The Clinical Investigation Of The Application Of Color Doppler Ulstrasound Design Submental Musculocutaneous Island Flap

Part one The vascular pedicle of submental musculocutaneous island flap were detected by color Doppler ultrasoundObjective: To explore the application value of color Doppler ulstrasound in detecting submental vessels and designing submental musculocutaneous island flap before the operation.Methods:The 35 patients for submental musculocutaneous island flap operation were recruited in the study.The distance from the midpoint of chin,the trend of vessels,the way of venous reflux,the way of abnormal vascular and the heamodynamics index of the external maxillary arteries,anterior facial veins,submental arteries and veins on preoperatively were detected by color Doppler ulstrasound.The results were checked and compared with the findings in operation.Results:1 The group with preoperative CDUS in 35 cases of vascular exploration patients,the results of ulstrasound in keeping with the findings in operation.1cases submental vein was not detected by color Doppler ulstrasound,but in the operation we found the submental vein was replaced by a small vein accompanying the external maxillary artery.1 cases did not detect the presence of anterior facial vein by ultrasound,in the operation we found the anterior facial vein was absent and the submental vein directly into the internal jugular vein.The location and movement of the external maxillary artery,the anterior vein and the inferior vena cava were consistent with the preoperative color Doppler ultrasound.The distance from edge of mandibular to the left submental artery was(5.25±0.93)mm,the distance from the mandible angle was(1.82±0.33)cm,the distance from the midpoint of chin was(6.08±0.52)cm.The distance from edge of mandibular to the right submental artery was(5.23±0.91)mm,the distance from the mandible angle was(1.75±0.29)cm,the distance from the midpoint of chin was(6.12±0.63)cm.The distance from the midpoint of chin to the external maxillary artery was(11.4±1.21)cm.2 By preoperative ultrasound detection we found 6 kinds of reflux in anterior facial vein: directly into the internal jugular vein,into the external jugular vein,and the posterior mandibular vein into the total facial vein and eventually into the internal jugular vein,the anterior facial vein is absent and the submental vein directly into the internal jugular vein,into the anterior cervical vein,into the comman facial vein and anterior cervical vein.Four kinds of origination of the external maxillary artery: directly originated from external carotid artery,and the tongue artery originated from external carotid artery,and the submental artery stem originated from external carotid artery,and the superior thyroid artery,tongue artery common stem originated from external carotid artery.Part two Clinical study of color Doppler ultrasonography in the iagnosis of cervical lymph node metastasisObjective: To explore the application value of color Doppler ulstrasound in diagnosing the lymph nides of the ? region in the neck before the operation and selecting submental musculocutaneous island flap.Methods:The operation explored the lymph nides of the ? region in the neck by the colour Doppler ultrasound and then used PDI and color Doppler flow imaging to observe the morphology of blood flow by recording its ultrasonic findings.According to the results of color Doppler ultrasound,the criteria for the diagnosis of the metastatic lymph node with single and comprehensive indicators.The ? gone lymph nodes which were detected by the color Doppler ultrasound were marked on the skin,and cut off in the operation.Surgical specimens were sent to the Department of Pathology to do the biopsy to the pathological diagnosed as diagnostic criteria.Using SPSS21.0 statistical software for statistical analysis.After comparing the results of pathologicaldiagnosis with the color Doppler ultrasound diagnosis we would evaluate the sensitivity,specificity and accuracy of color Doppler ultrasound in the diagnosis of metastatic and non metastatic lymph nodes in the ? region.The specificity and accuracy of which based on comprehensive index or single index were compared by using SPSS21.0 statistical software chi square test,taking P<0.05,which was considered statistically significant.Results:We chose the internal liquefaction necrosis,L/S?2,medullary deformation or deletion,and blood flow pattern type ? or type ? as the standard of comprehensive diagnosis of metastatic lymph nodes.The sensitivity 87.5%(14/16),the specificity was 92.5%(74/80),the accuracy was91.7%(88/96).We only chose L/S?2 as the standard of metastatic lymph nodes,the sensitivity 75%(12/16),the specificity was 80%(64/80),the accuracy was 79.2%(76/96).We only chose the blood flow pattern type ?or type ? as the standard of metastatic lymph nodes,the sensitivity 87.5%(14/16),the specificity was 80%(64/80),the accuracy was 81.3%(78/96).The specificity and accuracy between comprehensive index and single index were compared by chi square test,the difference was statistically significant(P<0.05).Conclusion:1 The color Doppler ulstrasound shows the trend and the distribution of the external carotid artery,anterior facial vein,submental artery and submental vein,measures their heamodynamics index,assesses their accurate quality conveniently and directly,and provides scientific basis for the design of submental musculocutaneous island flap before the operation.2 The color Doppler ulstrasound can accurately detect lymph node of?region,provide imaging evidence for the nature of the lymph nodes and the selection of the submental musculocutaneous island flaps.