Vascular clinical anatomy of the submandibular gland

OBJECTIVE

The aim of this study is to describe in depth the precise anatomy of the vascular supply of the submandibular gland, trying to determine the existence of patterns of glandular vascularization. Knowledge of these patterns could facilitate surgical management of the gland and the submandibular gland flap.

MATERIAL AND METHODS

Neck dissections of formaldehyde preserved human cadavers were performed. Submandibular and transmandibular approaches were used during the dissections. All the vascular branches found were registered and classified into 2groups: main or accessory branches. The anatomical data analyzed was: The diameter and length of the main and accessory branches, as well as the most important measurements of the submandibular gland flap pedicle.

RESULTS

33 glands were dissected to study the arterial supply of the submandibular gland (17 right, 16 left; 17 males, 16 females) and 29 were dissected to study the venous supply (15 left, 14 right; 15 males,14 females). A total of 123 arterial branches were found reaching the 33 submandibular glands (47 main and 76 accessories) and 116 venous branches were found draining the 29 submandibular glands (47 main branches and 69 accessory branches). A constant main venous branch that ran parallel to the Wharton duct and drained in the sublingual vein was found in all of cases (Concomitant Wharton Duct Vein or CWDV).

CONCLUSION

The CWDV is a constant venous branch for the drainage of the gland and should be considered as venous pedicle during the dissection of submandibular gland flaps.

[Implantation of a program for the early detection of neonatal hearing loss]

Permanent childhood hearing impairment is a serious public health problem. Identification by screening in the first few months of life has the potential to improve affected children development. Neonatal hearing screening programs endorse the WHO requirement for a cost efficient screening. This paper shows the implementation of a medium-size hospital-based universal newborn hearing screening program using transient evoked otoacoustic emissions. Operational procedures and requirements are discussed. Quality control and results are showed.

[Our experience in neuroma surgery]

Our 24-year experience with acoustic neuroma surgery is reported. Three approaches were used in 34 patients: translabyrinthine (11 cases), transtemporal (2 cases), and retrosigmoid (21 cases). Prolonged facial paralysis occurred in 27% of patients with the translabyrinthine approach and in 15% with the retrosigmoid approach. Facial nerve monitoring was used in all operations with the retrosigmoid approach. In the translabyrinthine approach, 5 patients had CSF leak, 2 required secondary surgery, and 2 developed meningitis. With the retrosigmoid approach, 5 patients had CSF leak, 2 required secondary surgery, 3 developed meningitis (1 died), and 1 patient required emergency reoperation for posterior cranial fossa hematoma. Auditory function was preserved in one patient. The advantages of the retrosigmoid approach have become apparent: good exposure, speed, and preservation of the facial and cochlear nerves.

Conservative management of epistaxis

A retrospective study to assess the clinical usefulness of non-surgical management of epistaxis was performed on 340 patients requiring hospitalisation at the ENT Department of La Paz Hospital (Madrid). The previous history, type of management, hospitalisation time, and volume of transfusion were considered. Nasal packing was employed in 94.1 per cent of the patients. Most patients (82.9 per cent) were hospitalised less than seven days, and 84.1 per cent of the patients required no transfusion. There was one death. This study supports the clinical usefulness of conservative management in the treatment of patients with epistaxis.

Successfully treated candida sinusitis in an AIDS patient

An AIDS patient with a subdural empyema as a complication of candida sinusitis is presented. Clinical features resembled those of invasive aspergillosis or phycomycosis. Microbiological diagnosis was established by blood cultures, sinus cultures, and histopathological examination. An aggressive surgical approach first to the sinuses and then to the subdural space, together with fluconazole produced a satisfactory result.