Measurement of Lingual Artery Using Ultrasound Versus Computed Tomography Angiography for Midline Glossectomy in Patients With Obstructive Sleep Apnea

Objective: To clarify the differences in assessing the course of the lingual artery between lingual artery computed tomography angiography (CTA) and ultrasound (US). Methods: Twenty-six OSA patients were included in this study and accomplished lingual artery CTA and US, respectively. The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries on 3 measurement levels based on lingual artery CTA and US were compared. Results: The depths of the lingual arteries on 3 measurement levels by CTA were deeper than those by US ( P < .01). There was no significant difference in the distances between bilateral lingual arteries on 3 measurement levels between CTA and US ( P > .05). Conclusions: The parameters of lingual artery measured by lingual artery US were similar to or smaller than those measured by lingual artery CTA. Like lingual artery CTA, lingual artery US could be used as an effective method to ensure the safety of the operation.

Defining Safety Space for Functional Tongue Surgery in Korean Male Obstructive Sleep Apnea Syndrome Patients; Analysis on Spatial Relation of the Tongue and the Lingual Artery

Background and Objectives Upon operation of the tongue base for obstructive sleep apnea syndrome (OSAS), the lingual artery and the hypoglossal nerve are put at risk of injury, resulting in fatal complications such as massive bleeding upon damage. We studied the course of lingual artery in its relation with the tongue in OSAS patients and compared it with the age-and- gender-matched normal population.Subjects and Method Korean male patients confirmed with OSAS by polysomnography, including those who had contrast-enhanced computed tomography (ceCT) of the head and neck, were defined as “OSAS group.” Patients who had their ceCT image during the same study period were defined as the “control group.” The control group was paired with the OSAS group by age and sex. By using foramen cecum (FC) as the main reference point, four reference marks were defined. For each reference point, the distance between both lingual arteries and the depth of the lingual artery from the lingual surface of the tongue were evaluated. Results The depth of the lingual artery from the lingual surface of the tongue in the OSAS group (25.1±8.6 mm) was significantly different from the control (29.5±5.9 mm) at 1 cm anterior to the FC level (p<0.014). The width of both lingual arteries was narrower in the OSAS group (20.9±2.9) than in the control (24.3±6.1) at the FC level (p<0.003). Conclusion The course of lingual artery and its spatial relation with the tongue in Korean male OSAS patients differs from the matched normal population.

Anatomical Variations in the Origin of Superior Thyroid Artery and its Relation with External Laryngeal Nerve and their Clinical Importance-A Cadaveric Study

INTRODUCTION The major arterial supply of thyroid gland is from superior and inferior thyroid arteries. The superior thyroid artery (STA) usually arises from the external carotid artery. The external laryngeal nerve runs in close proximity to the origin of the superior thyroid artery later leaves the artery by turning medially above or below the upper pole of the thyroid gland. MATERIAL AND METHODS A descriptive study was undertaken on 20 embalmed cadavers. The anterior triangle of neck was dissected bilaterally. The site of origin of STA level of origin in relation to the upper border of lamina of thyroid cartilage and relation of the STA with external laryngeal nerve were observed and noted. RESULTS The STA arises from the external carotid artery in 27.5%, common carotid artery in 62.5%, common carotid bifurcation in 5% and arises by a common trunk with lingual artery at common carotid bifurcation in 5%. The distance from the upper pole to the point where external laryngeal nerve turns medially is more than 10 mm in 50%, less than 10 mm in 25% and 10 mm in 25%. CONCLUSION The variations in the pattern of origin of the superior thyroid artery and its relation to external laryngeal nerve is a very common phenomenon. The head and neck surgeons must be aware of all possible variations to avoid postoperative complications and legal issues.

Embolization for Carotid Blowout in Head and Neck Cancer: Case Report of Five Patients

Carotid blowout syndrome (CBS) is defined as a rupture of common carotid artery or its branches. Endovascular intervention has been advocated as first line of treatment for CBS. This Case Report describes 5 patients with prior history of head and neck cancer who presented with CBS. Two patients presented as acute, 2 as impending, and one as threatened CBS. The lesions found were pseudoaneurysm and focal vascular irregularities involving the common carotid artery, cervical internal carotid artery and lingual artery. Embolization and occlusion with detachable coils of the artery was used in all patients. Technical success and immediate hemostasis were achieved in all patients. One patient presented transient cranial nerve palsy. No recurrent CBS was reported during the follow-up. In our experience, coil embolization, if possible, is a safe and efficient technique in treatment of CBS secondary to head and neck cancers.

Vascularity Outcomes of Lingual Artery Ligation in Transoral Robotic Base of Tongue Resections

To explore the effect of lingual artery ligation on tongue vascularity, we performed an analysis of 25 patients who underwent transoral robotic surgery for base of tongue cancers (May 2011 to December 2019). Hounsfield units of the intrinsic muscles (IMs) and genioglossus muscles (GGs) were measured in postoperative imaging (mean 4 months) as a surrogate for vascularity. In ligated patients (n = 15), the values from the ligated/resected side of the tongue were compared with the contralateral side and the nonligated side of resection. Individually, IMs and GGs on the ligated side demonstrated no significant difference to the contralateral side ( P = .662 and .618, respectively). Ligation produced a significant decrease in IM measurements but no difference between GG values vs nonligated patients ( P = .050 and .818, respectively). No difference was appreciated in mean values for combined IMs and GGs between cohorts ( P = .212). No gross tongue atrophy or complications were incurred. Future studies are warranted to delineate long-term effects.