title: Establishing a danger zone: An anatomic study of the lingual artery in base of tongue surgery.
abstract: To contrast the changes in measurement of the hypoglossal/lingual artery neurovascular bundle (HLNVB) to constant surface landmarks in the base of tongue (BOT) during surgically simulated retraction versus resting anatomic position, and to identify a safe zone for BOT robotic surgery to avoid injury to the HLNVB.
  
  
  
  Human cadaver study.
  
  
  
  Five fresh-frozen head and neck complexes were obtained, and seven HLNVBs were dissected. A microcaliper was used to measure the distance from the HLNVB to constant surface landmarks in resting and surgically simulated positions using a Feyh-Kastenbauer retractor.
  
  
  
  Measurements from foramen cecum to palatoglossus muscle (P < 0.042) was significantly different when comparing anatomical to surgically simulated positions. Importantly, the location of the lingual artery in reference to the surface landmarks measured was dramatically altered with tongue retraction. With retraction, the branches of the dorsal lingual artery were not encountered posterior to a horizontal line between midway circumvallate papilla (mCVP).
  
  
  
  Measurements of the HLNVB to surface landmarks in the BOT differs significantly between resting and a surgically simulated tongue position. The dorsal branch of the lingual artery seems more superficial in the BOT than previously described. A safe zone may exist posterior to an imaginary horizontal line between mCVP; however, further studies are needed to confirm this.
  
  
  
  NA Laryngoscope, 127:110-115, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: David S
authors.initials: DS
authors.lastname: Cohen
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A.
authors.forename: Garren M I
authors.initials: GM
authors.lastname: Low
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
authors.forename: Antoine E
authors.initials: AE
authors.lastname: Melkane
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Mutchnick
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Waxman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Sagar
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan.|Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan.
authors.forename: Mahdi A
authors.initials: MA
authors.lastname: Shkoukani
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, Michigan.
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Lin
mesh_terms: D059925:Anatomic Landmarks; D001158:Arteries / Q000033:anatomy & histology*; D002102:Cadaver; D006801:Humans; D007002:Hypoglossal Nerve / Q000033:anatomy & histology*; D008036:Lingual Nerve / Q000033:anatomy & histology*; D065287:Robotic Surgical Procedures; D014059:Tongue / Q000098:blood supply* / Q000294:innervation* / Q000601:surgery*
keywords: Lingual artery; base of tongue; hypoglossal nerve; neurovascular bundle; transoral robotic surgery