Localization and Staging of Vascular Adverse Events After Facial Fillers: A Detailed Assessment

Bleeding after tonsillectomy

COMBINED INTERNAL CAROTID AND HYPOGLOSSAL ARTERY ENDARTERECTOMIES IN A SYMPTOM-FREE PATIENT WITH CONTRALATERAL INTERNAL CAROTID ARTERY OCCLUSION

INTRODUCTION: There are several studies on the microstructure of main arteries of the body but limited have been dealt with the neck arteries. It has been mentioned that the vascular pathologies like the thrombo-embolism, atherosclerosis and infarction are common in the branches of vertebral and internal carotid artery as compared to the branches of external carotid artery. OBJECTIVE: To study the histological structure of the 3 medium sized arteries of neck namely external carotid, internal carotid and vertebral artery, calculation of their mean pulse pressure and pulsatory power and to find any association between them if present. METHOD: Fresh samples of external carotid, internal carotid and vertebral artery each measuring 10mm in length were taken from five cadavers and prepared for histological examination under microscope using orcein and H&E stain. The mean pressure and pulsatory power of these arteries were calculated by taking the measurements such as wall thickness, lumen circumference, arterial wall area, and smooth muscle fibre density in tunica media in that arterial segment. RESULT: The pulsatory power of external carotid artery, internal carotid artery and vertebral artery is found to be 120, 273.3, 400 Joules /heart beat and the mean pressure is 17.1 mm Hg, 27.3 mm Hg and 33.3 mm Hg respectively. CONCLUSION: The thickness of tunica media of an artery is directly proportional to its pulsatory power. The mean pulse pressure, pulsatory power as well the number of smooth muscles fibres in tunica media are more in internal carotid artery and vertebral artery in comparison to external carotid artery. It may be a very important reason why vascular pathologies are less common in branches of external carotid as compare to internal carotid and vertebral artery.

To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma. From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission/relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes). Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus/exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7/16 (43%) newly diagnosed retinoblastomas and 1/22 (4.5%) retinoblastomas undergoing partial remission/relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission/relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively. Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.

Transverse facial artery: Its role in blindness after cosmetic filler and botulinum toxin injections

How to Clamp and Bypass if There Is Single Artery Supply to the Head and That Contains Severe Stenosis?

Background: External carotid artery is the main artery supplying the structures of neck and face. Variability in the branching pattern of external carotid artery is important surgically and radiologically from the point of view of procedures carried out in that region. Purpose of the present study was to study the branching pattern of external carotid artery.Methods: Carotid triangle of the neck and the infratemporal fossa was dissected for studying the external carotid artery.Results: Generally the common carotid artery bifurcates at the level of upper border of lamina of thyroid cartilage. Level of bifurcation of common carotid artery may vary; it may arise at a lower level or at a higher level than its normal level of origin, which was observed in this study. Amongst the branches of external carotid artery like the superior thyroid artery, the facial artery, the lingual artery usually shows variations in their origin. These include origin of superior thyroid artery from common carotid artery, common trunk for facial and lingual arteries and many other different types of variations were seen in this study.Conclusions: Variant origins of the branches of external carotid artery are of significance in surgeries of thyroid, parotid gland, tongue as well as important in diagnostic procedures of head, neck, face region.

Background. The intraarterial approach is one of the most important routes for the administration of anticancer drugs for head and neck cancer. A profound knowledge of the anatomical characteristics and variations of the carotid artery, such as its branching pattern, length, and inner diameter, is essential to avoid complications with catheter insertion. Methods. We conducted a morphometric investigation of head and neck arteries in 29 Japanese cadavers (58 sites). Results. The branching pattern of the external carotid artery showed variations. In 65.5% of the cadavers, the lingual, facial, and superior thyroid arteries arose separately. However, in 31.0% of the cadavers, the lingual artery formed a common trunk with the facial artery, and in 3.5%, the lingual artery formed a common trunk with the superior thyroid artery. The transverse facial artery arose from the superficial temporal artery in 53.4% of the specimens, from the maxillary artery in 27.6%, and from a site central to the maxillary artery in 19.0%. The posterior auricular artery arose from the external carotid artery at the same level as the maxillary artery in 37.9% of specimens, and from a site central to the maxillary artery in 62.1%. The occipital artery arose from the external carotid artery at the same level as the maxillary artery in 55.2% of specimens, and from a site peripheral to the facial artery in 44.8%. The lengths from the auricular point to the origins of the upper branches of the external carotid artery were: 2.8 mm to the transverse facial artery, 3.2 cm to the maxillary artery, 3.8 cm to the posterior auricular artery, 6.6 cm to the occipital artery, 7.4 cm to the facial artery, 8.8 cm to the lingual artery, and 10.4 cm to the superior thyroid artery. Conclusions. These results, have led to some clarification of the clinicoanatomical basis for intraarterial infusion. These data should be helpful for assessing the approximate level of the catheter tip and for evaluating whether the catheter is placed appropriately, by transient staining of the infused area.

Extensive arterial anastomoses exist between the cavernous portion of the internal carotid artery and the external carotid artery. These arterial channels are seldom visible in the normal patient. They may enlarge, however, and become roentgenographically visible when they act as collateral pathways between the internal and external carotid arteries. In this report, we will review the anatomy of the arterial anastomosis between meningeal branches of the external carotid artery and the artery to the inferior cavernous sinus, a branch of the internal carotid artery. The clinical and roentgenographic findings in six patients in whom this pathway was visualized will be described. Anatomy The anatomy of the cavernous branches of the internal carotid artery has been reviewed extensively (3–7). The three main branches of the cavernous carotid artery are the meningohypophyseal trunk, the artery to the inferior cavernous sinus, and the capsular arteries of McConnell. The meningohypophyseal trunk, the first branch of the cavernous carotid artery, trifurcates into three branches of nearly equal caliber. These divisions are: (a) a tentorial artery, (b) a dorsal meningeal artery, and (c) an inferior hypophyseal artery. Parkinson (3, 4) noted that the meningohypophyseal trunk was present in all 200 necropsy specimens studied. In 80 per cent of the specimens, another main trunk arose from the internal carotid artery 0.5 cm anterior to the origin of the meningohypophyseal trunk (3). This branch, the artery to the inferior cavernous sinus, supplies the structures within the inferior cavernous sinus and its dural covering. It courses over the sixth nerve and gives branches to the gasserian ganglion. Branches of this trunk anastomose directly with the middle meningeal and accessory meningeal arteries near the foramen spinosum. When the artery to the inferior cavernous sinus is absent, the blood supply is assumed by branches of the meningohypophyseal trunk (2). The collateral pathway between the artery to the inferior cavernous sinus and the meningeal branches of the internal maxillary artery has been discussed previously in the anatomic literature (3–7). The following case reports illustrate this anastomotic channel as demonstrated by neuroradiologic studies. Case Reports Case I: This 62-year-old man had complete occlusion of the right internal carotid artery due to arteriosclerosis. The external carotid artery and its branches were well opacified. The cavernous portion of the internal carotid artery was filled via anastomoses between the internal maxillary artery and the artery to the inferior cavernous sinus (Fig. 1). Case II: A 52-year-old woman had a cerebrovascular accident with residual left facial weakness. Carotid arteriography revealed a complete occlusion of the right internal carotid artery. The carotid siphon was filled via the ophthalmic artery and the artery to the inferior cavernous sinus.

Applying cold is a common method for epistaxis management. In this study, the effect of cold on the blood flow of the internal and external carotid system was examined, with the help of ultrasonography, to get a more accurate picture of the effect of cold on blood flow to the head and neck. This study consisted of three separate phases conducted on healthy adult volunteers. Phase 1: Cervical skin and tympanic temperatures, systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR) were measured at baseline and every 5min for 25min, with an ice collar in place and after removal. Phase 2: Blood flow of the Internal carotid artery (ICA), External carotid artery (ECA), Facial Artery (FA), and Temporalis Artery (TA) were assessed before applying a regular cervical collar, and promptly after removing it, using Doppler ultrasound. FA and TA blood flows were also measured 5 and 15min after collar application. Phase 3: The second phase was repeated, this time using an ice collar. Blood flows were additionally assessed 10min after collar removal. Cold application was associated with tympanic and cervical skin temperatures (P-values: 0.002, < 0.0001), while it had no association with HR, SBP, or DBP (P-values: 0.16, 0.51, 0.36). Applying a regular collar did not affect ICA, ECA, FA, and TA blood flow (P-values:0.9,0.1,0.5,0.06). Pearson's correlation coefficients for flow assessment of ICA, ECA, FA, and TA by Doppler ultrasound before collar use and after its removal were 0.73, 0.96, 0.76, and 0.90, respectively (P-values: 0.01, < 0.001, 0.02, < 0.0001). The cold application did not alter ICA blood flow (P-value: 0.1) but decreased ECA, FA, and TA blood flows (P-values: 0.0002, < 0.0001, < 0.0001). Cold application on the neck can significantly decrease ECA, FA, and TA blood flows, while ICA blood flow remains unchanged. These findings indicate a differing effect of cold on the neck in epistaxis management within the internal carotid system, compared to the external carotid system.

The mechanism underlying the plateau or relative decrease in cerebral blood flow (CBF) during maximal incremental dynamic exercise remains unclear. We hypothesized that cerebral perfusion is limited during high-intensity dynamic exercise due to a redistribution of carotid artery blood flow. To identify the distribution of blood flow among the arteries supplying the head and brain, we evaluated common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and vertebral artery (VA) blood flow during dynamic exercise using Doppler ultrasound. Ten subjects performed graded cycling exercise in a semi-supine position at 40, 60 and 80% of peak oxygen uptake (VO2 peak) for 5 min at each workload. The ICA blood flow increased by 23.0 ± 4.6% (mean ± SE) from rest to exercise at 60% (VO2 peak). However, at 80% (VO2 peak), ICA blood flow returned towards near resting levels (9.6 ± 4.7% vs. rest). In contrast, ECA, CCA and VA blood flow increased proportionally with workload. The change in ICA blood flow during graded exercise was correlated with end-tidal partial pressure of CO2 (r = 0.72). The change in ICA blood flow from 60% (VO2 peak) to 80% (VO2 peak) was negatively correlated with the change in ECA blood flow (r = −0.77). Moreover, there was a significant correlation between forehead cutaneous vascular conductance and ECA blood flow during exercise (r = 0.79). These results suggest that during high-intensity dynamic exercise the plateau or decrease in ICA blood flow is partly due to a large increase in ECA blood flow, which is selectively increased to prioritize thermoregulation.

Carotid endarterectomy (CEA) is the main treatment for atherosclerotic plaque of the cervical internal carotid artery. The surgical anatomy of the carotid arteries was studied in the carotid triangle of 49 cadavers. The carotid bifurcation was located at the level of the lower third of C-3. The superior thyroid artery arose from the anterior wall of the external carotid artery in 70% of specimens and from the distal portion of the common carotid artery in 30%. The lingual artery arose as a separate trunk between the origins of the superior thyroid and facial arteries in 81% of specimens, with the facial artery from a common trunk in 18%, and with the superior thyroid artery in 1%. The occipital artery arose from the posterior aspect of the external carotid artery above the level of origin of the facial artery in 57% of specimens, between the origins of the facial and lingual arteries in 32%, and below the origin of the lingual artery in 11%. The origin of the occipital artery was positioned low and the distal portion of the occipital artery was crossed by the hypoglossal nerve in 20%. The ascending pharyngeal artery arose from the posterior wall of the external carotid artery above the level of origin of the lingual artery in 66% of specimens, below the origin of the lingual artery in 9%, from the proximal portion of the occipital artery in 19%, from the carotid bifurcation in 2%, and from the internal carotid artery in 2%. The branches of the external carotid artery are the key landmarks for adequate exposure and appropriate placement of cross-clamps on the carotid arteries. It is necessary to understand the surgical anatomy of the carotid arteries to carry out successful removal of plaque and minimize postoperative complications in a bloodless surgical field.

Introduction: The prime source of vascularization to the head and neck region is through the carotid arteries. The terminal branches of common carotid arteries, such as external carotid artery (ECA) and internal carotid artery (ICA), and their branches are crucial due to the wide area of distribution and variations in their branching pattern. The branching pattern and morphometry are essential for surgeons in the planning and execution of head and neck surgeries. Therefore, this study was conducted to observe the branching patterns of ECA and analyze them morphometrically.Materials and methods: This retrospective study includes 100 CT images, inclusive of 32 females and 68 males. The branching pattern and luminal diameter of CCA and ECA were measured and analyzed statistically.Results: The luminal diameter of CCA in males were as follows: 7.4 ± 1.01 (R), 7.1 ± 0.8 (L), and in females: 7.3 ± 0.9 (R), 7 ± 0.9mm (L); and the luminal diameter of ECA in males: 5.2 ± 1.0mm (R), 5.2 ± 0.9mm (L), and in females: 5.0 ± 0.9mm (R), 5.1 ± 1.0mm (L). The level of the carotid bifurcation and ECA branching pattern was observed, and variations were commonly seen in the superior thyroid artery (STA), lingual artery (LA), and facial artery (FA). Conclusion: The findings of the present study with regard to the external carotid artery and its branching pattern correlate with previous studies. The most common variations were observed in the superior thyroid and lingual and facial arteries. Knowledge about the morphology and branching pattern of the carotid artery is essential for procedures such as intra-arterial chemotherapy, carotid artery stenting, endarterectomy, and extra-intra cranial bypass revascularization procedure where it is harvested as a donor's vessel.

A rare anatomic variant: the lateral position of the external carotid artery

Thomas Willis, the man for whom this lecture is named, was an Englishman and a leading neuroanatomist of the 17th century. Born in 1621, he attended Oxford University, graduating from Christ Church College in 1639. While still at Oxford, he became Sedleian Professor of Natural History in 1660. He did much experimental work with his associate Richard Lower. He performed injection experiments on cadavers and noted that if he injected the carotid artery on one side, the dye solution would come forth from the carotid on the opposite side. In 1664 Willis published his monumental work Cerebri Anatome , the most complete and accurate account of the nervous system that had hitherto appeared. In it he contributed the term “neurology” to medicine, a word derived from the Greek, meaning “sinew,” “tendon,” or “bowstring.” The word was translated and introduced into the English language in 1681 in Samuel Pordage's translation of Willis' work. Cerebri Anatome contains a classification of the cerebral nerves, the first description of the eleventh nerve, and a description of the hexagonal network of arteries at the base of the brain that we know as the circle of Willis. Although others had described the circle before Willis, he was the first to grasp its physiological and pathological significance. He records the clinical histories of two patients in whom he suggests that the anatomic configuration of the arteries at the base of the brain could prevent apoplexy. The book was illustrated by Christopher Wren, an associate of Willis at Oxford, later to become England's leading architect and designer of St Paul's Cathedral, numerous other English churches, and many historic secular buildings. Willis moved to London in 1666 and acquired the largest fashionable practice of his day. He continued his careful clinical observations and made a number of other important …