Establishing a danger zone: An anatomic study of the lingual artery in base of tongue surgery

Cohen, David S.; Low, Garren; Melkane, Antoine E.; Mutchnick, Sean; Waxman, Jonathan; Patel, Shruti; Shkoukani, Mahdi A.; Lin, Ho‐Sheng

doi:10.1002/lary.26048

Cited by 20 publications

(25 citation statements)

References 13 publications

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“…Up to 4.1% patients present with postoperative hemorrhage and require an emergent procedure to stop bleeding in the operation room, 9 and the most common major complication is lingual artery (LA) injury. 10 Hence, establishing a safely excised region is crucial. Li et al suggested maintaining a conservative BOT ablation field of approximately 10 mm lateral to the midline bilaterally.…”

Section: Introductionmentioning

confidence: 99%

Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea

Chang

Hsiao

et al. 2020

The Laryngoscope

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Objectives/Hypothesis: To investigate the lingual artery (LA) position in the tongue base through intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS) and evaluate bleeding complications with or without the assistance of IOU. Study Design: Cohort study with historical control. Methods: Patients with obstructive sleep apnea (OSA) who underwent TORS for tongue base resection were recruited since 2016. During surgery, ultrasound imaging was employed to identify anatomic parameters of the LA in the tongue base, including distance to the midline and arterial depth and diameter. Results: Ninety-three OSA patients (82 men, 88.2%) were analyzed. Mean age was 42.2 AE 10.0 years and body mass index was 29.2 AE 4.5 kg/m 2. Average apnea-hypopnea index (AHI) was 58.1 AE 21.4 events/hour. Overall, 70 patients who underwent TORS with IOU had a shorter operation time (191.7 AE 3.8 vs. 220.1 AE 6.6 minutes), lower total blood loss (11.3 AE 10.8 vs. 19.6 AE 26.7 mL), and higher tongue base reduction volume (7.1 AE 2.5 vs. 3.9 AE 1.6 mL) than 23 patients who underwent TORS without IOU. Significant predictors of arterial depth included higher AHI level during the rapid eye movement sleep (P = .038), larger tonsil size (P = .034), and more elevated Friedman tongue position (P = .012). Postoperative complications associated with LA injury were not found in patients subjected to IOU. Conclusions: With the assistance of IOU, surgeons can confidently determine LA position. The use of IOU can maximize efficiency and minimize catastrophic bleeding complications when OSA patients undergo TORS for tongue base resection.

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Section: Introductionmentioning

confidence: 99%

Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea

Chang

Hsiao

et al. 2020

The Laryngoscope

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“…The pliability of the soft tissue around the DLAAP flap pedicle contributes to the increased flap mobility. [19][20][21] Doubtless, the rich mucosal vascularization and the laxity of the soft tissue surrounding the pedicle increase the survival rate of these flaps. The typical villous appearance of the tongue tissue disappears once the flap is transferred to the recipient site, becoming as smooth as the surrounding mucosa within 1 month after surgery.…”

Section: Deep Lingual Artery Axial Propeller Flapmentioning

confidence: 99%

“…The presence of a welldeveloped venous plexus with a larger caliber is usually associated with the artery, and also can be easily harvested between the anterior two-thirds and the posterior third of the tongue. 16,19 Elevation of the DLAAP flap usually starts from the anterior portion of the tongue with electrocautery, and then muscle dissection is performed using Stevens' scissors in the posterior third. A vessel loop around the pedicle can be useful to allow gentle traction and facilitate dissection.…”

Section: Surgical Techniquementioning

confidence: 99%

Propeller Flaps in the Head and Neck

et al. 2020

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Propeller flaps have significantly expanded the reconstruction possibilities in the head and neck region. They allow for increased flap mobility and better scar concealing, and/or to perform a one-stage reconstruction with local tissue of similar color and texture, where multiple surgeries would be needed with traditional flaps or even free flaps would be required. This article describes the main propeller flaps for one-stage reconstruction in the head–neck region (facial artery perforator, supratrochlear artery axial perforator, deep lingual artery axial perforator, and anterior supraclavicular artery perforator flaps), their indications, and possible complications. Aesthetic and functional results of propeller flaps in the head and neck region are very good and the complication rate is low, but due to their surgical complexity and the availability of many simpler local flaps, they are indicated only in select cases where local flaps are unavailable or would require multiple staged procedures to complete the construction.

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“…Filler embolism and arterial occlusion resulting from accidental cannulation during filler injection is known to be a cause of soft tissue infarction . The lingual artery is the primary source of arterial supply of the tongue; thus, this artery is the sole target for embolism and occlusion complications . This study investigated how filler can enter the lingual artery during chin augmentation.…”

Section: Introductionmentioning

confidence: 99%

“…7 The lingual artery is the primary source of arterial supply of the tongue; thus, this artery is the sole target for embolism and occlusion complications. 8,9 This study investigated how filler can enter the lingual artery during chin augmentation.…”

Section: Introductionmentioning

confidence: 99%

Investigation of the presence and variation of the ascending mental artery: Conventional dissections and ultrasonographic study

Tansatit

Phumyoo

Jitaree

et al. 2019

J of Cosmetic Dermatology

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Summary Background Tongue and mouth floor infarction following filler injections for chin augmentation is a rare complication that has the increase in incidence been reported. Objective This study investigated the arterial anastomosis between the submental and sublingual arteries that can lead to the emboli and subsequent tongue infarction during chin augmentation. Methods Forty‐two formaldehyde‐embalmed cadavers and four soft‐embalmed cadavers were dissected to verify the incidence and source of the ascending mental artery. Ultrasonographic study of the artery was performed in 10 healthy volunteers. Attention was paid to discriminate whether the ascending mental artery arose from the submental artery or the sublingual artery using the arch of the mylohyoid muscle as the discriminating landmark. Results Incidence of ascending mental artery from the sublingual artery was 7.1% in the studied population. All ascending mental arteries were 0.7 ± 0.2 mm in diameter at the mental protuberance and were branches of the submental artery that arose from the facial artery, except for two arteries that arose from the sublingual artery. Ultrasonographic study revealed that one left and one right sublingual artery from the lingual arteries penetrated the mylohyoid muscle near the midline to become the ascending mental artery in two volunteers. The ascending mental artery from the other side continued from the submental artery. Conclusion Findings from the cadaveric dissections and ultrasonographic study revealed that the ascending mental artery may be a branch that continues from the lingual artery, or communicates with the sublingual artery through the mouth floor.

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Establishing a danger zone: An anatomic study of the lingual artery in base of tongue surgery

Abstract: NA Laryngoscope, 127:110-115, 2017.

Cited by 20 publications

References 13 publications

Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea

Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea

Propeller Flaps in the Head and Neck

Investigation of the presence and variation of the ascending mental artery: Conventional dissections and ultrasonographic study

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