11-Relação anatomica

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69 REVISTA BRASILEIRA DE OTORRINOLARINGOLOGIA 68 (1) PARTE 1 JANEIRO/FEVEREIRO 2002 http://www.sborl.org.br / e-mail: [email protected] Anatomical relation between the hypoglossal nerve and the carotid artery bifurcation Resumo / Summary Introdução: Nas últimas décadas o índice de compli- cações neurológicas centrais e mortalidade após cirurgia da artéria carótida (tumor do corpo carotídeo e endarterec- tomia) diminuiu significativamente. A lesão de nervos cranianos continua pouco alterada e elevada, e a lesão do nervo hipoglosso é a mais freqüente. Objetivo: Estudar a relação entre o nervo hipoglosso e a bifurcação carotídea, determinando a distância entre estas estruturas, além de estudar a influência do sexo, idade, raça e comprimento do pescoço sobre esta medida. Forma de estudo: Experimental. Material e método: Foram realizadas 38 dissecções da artéria carótida em 38 cadáveres. Os cadáveres eram colocados em posição padrão (pescoço em extensão de 95 o ). Após identificação do nervo e da bifurcação carotídea, foi medida a distância entre as estruturas. O comprimento do pescoço foi medido do processo mastóide até a incisura jugular. Resultados: O nervo hipoglosso não foi encontrado abaixo da bifurcação, e a distância entre o nervo e a bifurcação variou de 0.5 a 4.3 cm (média = 2.1 cm, mediana = 2.0 cm, desvio padrão = 0.63 cm). Comprimento do pescoço, sexo, raça e idade não demonstraram significância estatística. Conclusão: Nesta amostra observamos grande variação anatômica entre o nervo hipoglosso e a bifurcação carotídea, e não houve correlação com comprimento do pescoço, sexo, raça e idade. Um melhor entendimento da anatomia do nervo hipoglosso e a sua variação em relação à bifurcação carotídea são importantes para prevenir lesão do nervo hipoglosso. Felipe S. G. Fortes 1 , Dr. Erasmo S. Silva 2 , Dr. Luiz U. Sennes 3 Palavras-chave: nervo hipoglosso, artéria carótida, anatomia, endarterectomia, tumor de corpo carotídeo. Key words: hypoglossal nerve, carotid artery, anatomy, endarterectomy, carotid body tumor. Relação anatômica entre o nervo hipoglosso e a bifurcação carotídea 1 Acadêmico do 6º ano da Faculdade de Medicina da USP. 2 Médico Docente da Disciplina de Topografia Estrutural Humana Departamento de Cirurgia da Faculdade de Medicina da USP. 3 Professor Doutor da Disciplina de Otorrinolaringologia da Faculdade de Medicina da USP. Médico Diretor do Serviço de Bucofaringologia do HCFMUSP. Trabalho apresentado no 35º Congresso Brasileiro de Otorrinolaringologia Menção Honrosa Endereço para correspondência: Felipe S. G. Fortes R. Fernão Cardim, 159, ap. 154 Jd. Paulista São Paulo SP 01403-020 Artigo recebido em 19 de setembro de 2001. Artigo aceito em 05 de outubro de 2001. I ntroduction: In the last decades the incidence of central nervous complications and death has decreased, especially in endarterectomy and carotid body tumor. Contrastingly, the incidence of cranial nerve following is a problem that remains high and little changed, and the hypoglossal nerve dysfunction is the most frequent. Aim: The aim of this study was to establish the anatomical relation between the carotid artery bifurcation and hypoglossal nerve. Study design: experimental. Material and method: Carotid artery and hypoglossal nerve dissections were carried out in 38 fresh corpses. All the individuals were placed in standard position and the dissections were performed with surgical technique. The measurements were done in centimeters and millimeters from the dissected carotid bifurcation to the XII nerve in the cervical area. Results: Twenty-six individuals were male and 12 female. The majority were whites, 30, and 8 were non- whites. The distance between hypoglossal nerve and carotid artery bifurcation ranged from 0.5 cm to 4.3 cm, with mean of 2.1 cm, median 2.0 cm and standard deviation of 0.63 cm. Neck length, age, gender and race were related with the measurements and failed to show significant statistic correlation (a > 0.05). Conclusion: In this sample there is a great anatomic variation of the distance between hypoglossal nerve and carotid artery bifurcation and there was no statistical difference concerning age, gender, race and neck length. A better understanding of the anatomic course of this nerve and its variation in relation to carotid artery bifurcation, are relevant to prevent hypoglossal nerve lesions in the carotid artery surgery. ORIGINAL ARTICLE ARTIGO ORIGINAL Rev Bras Otorrinolaringol. V.68, n.1, 69-73, jan./fev. 2002 «««««

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