R. Lopez

Vascular territories of the tongue: anatomical study and clinical applications.

The goal of this cadaver study has to propose the concept of angiosomes of the tongue (arterial cartography) from the notion of lingual artery segmentation, known in the literature since 1998. Fifteen fresh cadaver heads were used in this study. Four selective ink injections were made in specific location of the lingual artery like the segmentation concept. Three mucosal territories of the tongue were defined and they appear dependent on the precise segments of the lingual artery. The territory of the deep lingual artery is the dorsal side of the tongue, the territory of the sublingual artery is the ventral side and the territory depending of the dorsal artery is the root of tongue. No study was published yet about the vascular territories of the tongue. This study brings an additional knowledge and a review about the vascular risk of the tongue resections. The originality of this study consists of the description of vascular territories of tongue proceeding to different segment of lingual artery, which has not been described in the literature since now. The knowledge of these two notions is useful before every tongue resection, which can compromise the vascularity of the remaining tongue, and at the time of the lingual revascularization, once this vascularity is compromise.

Anatomic variations of the renal vessels: focus on the precaval right renal artery

The aim of this study was to determine the prevalence of precaval right renal artery and to investigate the distribution of renal arteries and veins. We discuss a theory of development of renal vascular variants. We retrospectively reviewed 120 arterial phase contrast material-enhanced spiral computerized tomography scans of the abdomen (1- to 2-mm section thickness) performed during a two-month period. Forty percent of the study group (48 patients) had one artery and one vein on each side, with typical course. There was a 9.17% prevalence of precaval right renal artery: 10 patients had a lower pole accessory artery in precaval position and one patient had the main and the accessory arteries that pass anterior to the inferior vena cava. In these cases, associated variations of renal vessels were higher than in the patients without precaval artery variant. There were multiple arteries in 28.3% of the right kidneys and in 26.7% of the left ones. Variants of the right renal vein consisted in multiple veins in 20% (24 cases). We detected no case of multiple left renal veins, but we described variations of its course (circum- or retroaortic vein) in 9.17% (11 cases). Twenty-six patients (21.7%) had associated variations of the renal pedicle. The current technical support allows for a minimally invasive study of vessels anatomy. In our study the prevalence of a precaval right renal artery appears to be higher than previously reported (9.17%). Knowledge on anatomical variations of right renal artery and associated renal vessels variations has major clinical implications.

The vascular system of the upper eyelid. Anatomical study and clinical interest

Thorough knowledge of the vascular supply is indispensable for repair and oncologic surgery of the eyelids, and has a significant impact on the management of complex defects of this region. This anatomic study was performed with five fresh cadavers after arterial injection of coloured neoprene latex. The distribution of the vascular system of the upper eyelid was examined after dissection and photographic study. It is made up of three arcades: the preseptal arcade, the supratarsal arcade, and the marginal arcade, under the orbicularis oculi muscle. These arcades are supplied by branches of the ophthalmic artery (supraorbital artery, supratrochlear artery and medial palpebral artery) and branches of the facial artery and temporal artery. Small vertical branches arising out of these arcades provide an anastomotic network. This anatomical study aimed to describe the vascular system of the upper eyelid in order to search for constant features and to map the blood supply of the principal upper lid flaps.

Description and variability of temporal venous vascularization: clinical relevance in temporoparietal free flap technique

The few studies on the venous vascularization of the temporal area indicate a high variability among individuals. The preoperative knowledge of the venous vascularization of the temporal area is critical for microsurgical reconstruction, such as temporoparietal fascia free flap, and especially in understanding the anatomy of the veins for flap survival. Therefore, we conducted an anatomic study to confirm the classification of Legre et al. and a radiologic study to examine the venous network of the temporal area. We found three frequent patterns of the temporal venous network: (1) Type I (the most common), with a predominant temporal vein; (2) Type II, with a predominant posterior auricular vein; (3) Type III, when both veins were equally important. Because of this great variability, the use of a temporal flap for reconstruction of the head and neck should be restricted, and the examination of venous vascularization appears to be necessary before surgery. Here, we report a three-dimensional description of the venous temporal vascularization by computer tomography, which is particularly useful before temporoparietal flaps.

La cartographie artérielle linguale. Étude anatomique et intérêts cliniques

But de l’etude cette etude anatomique a pour objectif de proposer le concept original de cartographie vasculaire linguale a partir de la notion de segmentation de l’artere linguale, connue dans la litterature depuis 1998. Materiel et Methodes cette etude a ete realisee au cours de l’annee 2003. Elle comprend 15 cas d’injections colorees selectives arterielles linguales. Resultats par ce travail anatomique, le concept de cartographie arterielle linguale a pu etre propose. Trois territoires muqueux linguaux ont ete definis et apparaissent sous la dependance de segments precis de l’artere linguale. Discussion les territoires vasculaires cutanes ont ete decrits depuis 1889 par Manchot puis en 1936 par Salmon. Ces territoires sont baptises « angiosomes » par Taylor en 1987. Ce n’est qu’en 2000 que des travaux equivalents a ceux entrepris plus de dix ans auparavant, permettent a Houseman de proposer une cartographie vasculaire des territoires de la face et du cou sous le terme d’angiosomes de la tete et du cou (the angiosomes of the head and neck). Aucune etude publiee a ce jour ne s’est interessee aux territoires vasculaires de la langue. La connaissance de ces territoires et la definition d’une cartographie vasculaire linguale apparaissent indispensables avant toute chirurgie d’exerese linguale ainsi que lors de la discussion de la logique vasculaire des lambeaux de langue. Conclusion l’originalite de cette etude tient au fait d’avoir adapte la notion de segmentation vasculaire linguale a celle de cartographie arterielle linguale, non decrite dans la litterature a ce jour. La connaissance de ces deux notions apparait utile avant tout geste d’exerese linguale pouvant compromettre la vascularisation de la langue restante et lors de revascularisation linguale une fois cette vascularisation compromise.

La vascularisation artério-veineuse linguale. Concepts de segmentation vasculaire et de cartographie artérielle linguale

De multiples travaux anatomiques ont permis la definition des territoires vasculaires cutanes. Plus recemment, des travaux anatomiques (Whetzel 1997, Houseman 2000), se sont interesses aux territoires cutanes de la face, de la muqueuse orale, de la tete et du cou. A ce jour, la definition des territoires vasculaires arteriels linguaux reste absente. Le travail anatomique propose a pour buts de confirmer ce concept de segmentation arterielle linguale, de preciser le drainage veineux de la langue et de definir le concept de cartographie arterielle linguale. Les implications cliniques touchent essentiellement le probleme des exereses carcinologiques linguales, pelvi-linguales et cervicales qui peuvent presenter un risque de devascularisation sur la langue mobile. Trente arteres linguales ont ete etudiees sur specimen frais. Nous avons realise des injections arterielles de Latex Neoprene colore, de matiere plastique (Altuglass®), de produit radio-opaque, et de colorants permettant une etude macro et microvasculaire et l’etude des territoires des divers segments de l’artere linguale. La segmentation arterielle linguale (Shangkuan 1998) a ete precisee, le drainage veineux de la langue complete. Nous avons defini trois territoires vasculaires linguaux, le territoire de l’artere profonde de la langue (segments III et IV), le territoire de l’artere sublinguale et le territoire sous la dependance du segment II de l’artere linguale. Cette etude apporte sans nul doute un complement d’information sur les territoires vasculaires de la muqueuse orale, et permet de mieux codifier le risque vasculaire des exereses carcinologiques de la region et d’anticiper dans certains cas sur la necessite d’un geste de revascularisation specifique.