Department of Translational Physiology, Location: AMC, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, Location: AMC, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
J Clin Monit Comput. 2023 Apr;37(2):639-649. doi: 10.1007/s10877-022-00936-9. Epub 2022 Nov 10.
The sublingual mucosa is a commonly used intraoral location for identifying microcirculatory alterations using handheld vital microscopes (HVMs). The anatomic description of the sublingual cave and its related training have not been adequately introduced. The aim of this study was to introduce anatomy guided sublingual microcirculatory assessment. Measurements were acquired from the floor of the mouth using incident dark-field (IDF) imaging before (T0) and after (T1) sublingual cave anatomy instructed training. Instructions consists of examining a specific region of interested identified through observable anatomical structures adjacent and bilaterally to the lingual frenulum which is next to the sublingual papilla. The anatomical location called the sublingual triangle, was identified as stationed between the lingual frenulum, the sublingual fold and ventrally to the tongue. Small, large, and total vessel density datasets (SVD, LVD and TVD respectively) obtained by non-instructed and instructed measurements (NIN (T0) and IM (T1) respectively) were compared. Microvascular structures were analyzed, and the presence of salivary duct-related microcirculation was identified. A total of 72 video clips were used for analysis in which TVD, but not LVD and SVD, was higher in IM compared to NIM (NIM vs. IM, 25 ± 2 vs. 27 ± 3 mm/mm (p = 0.044), LVD NIM vs. IM: 7 ± 1 vs. 8 ± 1mm/mm (p = 0.092), SVD NIM vs. IM: 18 ± 2 vs. 20 ± 3 mm/mm (p = 0.103)). IM resulted in microcirculatory assessments which included morphological properties such as capillaries, venules and arterioles, without salivary duct-associated microcirculation. The sublingual triangle identified in this study showed consistent network-based microcirculation, without interference from microcirculation associated with specialized anatomic structures. These findings suggest that the sublingual triangle, an anatomy guided location, yielded sublingual based measurements that conforms with international guidelines. IM showed higher TVD values, and future studies are needed with larger sample sizes to prove differences in microcirculatory parameters.
舌下黏膜是使用手持式活体显微镜 (HVM) 识别微循环改变的常用口腔内位置。舌下隐窝的解剖描述及其相关培训尚未得到充分介绍。本研究旨在介绍解剖引导的舌下微循环评估。使用暗场 (IDF) 成像在舌下隐窝解剖指导培训前后 (T0 和 T1) 从口底采集测量值。指导包括检查通过与舌系带相邻的可观察解剖结构识别的特定感兴趣区域，舌系带位于舌下乳头旁边。解剖学上称为舌下三角的位置被确定为位于舌系带、舌下皱襞之间，并向舌腹侧。非指导测量 (NIN (T0)) 和指导测量 (IM (T1)) 获得的小血管、大血管和总血管密度数据集 (SVD、LVD 和 TVD 分别) 进行了比较。分析了微血管结构，并确定了是否存在与唾液腺相关的微循环。共分析了 72 个视频剪辑，其中 IM 中的 TVD 高于 NIM，但 LVD 和 SVD 则不然 (NIM 与 IM 相比，25 ± 2 与 27 ± 3mm/mm(p=0.044)，LVD NIM 与 IM：7 ± 1 与 8 ± 1mm/mm(p=0.092)，SVD NIM 与 IM：18 ± 2 与 20 ± 3mm/mm(p=0.103))。IM 导致了微循环评估，包括毛细血管、小静脉和小动脉等形态学特性，而没有与唾液腺相关的微循环。本研究中确定的舌下三角显示出一致的基于网络的微循环，没有与专门解剖结构相关的微循环干扰。这些发现表明，作为解剖引导位置的舌下三角产生了符合国际指南的基于舌下的测量值。IM 显示出更高的 TVD 值，需要进行更大样本量的未来研究以证明微循环参数的差异。
