THE CAROTID - SUBCLAVIAN ARTERIES

CHAÛY MAÙU MUÕI TAÙI PHAÙT : THE EXTENAL CAROTID ARTERY. THE EXTENAL CAROTID ARTERY[r]

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DEPARTMENT OF ANATOMY

THE CAROTID - SUBCLAVIAN

ARTERIES

THE CAROTID - SUBCLAVIAN THE CAROTID - SUBCLAVIAN

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE EXTENAL CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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THE CAROTID ARTERY

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1 SECOND SEG

 TYPE

2.SECOND SEG

 TYPE

Rouviere 1948 & Gardner 1969

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PHÂN CHIA ĐOẠN

Harry 1947, Barry 1966, Gardner1969, Harold 1969 …

PHÂN CHIA ĐOẠN

Sicher Harry & E Lloyd du Brul 1970 …

10 ĐM hốc mắt

11 ĐM huyệt sau

12 ĐM ống chân bướm 13 ĐM xuống 14 ĐM bướm cái 1 ĐM huyệt dưới

2 ĐM màng não giữa 3 ĐM nhĩ trước

4 ÑM tai saâu

1

2 4

5 ĐM thái dương sâu trước 6 ĐM thái dương sâu sau 7 ĐM cắn

8 ĐM chân bướm 9 ĐM má

6 5

8

7 9

10 ĐM hốc mắt

11 ĐM huyệt sau

12 ĐM ống chân bướm 13 ĐM xuống 14 ĐM bướm cái

10

11

13 14

Phân nhỏ ĐOẠN thứ 3 thành 2 phân đoạn  ĐOẠN

P: 100,0% T: 100,0% P: 100,0% T: 100,0% P: 83,3% T: 63,3% P: 86,7% T: 66,7%

P: 100,0% T: 96,7% P: 100,0% T: 96,7% P: 66,7% T: 63,3% P: 90,0% T: 90,0% P: 100,0% T: 90,0%

P: 100,0% T: 100,0% P: 100,0% T: 100,0%

P: 16,7% T: 13,3% P: 100,0% T: 100,0% P: 100,0% T: 100,0%

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10

11

12

13 14

10 ÑMDHM 12 ÑM OCB 14 ÑM BKC 11 ÑM HRTS 13 ÑM KCX

10 ÑMDHM 12 ÑM OCB 14 ÑM BKC 11 ÑM HRTS 13 ÑM KCX

P : 56,7% T : 73,3% trên

dưới

ngồi trong

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T : 73,3% P : 56,7%

Góc STT T – 2/3 P : 16,7% Góc STT T – 1/2 P : 6,7%  định vị ĐMBKC :

mở rộng 1/4 thành sau xoang hàm THE EXTENAL CAROTID ARTERY

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11 10 10 10 10 10 10 11 11 11 11 11 12 12 12 12 12 12 13 13 13 13 13 13 14 14 14 14 14 14

10 ÑM DHM 12 ÑM OCB 11 ÑM HRTS 13 ÑMKCX 14 ÑM BKC

10 ÑM DHM 12 ÑM OCB 11 ÑM HRTS 13 ÑMKCX

14 ÑM BKC

3,3% (P)

96,7% (P&T) 3,3% (T)

Mạng mạch máu phụ nhiều

2 ĐMH nhiều phân nhánh xuất phát từ thân chung

3 Khoâng có quy luật định

CHẢY MÁU MŨI TÁI PHÁT : THE EXTENAL CAROTID ARTERY

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93%

53,3% ms1

7%

Vị trí lỗ BKC : nằm ¼ đi 93 %

 Phù hợp với Bolger – Winstead’s

46,7% ms2

2 Bolger : 1 maøo 36,4 % & maøo 63,6 %

Băng ngang : 66,6% Trước : 33,4%

Băng ngang : 60 % Bờ trước lỗ : 33 % Trước : %

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4,5mm 5,2mm 4,2 mm 4,6 mm 1,4 mm 1,3 mm BTV

1 Ngay trước

1-2mm : 67%

2 Ngay dưới

1-2mm : 33%

5,4 cm

1 Mối liên hệ mào sàng - LBKC   CMM

2 Rạch # mm cắt đuôi CMG, hướng sau 

nhận dạng ĐMBKC phía sau ms  đặt clip

3 Ưu điểm : a biến chứng xuyên xoang 28% ><ngã mũi 0%b thấy & tiếp cận trực tiếp nguồn chảy máu ĐMBKCc Dễ dàng, giảm thời gian gây mê & thành công 100%

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Đề xuất kỹ thuật “ CON TEM BƯU CHÍNH ”

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PLAN OF RELATIONS OF 1ST PORTION

1 1STST

R-C R-C

1 Skin, fascial

2 Platysma

3 Sterno-mastoid

4 Sterno-hyoid, thyroid 5 Jugular, vertebral V.

6 X, cardiac N.

7 Loop fr sympathetic

1 Recurrent laryngeal N.

2 Sympathetic

3 Pleura & apex of lung

1 Pleura

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PLAN OF RELATIONS OF 1ST PORTION

1 1STST

L-C L-C

1 Skin, fascial

2 Platysma

4 Sterno-hyoid, thyroid 5 Jugular, vertebral V.

6 X, cardiac, phrenic N.

1 Pleura, left lung

1 Esophagus, thoracic duct

2 Inf Cer ganglion of Sympathetic

3 Longus colli

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PLAN OF RELATIONS OF 2nd PORTION

2 2ndnd

C C

1 Skin, fascial

2 Platysma

4 Phrenic nerve

5 Scalenus anticus

6 Subclavian V.

1 Pleura

1 Brachial plexus

1 Pleura

2 Middle scalenus

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PLAN OF RELATIONS OF 3rd PORTION

2 2ndnd

C C

1 Skin, fascial

2 Platysma

3 Descen br of cervical plexus

4 SuprascapularA V. 5 External jugular, tranverse cervical V.

6 The clavicle

1 Brachial plexus

1 1st rib

1 Middle scalenus

2 Lower cord of brachial plexus

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THE BRANCHES OF SUBCLAVIAN ARTERY

Suprascapular a.

Tranverse cervical a.

Superficial cervical a.

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COLLATERAL CIRCULATION

Subscapular a.

1 Superior & long a. 2 Br of subscapular a. Sup thyroid a.

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REFERENCES REFERENCESREFERENCES REFERENCES 1 TEXTBOOKS 1 TEXTBOOKS 1 TEXTBOOKS 1 TEXTBOOKS

1 Williams PL, Warwick R et al

1 Williams PL, Warwick R et al Gray’s Anatomy, 37Gray’s Anatomy, 37thth ed ed NewYork : Churchill Livingstone, 1989, NewYork : Churchill Livingstone, 1989,

pp 401-22, 499-16

2 Pick TP & Howden R

2 Pick TP & Howden R Gray’s Anatomy, The Classic Collector’s edGray’s Anatomy, The Classic Collector’s ed NewYork : Gramercy, 1977 NewYork : Gramercy, 1977 Netter Frank H

3 Netter Frank H Atlas of Clinical Anatomy on CD-ROM, ver 2.0Atlas of Clinical Anatomy on CD-ROM, ver 2.0 Novartis : DxR Development Group, Novartis : DxR Development Group, Inc, 1998

Inc, 1998

4 Gosling JA, Harris PF et al

4 Gosling JA, Harris PF et al Human Anatomy, 2Human Anatomy, 2rdrd ed ed HongKong: Wolfe, 1993. HongKong: Wolfe, 1993.

5 Sabiston

5 Sabiston Textbook of Surgery, 15Textbook of Surgery, 15thth ed ed Philadelphia : W.B Saunder Company, 1997. Philadelphia : W.B Saunder Company, 1997.

6

6 Oxford Textbook of Surgery on CD-ROM, ver 1.0Oxford Textbook of Surgery on CD-ROM, ver 1.0 Oxford University Press, 1995 Oxford University Press, 1995 Williams PL, Warwick R et al

1 Williams PL, Warwick R et al Gray’s Anatomy, 37Gray’s Anatomy, 37thth ed NewYork : Churchill Livingstone, 1989, ed NewYork : Churchill Livingstone, 1989,

pp 401-22, 499-16

2 Pick TP & Howden R

2 Pick TP & Howden R Gray’s Anatomy, The Classic Collector’s edGray’s Anatomy, The Classic Collector’s ed NewYork : Gramercy, 1977 NewYork : Gramercy, 1977 Netter Frank H

3 Netter Frank H Atlas of Clinical Anatomy on CD-ROM, ver 2.0 Novartis : DxR Development Group, Atlas of Clinical Anatomy on CD-ROM, ver 2.0 Novartis : DxR Development Group,

Inc, 1998

4 Gosling JA, Harris PF et al

4 Gosling JA, Harris PF et al Human Anatomy, 2Human Anatomy, 2rdrd ed HongKong: Wolfe, 1993. ed HongKong: Wolfe, 1993.

5 Sabiston

5 Sabiston Textbook of Surgery, 15Textbook of Surgery, 15thth ed Philadelphia : W.B Saunder Company, 1997. ed Philadelphia : W.B Saunder Company, 1997

6

6 Oxford Textbook of Surgery on CD-ROM, ver 1.0 Oxford University Press, 1995 Oxford Textbook of Surgery on CD-ROM, ver 1.0 Oxford University Press, 1995

2 WEBSITES 2 WEBSITES 2 WEBSITES 2 WEBSITES http://anatomy.uams.edu/htmlpages/anatomyhtml/ http://anatomy.uams.edu/htmlpages/anatomyhtml/ http://www.ptcentral.com.muscles http://www.ptcentral.com.muscles http://cim.ucdavis.edu/users/grogo/cha101/mnemonics.shtml http://cim.ucdavis.edu/users/grogo/cha101/mnemonics.shtml http://www.anatomy.tv http://www.anatomy.tv

5 Anatomy of the Human Body Henry GrayAnatomy of the Human Body Henry Gray http://www.bartleby.com/107/ http://www.bartleby.com/107/

6 http://www.mednote.co.kr/ANATOMYHNADOUThtm.htm http://www.mednote.co.kr/ANATOMYHNADOUThtm.htm http://anatomy.uams.edu/htmlpages/anatomyhtml/ http://anatomy.uams.edu/htmlpages/anatomyhtml/ http://www.ptcentral.com.muscles http://www.ptcentral.com.muscles http://cim.ucdavis.edu/users/grogo/cha101/mnemonics.shtml http://cim.ucdavis.edu/users/grogo/cha101/mnemonics.shtml http://www.anatomy.tv http://www.anatomy.tv

5 Anatomy of the Human Body Henry GrayAnatomy of the Human Body Henry Gray http://www.bartleby.com/107/ http://www.bartleby.com/107/

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