The Research Of The Carotid Bifurcation Microanatomy And Clinical Significance

Objectives: To understand the anatomy of important vascular nerves around the carotid bifurcation area,observe and analyze the size and location of neurovascular structures,and the relationship between them.It aims to provide anatomical landmarks for carotid bifurcation surgery and reduce the injury of important neurovascular vessels,Avoiding serious complications after surgery.Secondly,it provides an anatomical references for the treatment of peripheral facial paralysis by hypoglossal-facial nerve anastomosis.Methods: 1.In order to obtain better image data and exposure,12(24 sides)of Chinese adult cadavers are firstly filled with glue(arterial red,vein blue)in their vessels and stored with 75% alcohol.2.Analyze the soft tissue structure of neck layer by layer,expose the platysma in the superficial fascia of the neck,then turn the platysma to the upper to reveal the sternocleidomastoid muscle,and then under the microscope(Carl Zeiss Meditec AG,Jena,Germany)Microscopic anatomy of the descending carotid sheath and peripheral nerve vessels;clear the position of the neurovascular in the carotid bifurcation area,observe the height of the carotid bifurcation,the position of the external carotid artery and the internal carotid artery,and the nerves around the carotid bifurcation The diameters of the common carotid artery,the external carotid artery,the internal carotid artery,the superior thyroid artery,the lingual artery,and the facial artery were measured;the angle of the carotid bifurcation and the distance between the superior thyroid artery and the bifurcation of the carotid artery were measured.In addition,the facial nerve was dissected under the microscope,and the nerve was exposed to observe the facial nerve.3.Summarize the location of adjacent nerve vessels,provide a good anatomical landmark for carotid bifurcation surgery and provide a reference for the treatment of peripheral facial paralysis.Results: The low-risk carotid bifurcation was(left: right = 66.7%:75.0%);the high-risk carotid bifurcation was(left: right = 33.3%:25.0%)fork.The diameter of the common carotid artery was approximately CCA 6.93 ± 0.54 mm on the left side and 6.37 ± 0.46 mm on the right side.The diameters of the left and right sides of the internal carotid artery were 5.84 ± 0,63 mm,5.78 ± 0.55 mm,respectively.The left side was 4.74±0.76 mm,and the right side was 4.65±0.56;while the left side of the carotid bifurcation angle was 37.65±12.60,and the right side was 32.51±12.78.The left carotid artery angle was significantly larger than the right side;the diameters of the STA,LA,and FA vessels were: 1.1±0.3mm,1.3±0.4mm,1.5±0.4mm on the left side,and 1.3±0.2mm,1.2±0.3mm.1.4 ± 0.3 mm on the right side.The distance between STA and CB is 6.5 ± 3.2 mm on tht left side;5.6 ± 3.5 mm on the right side respectively.The sternocleidomastoid artery can be used as an important anatomical landmark to distinguish the hypoglossal nerve.The hypoglossal nerve is located behind the posterior abdomen of the second abdominal muscle.Here,the hypoglossal nerve can be anastomosed to the facial nerve according to the lesion.Conclusions: 1.The carotid high bifurcation population is relatively low.For patients with carotid stenosis with high carotid bifurcation,endovascular treatment can be considered.For other carotid bifurcation lesions,styloidectomy,mandibular removal,subluxation of the mandible,and cutting of the posterior abdomen of the second abdominal muscle can be performed.2.The carotid bifurcation area of the outer diameter of the blood vessels and the adjacent relationship of the nerve vessels,whether for the atherosclerosis caused by arteriosclerosis attached to the carotid bifurcation caused by vascular stenosis or carotid endarterectomy It is of great significance,and can also be applied to vascular embolization of cervical malignant tumors and selective or even superselective chemical embolization.Secondly,it can be applied to neck burns or neck skin defects after surgery.3.Sternocleidomastoid artery can be used as an important anatomical landmark to distinguish the hypoglossal nerve,the hypoglossal nerve is located in the deep of the posterior belly of the digastric muscle,where the hypoglossal nerve and the facial nerve can be anastomosed according to the lesion.4.Familiar with the neurovascular anatomy of the carotid bifurcation,can avoid damage to adjacent vessels and nerves during operation around carotid bifurcation area.Reduce postoperative recovery from nerves and vascular injuries,and increase additional costs.5.A triangle bounded by the styloglossus muscle,external carotid artery,and facial artery housed the glossopharyngeal nerve.The vagus nerve ran inside the carotid sheath posterior to internal carotid artery.A triangle formed by the posterior belly of digastric muscle,sternocleidomastoid muscle,and internal jugular vein housed the accessory nerve.A triangle outlined by the posterior belly of digastric muscle,internal jugular vein,and common facial vein housed the hypoglossal nerve.The triangle outlined superiorly by the stylohyoid muscle(SHM),posteriorly by the external carotid artery(ECA),and inferiorly by the superior thyroid artery(STh A).This triangle houses the superior laryngeal nerve(SLN).