China
Africa
Explore chapters and articles related to this topic
Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The upper part of the face and scalp is supplied by the terminal branches of the external carotid artery. The deep facial structures are supplied by the maxillary artery, which passes deep to the mandible. The superficial temporal artery passes upwards to supply the temporal region. The transverse facial artery is a branch of this artery that runs medially across the face, supplying the cheek structures. Small supraorbital and supratrochlear arteries, branches of the ophthalmic branch of the internal carotid artery, supply the forehead and anterior scalp.
Middle Fossa Surgery
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
Raghu N.S. Kumar, Sunil N. Dutt, Richard M. Irving
This is either an inferiorly based U-shaped flap or a vertical line. It begins 0.5 cm anterior to the base of the helix, at the level of the zygomatic arch, and extends approximately 7 cm superiorly. Branches of the superficial temporal artery that are encountered at this stage should be ligated to avoid post-operative bleeding. The temporalis fascia plane is developed by finger dissection. An incision is placed in the temporalis muscle along its insertion line and it is elevated inferiorly and anteriorly taking care to preserve its neurovascular supply. Elevation of the temporalis exposes the squamous part of the temporal bone. The root of the zygoma indicates the level of the MF floor and it is crucial that the initial exposure adequately identifies this both anteriorly and inferiorly.
Complications in Mohs Surgery
Published in Alexander Berlin, Mohs and Cutaneous Surgery, 2014
Jordan B. Slutsky, Scott W. Fosko
When transected, larger vessels require suture ligation at both ends with a figure-of-eight technique. Hemostats are useful for clamping larger bleeding vessels prior to ligation. Extra care should be taken when operating on the temple, as the superficial temporal artery and its branches may be encountered and can cause significant bleeding challenges (Figure 4.3). Occasionally, surgical drains may be needed for large wounds with significant bleeding. Rarely, arterial bleeding cannot be controlled in the Mohs suite and patients must be managed in a more controlled operating room setting, where they may even require blood products or reversal of anticoagulation.33 It is imperative to have protocols in place for such emergencies.
A new prediction model for giant cell arteritis in patients with new onset headache and/or visual loss
Published in Annals of Medicine, 2022
Walid Moudrous, Leo H. Visser, Tansel Yilmaz, Marjan H. Wieringa, Tim Alleman, Jörgen Rovers, Mark P.W.A. Houben, Paula M. Janssen, Johan J. B. Janssen, Pieter L. Rensma, Geert J. F. Brekelmans
A positive halo sign on duplex can be a sign of GCA, but the reported sensitivity and specificity is greatly variable between studies, with sensitivity ranging from 50–100% and specificity 78–100% [12,16]. In this study we found a high sensitivity but a low specificity despite ultrasound guided biopsies in 87.6% of the patients with a positive halo. Many patients had a clear halo of the superficial temporal artery, but ultrasound-guided biopsy taken at these particular areas did not show inflammation of the temporal artery in 39 of 65 (60%). We did not perform a compression test as suggested by another study [19] and this may have led to false positive findings, but more research is necessary on this subject. In malignant, infectious diseases and in arteriosclerosis of the cranial vessels false-positive halos have been described. There is some debate about the definition of the halo sign, some researchers suggest that intima-media thickness measurement may be more correct for evaluating vasculitic wall oedema than morphologic criteria with colour duplex. But the studies performed are limited and small, and difficult to interpret without a good gold standard like a high positive TAB. Moreover, a discussion has been started about the golden standard in the diagnosis of GCA. The international TABUL study showed that the interobserver agreement on biopsies between pathologists had only a kappa of 0.61 [9]. So, it is possible that in the group with a negative biopsy patients could have GCA. In our study the decision whether a biopsy was negative or positive was decided independently by two trained pathologists.
A split flap technique shifting the location of perforator entry point to lengthen the pedicle of a multiple perforator based free flap
Published in Acta Chirurgica Belgica, 2022
Yi Zhang, Ying Liu, Tingliang Wang, Jiasheng Dong, Liping Dong, Hua Xu
A 45-year-old male patient was referred to our hospital with postoperative TMI exposure in his left temporal-parietal region (Figure 3(A)). He had undergone titanium cranioplasty for posttraumatic skull defects 4 years earlier. The exposed part of the titanium mesh was cut and removed by neurosurgeons, leaving a soft tissue defect of 10 × 15 cm (Figure 3(B)). A two perforator ALT flap (10 × 21 cm) was initially designed (Figure 4(A)). The ‘split flap’ technique was performed due to pedicle length deficiency (Figure 4(B)). The entry points of the perforators were repositioned close to the margin of the flap, extending the pedicle ‘working length’ (Figure 5). The left superficial temporal artery and vein were used as the recipient vessels. Six-month follow-up showed healed incisions without complications (Figure 6).
Surgical treatment of foreign body embolus in the Middle cerebral artery secondary to neck injury
Published in British Journal of Neurosurgery, 2020
Hui Wang, Xin-Jie Ning, Chuan Chen, Cong Lin, Jia-Ji Liang, Yu-Zhang Li
He had a right frontotemporal craniotomy. The superficial temporal artery was retained. The lateral Sylvian fissure was dissected under ultrasonic guidance to expose the M2 branch of the right MCA. We found the bifurcation of the M2 upper trunk to be swollen and pale; moreover, we also observed narrowed distal blood vessels, thinner vascular walls at the bifurcation, and a conspicuous metallic foreign body was seen through the arterial wall (Figure 3). After temporary occlusion, we incised the bifurcation of the artery and observed that the metallic foreign body was surrounded by recent granulation tissue. Only the foreign body was removed slowly (Figure 4) while retaining the granulation tissue to prevent further damage to the thinned arterial wall. The vessel lumen was rinsed with heparin saline, and 10-0 prolene was used to close the arteriotomy. Intraoperative indocyanine green angiography suggested that the distal artery was still obstructed. Therefore, the sutures removed from the vessel and the granulation tissue was carefully separated. Then the temporary clips were removed and the blood flow was good. Heparin saline was used to rinse the vessel lumen, and the artereotomy was sutured with 10-0 prolene (Figures 5 and 6). Indocyanine green angiography confirmed that this vessel was patent.