THE USE OF MAGNETIC-RESONANCE ANGIOGRAPHY PRIOR TO PHARYNGEAL FLAP SURGERY IN PATIENTS WITH VELOCARDIOFACIAL SYNDROME

Twenty consecutive patients with velocardiofacial syndrome underwent m agnetic resonance angiography (MRA) to determine if abnormalities of t he neck arteries would contraindicate pharyngeal flap surgery. All 20 patients were found to have anomalies of the carotid arteries, vertebr al arteries, or both. Anomalies included tortuous or kinked vertebral arteries, medially placed internal carotids, low carotid bifurcations, and tortuous or kinked internal carotids. The internal carotids were found to be almost directly under the mucous membrane of the pharynx i n two patients In these two patients, the arteries were close to the p haryngeal midline at the base of the first cervical vertebra and might easily be severed during the raising of a pharyngeal flap. Hypoplasti c vertebral arteries also were found. One patient had an extra neck ve ssel. The anomalies of the internal carotids did not have a strong cor relation with endoscopically observed pulsations in the posterior phar yngeal wall. It also was found that head position affected the locatio n of the internal carotid arteries when they were located close to the pharyngeal mucous membrane. The information provided in the MRA studi es allowed assessment of the arterial anomalies in relation to the fla p donor site so that the patients in the sample who underwent pharynge al flap surgery using a short superiorly based flap had no major bleed ing complications.