Minimally invasive surgical approaches to the management of ameloblastoma

Abstract

Background: Intraarterial chemotherapy (IAC) for oral cancer can deliver a higher concentration of anticancer agent into a tumour-feeding artery. However, distribution of anticancer agent into several branches of the external carotid artery (ECA) in IAC has not demonstrated sufficient treatment efficacy. Objectives: To investigate flow distribution of anticancer agent into the branches of the ECA in several IAC methods using computational fluid dynamics (CFD). Methods: Patient-specific three-dimensional vessel models were created from computed tomography images of two patients with tongue cancer. Catheter models were combined with the vessel models. 32 models were generated with varying vertical and horizontal positions of the catheter tip. With the use of a zerodimensional resistance model of the peripheral vessel network, conventional and superselective IAC were simulated in 30 and 2 models, respectively. The flow distribution of anticancer agent into the branches of the ECA was investigated in 32 models. Findings and Conclusion:The CFD simulations could be conducted within a reasonable computational time. In several models, the anticancer agent flowed into the target artery only when the catheter tip was located below the bifurcation of the ECA and each target branch. Furthermore, the anticancer agent tended to flow into the target artery when the catheter tip was shifted toward the target artery. This CFD study showed that in IAC, a curved catheter tip should be placed both below and toward the target artery to increase the distribution rate of anticancer agent into the tumour-feeding artery.