SPIRAL CT ANGIOGRAPHY - AN ALTERNATIVE VASCULAR EVALUATION TECHNIQUE FOR HEAD AND NECK MICROVASCULAR RECONSTRUCTION

Facial trauma and head and neck oncologic patients are often destined for extensive reconstructive procedures with microvascular free flaps due to ablative injuries or postoperative defects. The integrity and c ompetence of the vasculature in the head and neck recipient site must be imaged and evaluated preoperatively as an essential prerequisite fo r the success of the reconstructive transfer. In a prospective study o f five patients, we compared conventional angiography, the traditional technique, with a new vascular imaging modality-spiral computed tomog raphic (CT) angiography. One patient suffered from an extensive, ablat ive facial trauma, and the other four had undergone mandibulectomy as part of their oncologic therapy. In contrast to conventional angiograp hy, spiral CT angiography is a noninvasive imaging technique, which we found to be characterized by much shorter patient examination time, a voidance of selective cannulation with its attendant risks, improved p erception of anatomy, and the ability to rotate the reconstructed imag es in any plane to obtain the best view of any vessel in question. Dis advantages of spiral CT angiography in imaging vessels include the nee d for relatively large amounts of contrast medium, great dependence on the skill and experience of the operator, and the need for optimizing the timing of the contrast bolus and the scan.