Superficial temporal artery retrograde cannulation

Superficial temporal artery intubation for the surgical treatment of oral and maxillofacial malignancies. Head and neck malignant tumors can be treated with chemical drugs before surgery. The route of administration is the best effect of direct bolus injection of drugs into the tumor area. Recently, there are microspheres of anti-tumor drugs, which are pushed from the artery to the tumor site, and then slowly release the drug, which is more effective. After the tumor is confined or reduced, surgical resection can be performed. The external carotid artery originates from the common carotid artery. The common carotid artery is located in the sheath of the carotid artery, and there are still internal jugular veins and vagus nerves in the sheath. The common carotid artery is located on the medial side, the internal jugular vein is on the lateral side, and the vagus nerve is behind the arterie and venous, separated by a thin layer of connective tissue. The external carotid artery is separated from the common carotid artery at the upper edge of the thyroid cartilage and is located in the anterior medial aspect of the internal carotid artery at the neck. The internal carotid artery has no branches in the neck, and the external carotid artery has branches of the superior thyroid artery, the lingual artery, the external maxillary artery, the internal maxillary artery, the superficial temporal artery, the posterior ear artery, and the occipital artery. Clinically identifying the location of the artery in the neck with no branches and arteries is an important indicator of the internal and external carotid arteries. The external carotid artery chemotherapy is the first choice for superficial temporal artery intubation. Its position is superficial and easy to operate, followed by the superior thyroid artery and the lingual artery. Treatment of diseases: oral and maxillofacial tumors Indication For maxillary sinus, hard palate, upper and lower gingiva and malignant tumors of the jaw, lip, cheek, parotid gland, nose, oropharynx, it is advisable to first use retrograde catheterization of the superficial temporal artery. Contraindications 1, severe liver and kidney dysfunction, white blood cells below 4 × 109 / L (4000 / mm3), platelets below 100 × 109 / L (100,000 / mm3), generally do not consider arterial intubation chemotherapy. 2, have been treated with radiation, arterial intima thickening, or obvious arteriosclerosis. 3. The tumor directly oppresses the deafness area and causes difficulty in intubation. Preoperative preparation 1. Prepare the skin in front of the tragus and the ankle, and shave the hair on the ear about 10cm (3 inches). 2. The instrument is prepared for venous incision and a number of silicone tubes with different thicknesses. 3. Drug preparation anticancer drugs, methylene blue, sodium citrate or heparin. Surgical procedure Incision Before the tragus, the pulsation of the superficial temporal artery was taken out, and it was marked with methylene blue according to its path, and then a local anesthetic was injected, and the skin and subcutaneous tissue were cut longitudinally, and the length was about 2 cm. Free arteries In the subcutaneous tissue, the long axis of the superficial temporal artery was bluntly separated, and a shallow superficial temporal artery about 2 cm long was dissected. Then, two wires are bypassed under the artery, and the distal end blood vessels are ligated with a silk thread, and the ligature is not cut, and is reserved for pulling. The proximal cardiac wire lifts the blood vessel to temporarily block blood flow. 3. Intubation A small scissors was used to cut a V-shape on the central vessel wall of the two wires, and then placed into a silicone catheter. The outer diameter of the silicone catheter is about 1.5 to 2 mm, and the nozzle should be rounded, but the side is cut into a slanted opening, which is advantageous for placement. The silicone tube should be filled with 0.5% procaine solution. When entering the vascular cavity, relax the proximal blood vessels, you can see the blood return, and prove that the catheter enters the blood vessel cavity, then you can continue to insert downward. The superficial temporal artery is wound from the slightly deep plane, between the mandibular joint and the external auditory canal, to the deafness. Therefore, when the condyle is bypassed, it is curved here, often encountering difficulties, and can be pulled up and down. The artery is made to bend and become smaller, and then the patient can open the mouth and make a gentle rotation when inserted, and can smoothly slide down to reach the carotid bifurcation below the mandibular angle. The length of the silicone catheter from the insertion port to the bifurcation of the common carotid artery varies from person to person, but the average adult male is about 11 to 12 cm, and the adult female is about 10 to 11 cm. Therefore, if you need to perfuse the internal maxillary artery, you can insert about 8cm, and the perfusion of the tongue can be inserted about 10cm. How to determine whether the depth of the cannula is appropriate, you can inject 1 to 2 ml of methylene blue from the catheter, and observe whether there is blue staining in the lesion area, then you can know whether the depth of the intubation is appropriate. If the intubation is too deep into the common carotid artery, the frontal artery area may appear blue, so it should be adjusted back. 4. Fixed cannula The proximal end of the wire is ligated and a wire is wound over it to ligation the catheter. Finally, a thread is passed under the proximal end of the blood vessel, and the two ends are respectively worn out of the skin, and are prepared to be tightened and ligated in the future when the catheter is removed to prevent bleeding. 5. Stitching The skin wound is layered and sutured, and the catheter is exposed outside the skin, and is ligated and fixed by the skin suture to prevent slippage. Finally, the silicone tube was coiled at the upper end of the slit, and was fixed to the crotch with a tape to prevent the tube from being pulled. In the whole process of operation, the gel catheter must be continuously filled with procaine solution or anticoagulant solution to prevent arterial spasm. In the same fashion, 5% glucose solution and physiological saline should be continuously injected to prevent blood from condensing in the silicone tube. Finally, a 0.05% sodium citrate solution or 2 ml of 0.1% heparin was injected into the tube to make it full, kept in the catheter for anticoagulation, and clamped to the end of the catheter with a clamp. complication 1. Major bleeding occurs due to the slippage of the indwelling catheter or the clip of the clamp slipping off. 2. The catheter was blocked by blood clots and the operation failed. 3. Hematopoietic system inhibition or digestive tract reaction occurs.