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Case 2.2
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
You mentioned that you would aim to avoid using the lingual artery – where possible if it hasn’t been divided as part of the resection. Why is that?The left and right lingual arteries are the main blood supply to the tongue.Using this as a first-line recipient vessel would put the tongue vascularity at risk if both sides were used (e.g., with eventual bilateral head and neck flaps), or if one is used for a flap and the other side is divided as part of a subsequent resection.Therefore, I would reserve its use unless all other options are exhausted.If the lingual artery is ligated as part of the resection, then the proximal stump becomes my second-line option if the facial artery is not available, as it is usually of good size.
Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Blood supply Lingual artery (a branch of the external carotid artery) and tonsillar artery (a branch of the facial artery)
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The tongue receives its blood supply primarily from the lingual artery, a branch of the external carotid artery. The fibrous septum dividing the two halves of the tongue prevents any significant anastomosis of blood vessels across the midline. In contrast, a significant feature of the tongue’s lymphatic drainage is that lymph from one side, especially of the posterior part, may reach nodes on both sides of the neck (in contrast to the blood supply which remains unilateral). Because the lymphatic plexus freely communicates across the midline, cancer of the tongue frequently metastasizes bilaterally.
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).
Transoral robotic surgery in the management of head and neck squamous cell cancer with unknown primary
Published in Acta Oto-Laryngologica, 2020
Johan S. Nilsson, Peter Wahlberg, Lennart Greiff
The surgical procedures were carried out using the DaVinci S or Si system for robotic surgery (www.intuitivesurgical.com). The procedure was performed as a superficial hemi-excision of the BOT not exposing the lingual artery. A typical biopsy had a surface area of 400–500 mm2 (complete data on the matter is lacking). No serious complications were encountered.
Z-palatopharyngoplasty combined with 70-degree endoscopy-assisted coblator partial medial glossectomy on severe obstructive sleep apnea
Published in Acta Oto-Laryngologica, 2019
Huaihong Chen, Jiangping Wang, Xiaoxing Huang, Yuanshou Huang, Juan Lu, Xiangping Li
All cases were anesthetized by nasal tracheal intubation and completed by the same anesthesiologist. The patients were positioned so that the shoulder was raised and the head was tilted back. Each patient underwent ZPPP plus Eco-TBR in the same setting. ZPPP procedure was performed as described in previous literature [2,11] (see Figure 1(C,D)). Radiofrequency ablation was performed with the Arthro Care Coblator II plasma surgery system under the guidance of a rigid 70-degree nasal endoscope. The front end of the plasma cutter was bent and shaped to accommodate the curvature of the tongue base during surgery. Two centimeters in front of the circumvallate papilla, the tongue was sutured and pulled with a No. 1 silk thread, and the teeth were placed on the dental pad to adjust the opening device to fully expose the visual field. The tongue base was removed from the foramen cecum linguae to the epiglottis tip by layer under the guidance of a 70-degree endoscope. The depth of ablation was calculated according to the preoperative upper airway CT angiography reconstruction, about 1.5–2.5 cm; the width was about 2–3.5 cm and the bilateral boundary was more than 1 cm from the pharyngeal wall. Under 70-degree endoscope, much attention was paid to the ascending branch of lingual artery within the lateral side of the tongue, where any bleeding observed under the endoscope was properly stopped. The wound did not require end suture. The tracheal intubation was preserved after surgery and the patient was observed in intensive care unit (ICU) for 24 h after surgery. The average length of stay in the ICU was 24.4 h. Once the condition of the patient was stable, extubation was performed and the patient was returned to the general ward. The patient received postoperative Pulmicort respiratory local nebulization and analgesic pump maintenance for three days. Subsequently, systemic venous administration of the cephalosporin (second generation) and a proton pump inhibitor were carried out for 4–7 days. The average length of total hospital stay was 7.6 ± 1.3 days.