Abstract
Since E. MONIZ (1927) introduced angiography in the diagnosis by a clinician the use of it in the exploration of the vascular system of head and neck has gradually increased.
The techiniques and indications of cerebral angiography has been discussed in detail by many students.
The materials for my study had been collected from July 1966, to August 1967 in the Otorhinolaryngological Clinic of Kyushu University and Kyushu Central Hospital ; the carotid angiography was applied for the 30 normal cases and for the 31 pathologic cases ( including 29 cases of maxillary carcinoma and 2 of maxillary sarcoma).
The carotid angiography was applied for all the cases, and besides for several cases was applied the selective external carotid angiography.
The common carotid artery was punctured percutaneously, under local anesthesia, low in the neck, using a Kitamura's needle, and 10ml-15ml of 60% Urografin was used as the contrast medium.
ZIEDSES DES PLANTES (1934) published the first description of the subtraction techinique applied to roentgen diagnostic work, stating that the difference between the two roentgenograms of the same part of the body might be made apparent by covering one of them with a diapositive of the other.
I applied this subtraction method to the angiography of maxillary tumors, the method is purely photographic, the direct positive copy being made by means of ordinary light.
All the bony structures are removed, leaving vessels behind.
I consider that the subtraction method in angiography is of high value because vessels are occasionally obscured by bony structures.
The results of normal cases are as follows:
1) The external carotid artery of the normal cases branches from the common carotid artery at the level of the hyoid bone.
2) The branches of the external carotid artery are divided into 4 groups: anterior, posterior, ascending, and terminal.
3) The anterior branches include the superior thyroid, the lingual and the facial arteries. Posteriorly, the occipital artery arises at the level of the facial artery and the posterior auricular artery is a relatively small vessel. The ascending pharyngeal artery is also a small artery. The superficial temporal artery and the maxillary artery are the 2 terminal branches of the external carotid artery.
4) The ophthalmic artery, the first branch of the internal carotid artery is nearly always visible in part of its course in the lateral carotid
arteriogram. The main trunk of the ophthalmic artery is considerably larger than any of its branches, the average size of the main trunk being about 1.5 mm in the lateral arteriogram.
The carotid angiography is a valuable aid in the diagnosis of tumors in the maxillary region. Operation was performed, and the diagnosis of maxillary carcinoma or maxillary sarcoma was verified histologically in most of 31 pathologic cases. The arteriograms of maxillary tumors were compared with the inspected views of the operation field, the removed samples, the histologic samples, and the various roentgenograms.
The results of the pathologic cases are as follows
1) The malignant tumors in the maxillary region are usually supplied with blood from both the internal and the external carotid arteries.
2) Particularly the maxillary artery supplies blood to these tumors, although the smaller maxillary branches may also contribute to the blood supply in some location.
3) The angiographic diagnosis of malignant tumors in the maxillary region is based upon two factors ; the vascularity of the tumor, namely the abundance of vessels in the tumor, and the displacement of normal vessels by the growth.
4) The branches of the external carotid artery supplying blood to the tumor are enlarged and usually abnormally tortuous.
5) The vessels inside the tumor are tortuous and wound, the tumor vessels frequently having a radial spoke-like appearance.
