases of hypopharyngeal and larynx carcinoma (p = .028). The inferior vessel group was conversely impacted: those with cases of larynx and hypopharynx cancer were more affected than those with cancers of the oropharynx and the oral cavity (p = .017) (Table 2).