The significance of preoperative neck enhanced multidetector computed tomography in predicting the recurrent veins and classifying their courses of the submental flap reflux vein for repair in pharyngeal cancer
10.3760/cma.j.cn115330-20250106-00011
- VernacularTitle:术前颈部增强CT预判颏瓣回流静脉及走行分型对喉咽癌修复的意义
- Author:
Qian SHI
1
;
Jugao FANG
1
;
Qi ZHONG
1
;
Lizhen HOU
1
;
Hongzhi MA
1
;
Ling FENG
1
;
Shizhi HE
1
;
Meng LIAN
1
;
Yanming ZHAO
1
;
Ru WANG
1
;
Yunxia LI
1
;
Xixi SHEN
1
;
Yifan YANG
1
;
Lingwa WANG
1
Author Information
1. 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科 耳鼻咽喉头颈科学教育部重点实验室（首都医科大学），北京 100730
- Publication Type:Journal Article
- Keywords:
Hypopharyngeal neoplasms;
Reconstructive surgical procedures;
Submental perforator flap;
Reflux vein;
High-resolution enhanced CT
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2025;60(10):1208-1214
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate preoperative high-resolution thin-layer cervical enhanced CT used to predict the venous route of the submental flap reflux vein and its relationship with adjacent structures in order to guide the anatomical understanding and protection of submental flap in pharyngeal cancer surgery.Methods:Sixty consecutive patients with pharyngeal cancer who underwent submental flap repair surgery in our department from March 2022 to December 2024, as well as 60 patients who were accepted neck dissection suffering other cancers, were selected. Before surgery, high-resolution cervical enhanced CT scans were performed, and the position of the transverse section of the facial vein in the venous phase horizontal image gradually variation tendency was focused layer by layer. The direction and adjacent relationship of the submental flap reflux veins were determined and recorded. Combined with 60 patients with other head and neck tumors who underwent neck dissection in our department during the same period (a total of 120 cases, 240 sides), the classification and management of the draining veins of Fang′s mental flap were conducted. Type Ⅰ mainly drains into the internal jugular vein; Type Ⅱ mainly drains into the external jugular vein and Type Ⅲ mainly drains into the anterior jugular vein (often accompanied by an external jugular draining branch). The status and proportion of venous drainage were analyzed.Results:Vascular predictive coincidence rate was 98.3% (59/60) among the 60 patients with pharyngeal cancer. Only one patient was predicted to have a simple return to the external jugular vein. However, during the operation, in addition to the main return to the external jugular vein, a small portion also returned to the internal jugular vein. Submental flap reflux vessels were classified into three types based on intraoperative submental flap venous return in 60 cases of laryngopharyngeal cancer, in conjunction with the analysis of venous return patterns from 240 cervical CT scans. Type Ⅰ mainly refluxed to the internal jugular vein, accounting for 42.1%. Type Ⅱ mainly refluxed to the external jugular vein (47.9%). Type Ⅲ mainly refluxed to the anterior jugular vein (10.0%). The total detection rate of CT reading of 240 venous reflux was 98.7% (237/240). Vascular predictive coincidence rate was 97.9%(235/240).Conclusion:The detailed analysis of submental venous return vessels can accurately predict the direction of reflux veins and its surrounding areas by preoperative high-resolution enhanced CT scan. This provides reliable guidance for the anatomy and protection of the submental flap reflux veins during surgery.
