Figure - available from: BMC Medical Imaging
This content is subject to copyright. Terms and conditions apply.
Examples of the image quality of 3D phase contrast magnetic resonance angiography (3D PC-MRA) to visualize the facial artery courses based on four-point score.0 = poor (a); 1 = questionable (b); 2 = adequate (c); and 3 = good (d). Green arrows indicate the facial artery course
Source publication
Background:
The aim of this study was to compare non-contrast-enhanced 3D phase contrast magnetic resonance angiography (3D PC-MRA) and conventional intravenous administration of contrast media, i.e., contrast-enhanced MRA (CE-MRA), to evaluate the courses of facial arteries for the preparation of vascularized submental lymph node flap (VSLN flap)...
Citations
... Submental artery perforator flap 11 www.nature.com/scientificreports/ region, with many variations in submental venous drainage, which can easily lead to congestion and necrosis of the flap due to accidental injury during operation 25,26 . This study identified the venous drainage to the internal jugular vein in 68.67% of the cases, to the external jugular vein in 21.69% of the cases, and the anterior jugular vein in 9.64% of the cases. ...
Submental island flap has certain advantages in repairing postoperative defects of oral cancer, and it can often achieve similar or even better effects compared with those of the free tissue flap. In this study, according to the different characteristics of patients and postoperative defects of oral cancer, submental island flaps with different states of vascular pedicle were prepared, and its repair methods, safety, and clinical effects in treating postoperative defects of oral cancer were investigated. 83 patients with oral cancer who met the inclusion criteria were selected. According to the different characteristics of the patients and postoperative defects of oral cancer, the traditional submental island flap vascular pedicle was modified into three different states: submental artery perforator flap, vascular pedicled flap with the anterior belly of digastric muscle but without the submandibular gland (SIF with anterior belly of DM), and vascular pedicled flap with the anterior belly of the digastric muscle and the submandibular gland (SIF with anterior belly of DM and SG). The types of the submental artery and the drainage vein, flap survival, and complications, were observed. The flap was successfully harvested for all patients, and the submental artery could be found or separated for all of them, with the venous drainage to the internal jugular vein in 57 (57/83, 68.67%), to the external jugular vein in 18 (18/83, 21.69%), and to the anterior jugular vein in eight (8/83, 9.64%) cases. Submental artery perforator flap was used for 11 cases, complete necrosis occurred in two cases (2/11, 18.18%), partial necrosis occurred in one case (1/11, 9.09%); SIF with anterior belly of DM was used for 49 cases, complete necrosis occurred in one case (1/49, 2.04%), partial necrosis occurred in four cases (4/49, 8.16%); SIF with anterior belly of DM and SG was used for 23 cases, including chimeric flap combining the submental island flap and the submandibular gland used for 15 cases, there were no cases of complete or partial necrosis. Submental island flap was effective in repairing postoperative defects of oral cancer. Submental island flaps with three different states of vascular pedicle could repair oral cancer-affected tissues with different defect characteristics.
... Thus, the FA might be at a risk of injury by MTM extraction procedures. Most anatomical studies of the FA are based on extraoral dissection of the cadaver and/or computed tomography (CT) angiography studies and show the course and variation of the FA (Cong et al., 2021;Herrera-Núñez et al., 2020;Lee et al., 2020;Wu et al., 2019). A critical understanding of FA anatomy for dentists and oral surgeons is via an intraoral view of the FA and interpretation of the FA on imaging which has not been shown in previous studies. ...
The purpose of this study was to evaluate the risk of injury to the facial (FA) and related arteries during mandibular third molar (MTM) extraction using contrast‐enhanced computed tomography (CE‐CT). CE‐CT images of the MTM region were retrospectively reviewed. The area of the MTM was equally divided into three zones in the coronal images from mesial to distal, that is, zone 1, zone 2, and zone 3. The FA, submental artery (SMA), and sublingual artery (SLA) were identified. The distance from the mandible to FA, SMA, and SLA and the diameter of the FA, SMA, and SLA was measured in three zones, respectively. The thickness of the facial soft tissues and width of the mandible were measured at their maximum. The mean distance from the FA to the buccal cortical bone in zone 1, zone 2 and zone 3 was 2.24 mm, 2.39 mm and 1.67 mm, respectively. The SMA and SLA were found to be distal to the mandible. The mean diameter of the FA was 1.26 mm in males and 1.04 mm in females, respectively (p < 0.0001). The distance between the FA and buccal cortical bone of the mandible, and the patients' weight showed moderate correlation in zones 1 and 2. Based on our findings, the FA can be damaged if the surgical invasion reaches the facial soft tissues during MTM surgery. The patients' weight might be a good predictor for FA injury when CE‐CT is not available.
... On the other hand, conventional angiography is invasive, and complications from catheterisation make it less suited as a routine examination for VWF. However, MRA still uses intravenous gadolinium contrast [15,25], but methods without contrast are under development [10,11,29]. In our study, the imaging from the non-contrast phase was inadequate for the study of arterial abnormalities. ...
Vibration white finger (VWF) is a complication from exposure to hand-arm vibrations. Poor knowledge of the pathophysiology of VWF means that making an accurate prognosis is difficult. Thus, a better understanding of VWF’s pathophysiology is of importance.
The purpose of this study was to investigate whether there were arterial abnormalities in the hands in patients with VWF and a positive Allen’s test, using ultrasound and MRA imaging.
This was a case series where arterial abnormalities in the hands were investigated in ten participants with VWF and using prolonged Allen’s test (> 5 s). The participants had an average vibration exposure of 22 years and underwent Doppler ultrasound and Magnetic Resonance Angiography (MRA) to check for arterial abnormalities.
The participants had VWF classified as 1–3 on the Stockholm workshop scale. Ultrasound and MRA identified vascular abnormalities in all participants, the predominant finding was missing or incomplete superficial arch. Also, stenosis was identified in four participants.
This study reveals a high proportion of arterial stenosis and abnormalities in patients with VWF and a prolonged Allen’s test.
The vascularized submental lymph node flap is an excellent donor site for vascularized lymph node transfer (VLNT). Iatrogenic donor site lymphedema of the head and face has not been reported, and it has the advantages of greater number of lymph nodes, reliable skin paddle for flap observation, and larger pedicle facial vein for lymphatic drainage for greater functional improvement of extremity lymphedema. Further studies have been performed to refine the technique of the submental VLN flap transfer, including anatomical variation, platysma-sparing technique, minimizing morbidity to the marginal mandibular nerve, and flap inset with delayed primary retention suture.KeywordsVascularized lymph node transfer (VLNT) Submental Iatrogenic donor site lymphedema Platysma-sparing Marginal mandibular nerve Delayed primary retention suture
Background:
Heparin-induced thrombocytopenia and thrombosis (HITT) may result in microsurgical flap failure. This study investigated the outcomes of HITT in primary lymphedema patients who underwent vascularized lymph node transplantations (VLNT).
Methods:
Between 2012 and 2019, primary lymphedema patients who underwent VLNTs were retrospectively included. The 4Ts score was used to categorize patients into HITT (scores of 5-7) and non-HITT (score < 5) groups. Outcome evaluations included the re-exploration rate, success rate, circumferential differences, cellulitis episodes, and Lymphedema Specific Quality of Life Questionnaire (LYMQoL) scores.
Results:
Twenty-six and 15 patients with 31 and 16 VLNTs were included in the HITT and non-HITT groups, respectively. The HITT group had significantly greater first, second and third re-exploration rates of 38.7% (12/31), 25.7% (8/31), and 6.5% (2/31) than the non-HITT group (6.3%, 0%, and 0%, all p < 0.01), respectively. The platelet counts significantly decreased by 21.0% in the HITT group compared with the non-HITT group (14%) on postoperative Day one (p < 0.01) with a cutoff value of 17% and AUC = 0.88.
Conclusions:
HITT may cause a high re-exploration rate of VLNTs in primary lymphedema patients. The 17% reduction in platelets on postoperative day one was an early sign for detecting HITT.
