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Concept: Temple

23

Limited information is available about the anatomical feasibility and clinical applications of flaps based on distal divisions of the superficial temporal artery (STA). The aim of this study was to investigate the anatomy of the STA, focusing on the number and reliability of distal branches and to show representative cases for the use of such flaps for zygomatic, parieto-frontal and occipital reconstructions.

Concepts: External carotid artery, Anatomy, Human anatomy, Scalp, Temple, Superficial temporal artery

22

In this 3-dimensional video, we perform a side-to-side and end-to-side double anastomosis using the parietal-branch of the superficial temporal artery (STA) to provide flow augmentation in a symptomatic 59-yr-old male with bilateral internal carotid artery occlusion at the origin, and left M1 segment occlusion. The patient suffered multiple left hemispheric strokes despite maximal medical therapy and was found to have poor hemodynamic reserve in the left hemisphere during evaluation with regional and global blood oxygenation level-dependent functional magnetic resonance imaging with CO2-challenge as well as quantitative magnetic resonance angiography and noninvasive optimal vessel analysis pre- and post-acetazolamide challenge. Postoperatively, the patient did very well and his hemodynamic studies improved significantly. The importance of this technique relies on the fact that we are using a single donor vessel to perform 2 anastomoses, and carries the following advantages: (1) the frontal STA branch remains intact and therefore can still be used at a later time if further revascularization is needed; (2) wound complications related to devascularizing the scalp from harvesting both STA branches are reduced; (3) 2 vascular territories are augmented (frontal and temporal) while using a single donor; (4) we are maximizing donor potential and optimizing cut flow index (CFI; total bypass flow postanastomosis divided by bypass cut flow) by flow augmenting 2 separate vascular beds therefore increasing demand. To explain that fourth point further: if the STA donor is able to carry a maximum 100 mL/min when cut, and after performing the first anastomosis bypass flow is only 37 mL/min, CFI will be 37/100 = 0.37, reflecting low demand, a poor indicator of graft patency, as previously published.1,2 By adding a second anastomosis which demands an additional 60 mL/min from the same STA donor, CFI (60 + 37)/100 improves to 1. Institutional Review Board approval was obtained for the review of patient chart and video files. Informed consent was obtained directly from the patient via telephone regarding use of media for educational and publication purposes.

Concepts: Medical imaging, Magnetic resonance imaging, Common carotid artery, External carotid artery, Arteries of the head and neck, Scalp, Temple, Superficial temporal artery

2

Giant cell arteritis typically involves the temporal arteries, but can involve other cranial arteries. Temporal artery biopsy is the mainstay for the diagnosis of giant cell arteritis; however, biopsy may be problematic if giant cell arteritis involves other cranial arteries that are inaccessible for sampling. In these situations, magnetic resonance angiography is a useful, non-invasive adjunctive method in the diagnosis of giant cell arteritis. In this case report, we describe a case of giant cell arteritis involving only the occipital artery which was revealed by magnetic resonance angiography.

Concepts: Atherosclerosis, Atheroma, Medical imaging, External carotid artery, Arteries of the head and neck, Scalp, Giant cell arteritis, Temple

1

Successful total scalp replantation was performed in our case. Based on the angiosome concept and anatomical study, the avulsed scalp survived with unilateral anastomosis of the superficial temporal artery and superficial temporal vein, largely due to the presence of rich arterial and venous arcades in the scalp. The patient currently has no problems with activities of daily living, although total hypoaesthesia and dysfunction of the left frontal muscle of the forehead are present. In addition, the combined findings of hair growth pattern indicated the vascular territories of the scalp skin.

Concepts: Blood, Heart, Artery, Vein, Scalp, Temple, Superficial temporal artery, Superficial temporal vein

1

Ritual healing has been one of the core topics in anthropology and, to a lesser extent, in psychology as well. Much of the research on ritual healing has focused on how healing works, and what factors constitute the efficacy of healing. In answering this question, scholars have focused primarily on two main factors-the symbolic significance of rituals, and the relationship between the healer and the patient. This paper explores understandings about efficacy in a context where elaborate rituals do not occur, the role of the healer is minimal, and the sufferers do not have expectations of complete wellness. In the Mahanubhav temples in India, healing is not understood as the removal of symptoms. The healing process involves amplifying unpleasant and painful symptoms, thereby ‘drawing out’ the illness from the body. Moreover, the temple narratives emphasize the transient nature of temple healing, where people rarely become completely well. They therefore frequently return to stay in the temple as and when their symptoms recur, thus forging long-term bond with the temple community and sect. These findings suggest that temple healing is powerful not so much for the practice of specific exorcist rituals, but for providing a refuge and a community for suffering individuals.

Concepts: Medicine, Healing, Pain, 2006 albums, Suffering, Temple, Temple in Jerusalem, Worship

0

The face is unique because functional and aesthetic considerations are equally important. Extensive deep chemical burns of the face are usually reconstructed with flaps. In males, the use of the hair - bearing superficial temporal artery flap has the advantage of achieving a satisfactory outcome with regards to both function and aesthetics.

Concepts: Temple, Superficial temporal artery

0

Superficial temporal artery (STA) -to- superior cerebellar artery (SCA) bypass is associated with a relatively high risk of surgical complications, such as hematoma and/or edema caused by temporal lobe retraction. Therefore, the right side is typically used to avoid retraction of the left temporal lobe. In this report, we present a case of left STA-SCA bypass with anterior petrosectomy to avoid retraction of dominant side temporal lobe and describe the surgical technique in detail.

Concepts: Left-wing politics, Cerebral cortex, Temporal lobe, Cerebellum, Arteries of the head and neck, Temple, Superficial temporal artery

0

A 68-year-old man presented with rapid swelling of the right forehead 11 days after sustaining a laceration secondary to a fall. Presumed to be an abscess due to retained foreign body, needle aspiration was performed and arterial blood obtained. Doppler ultrasound revealed a 3 cm mixed echogenicity lesion with ‘see-sawing’ internal Doppler flow arising from the superficial temporal artery (STA), in keeping with a pseudoaneurysm. Treatment options including interventional radiology and open surgery were considered. Open operative intervention with direct surgical ligation provided an excellent outcome. Delayed pseudoaneurysm of the STA is a rare complication of trauma but should be considered in the differential of a traumatic lateral forehead swelling to prevent complications and inappropriate investigations and management.

Concepts: Surgery, Medical imaging, Medical ultrasonography, Acoustics, Parotid gland, Interventional radiology, Temple, Superficial temporal artery

0

Cerebral hyperperfusion syndrome (CHS) is a well-known complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass for ischemic cerebrovascular disease. While this argues against “low flow” in the bypass construct, flow rates in the graft have not been previously quantified in the setting of CHS.

Concepts: Middle cerebral artery, Cardiovascular system, External carotid artery, Arteries of the head and neck, Temple

0

A variety of island flaps can be based on the superficial temporal artery with variable tissue composition. They can be used for defect reconstruction, cavity resurfacing, facial hair restoration, or contracture release.

Concepts: Parotid gland, Temple, Superficial temporal artery