The identification of features topography of neck’s vessels in the prevention of bleedings at surgical interventions on a pharynx

Knowledge of topography and syntopy of neck’s vessels is necessary when carrying out surgical interventions on ENT organs, in particular on palatine tonsils, a larynx, Eustachian tube and a nasopharynx. Authors have studied a anatomo-topographical features of large neck’s vessels in relation to the pharynx’s structures according to MRI-researches that allows to plan tactics of surgical treatment of patients and carry out prevention of hemorrhagic complications. 109 patients (the 218th palatine tonsils) with chronic tonsillitis (64 women and 45 men) aged from 15 up to 54 years are examined. To all patients MRI-diagnostics of neck’s vessels in the vascular mode was carried out, and measurements from the revealed vessels to the capsule of palatine tonsils at the level of the upper and lower poles and in the field of an average third of a palatine tonsil were performed. The distance from external carotid artery to the upper pole of a palatine tonsil makes 17,1 ± 1,01 mm, to the lower pole - 10,3 ± 0,18 mm, in the field of an average third - 10,7 ± 0,12 mm; the distance from internal carotid artery to the upper pole of a palatine tonsil makes 14,5 ± 0,84 mm, to the lower pole - 16,8 ± 0,77 mm, to an average third of a palatine tonsil - 15,3 ± 0,07 mm. Branches of external carotid artery, blood supplying palatine tonsil, are the most frequent sources of bleedings: maxillary artery: 16,4 ± 0,43 mm (17,4%) - the upper pole; 9,6 ± 0,02 mm (46,2%) -an average third of a palatine tonsil; 18,5 ± 0,74 mm (29,5%) - the lower pole; lingual artery: 4,7 ± 0,02 mm (6,8%) - an average third of a palatine tonsil; 6,2 ± 0,82 mm (56,8%) - the lower pole; facial artery: 4,2 ± 0,01 mm (0,76%) - an average third of a palatine tonsil; occipital artery: 25,6 ± 0,12 mm (19%) - the upper pole; 14,8 ± 0,11 mm (18,9%) - an average third of a palatine tonsil; 9,56 ± 0,12 mm (3,8%) - the lower pole; tonsillar arteries: 1,88 ± 0,01 mm (9,8%) - the upper pole; 2,51 ± 0,01 mm (23%) - an average third of a palatine tonsil; 2,12 ± 0,01 mm (11%) - the lower pole. Distance from internal jugular vein to the capsule of palatine tonsils: in the field of the upper pole of a palatine tonsil: 28,3 ± 1,01 mm, in the lower pole: 26,6 ± 1,54 mm, in the field of an average third: 22,7 ± 1,24 mm. Anomalies of internal carotid artery meet in 11,9% of cases, from them in 6,88% of cases C-and a S-shaped tortuosity of internal carotid artery is revealed; in 4,13% of cases - kinking of internal carotid artery and in 0,92% - coiling of internal carotid artery. The majority of the anomalies settled higher than the level of the upper pole of a palatine tonsil that doesn’t increase risks of a traumatization of large neck’s vessels and possible development of bleedings. In 0,46% of cases (1 patient) the kinking of the right internal carotid artery located in close proximity to the capsule of a palatine tonsil in the field of an average third is revealed. Internal carotid artery and internal jugular vein this for anomalies as a result of the conducted research aren’t received. This method of diagnostics allowed to reveal rare anatomic feature of development of internal carotid artery (1: 2398 operated patients - 0,04%), it was an important find at the patient preparing for plan surgical treatment concerning chronic tonsillitis. The received results need to be considered not only in case of surgical interferences at patients with chronic tonsillitis, but also in case of surgical treatment of other ENT-organs that is the most important -Eustachian tube.

топография сосудов шеи, аномалии сосудов шеи, хронический тонзиллит, тонзиллэктомия, МРТ-диагностика, topography of neck’s vessels, anomalies of neck’s vessels, chronic tonsillitis, tonsillectomy, MRI-diagnostic

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