上顎癌術野における内頸動脈の位置
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概要
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In case the tumor extends toward the postero-superior aspect of the maxillar bone to the base)f the skull, it is imperative to identify the exact location of the internal carotid artery in the opera-tive field, since the constant danger of traumatizing the internal carotid artery prevents complete exen-teration of the tumor.With formalin-fixed cadavers, the author iden-tified the topographic anatomy of the major landm-arks, thereby locating the internal carotid artery in the immediate operative field. (Fig. 1).However, in the actual operrtive field of cancer of the maxilla, a clear visualization of and around the internal carotid aretery is often difficult because of inaccessbility to the area, bleeding. and invasion of the tumor itself.Because of the necessity of finding another ap-proach in locating the internal carotid artery, apart from this immediate operrtive field, the author devised the following methods of locating the ape-rtura externs canalis carotici : A) by drawing an imaginery line connecting the anterior-most portion of the bony walls of the external auditory canal on both Sides; and B) by drawing an imaginery line anteroposterially, passing the outer edge of the oval foramen and parallel to the medial line. (Fig. 2, 3, 4). A=PP, B=FO The author measured 105 skulls of cadavers (Japanese). Of these 105 specimens, there were only two specimens in which the location of the apertura externa canalis carotici was slightly off the aforementioned lines. Howerer, their maximum deviations were less than 2 millimeters. The author believes the fact that the aforementioned lines pin-point the exact location of the apertura externa canalis carotici and is reliable enough for clinicaluse.In addition to this, even in recurrence of the lesion, application of the line-(A) can be advanta-geous especially when the proximity of the lesion to the internal carotid artery is questionable.