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Kartum TA, Aydin L, Vergili E, Tahmazoglu B, Dağlar Z, Küçükyürük B, Tanriover N. Localization of Maxillary Artery for Cerebral Revascularization: L-Shaped Perpendicular Two-Step Drilling Technique Stretching from the Foramen Ovale to Rotundum. World Neurosurg 2024; 185:e1101-e1113. [PMID: 38508387 DOI: 10.1016/j.wneu.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The use of the maxillary artery (MA) as a donor has increasingly become an alternative method for cerebral revascularization. Localization difficulties emerge due to rich infratemporal anatomical variations and the complicated relationships of the MA with neuromuscular structures. We propose an alternative localization method via the interforaminal route along the middle fossa floor. METHODS Five silicone-injected adult cadaver heads (10 sides) were dissected. Safe and effective localization of the MA was evaluated. RESULTS The MA displayed anatomical variations in relation to the lateral pterygoid muscle (LPM) and the mandibular nerve branches. The proposed L-shaped perpendicular 2-step drilling technique revealed a long MA segment that allowed generous rotation to the intracranial area for an end-to-end anastomosis. The first step of drilling involved medial-to-lateral expansion of foramen ovale up to the lateral border of the superior head of the LPM. The second step of drilling extended at an angle approximately 90° to the initial path and reached anteriorly to the foramen rotundum. The MA was localized by gently retracting the upper head of the LPM medially in a posterior-to-anterior direction. CONCLUSIONS Considering all anatomical variations, the L-shaped perpendicular 2-step drilling technique through the interforaminal space is an attainable method to release an adequate length of MA. The advantages of this technique include the early identification of precise landmarks for the areas to be drilled, preserving all mandibular nerve branches, the deep temporal arteries, and maintaining the continuity of the LPM.
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Affiliation(s)
- Tufan Agah Kartum
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Levent Aydin
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ender Vergili
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Tahmazoglu
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Dağlar
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Barış Küçükyürük
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necmettin Tanriover
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Tadokoro O. Coexistence of a retroesophageal right subclavian artery with a left maxillary artery medial to the mandibular nerve. Anat Sci Int 2024:10.1007/s12565-024-00763-9. [PMID: 38557948 DOI: 10.1007/s12565-024-00763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
This case report describes the coexistence of a retroesophageal right subclavian artery and left maxillary artery which passed deep to the mandibular nerve. An 88-year-old woman died of acute heart failure, and the postmortem revealed that the right subclavian artery originated from the aortic arch as the last branch at the level of the fourth thoracic vertebra, then passed between the esophagus and the vertebral column. The artery then ascended right superiorly and passed behind the anterior scalene muscle. The right vertebral artery arose from the retroesophageal right subclavian artery and entered the transverse foramen of the sixth cervical vertebra. The left maxillary artery branched at the common trunk of the posterior deep temporal and the inferior alveolar arteries. The maxillary artery then turned anteromedially and branched to give the middle meningeal artery. The mandibular nerve gave off the buccal nerve, deep temporal nerve and a thick nerve just below the foramen ovale. The auriculotemporal nerve that branched from the thick nerve ran deep to the maxillary artery. The maxillary artery turned anteriorly, passing deep to the branches. The artery then split to give the buccal artery and the anterior deep temporal artery. In the pterygopalatine section, the maxillary artery branched off to form the common trunk of the infraorbital and sphenopalatine arteries and the posterior superior alveolar artery. It may be necessary to pay attention to the course of the maxillary artery and its relationship to the mandibular nerve branches, when a retroesophageal right subclavian artery is seen.
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Affiliation(s)
- Osamu Tadokoro
- Department of Anatomy, Matsumoto Dental University, 1780, Gobara-Hirooka, Shiojiri, Nagano, Japan.
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Degollado-García J, Casas-Martínez MR, Mejia BRF, Balcázar-Padrón JC, Rodríguez-Rubio HA, Nathal E. Internal maxillary artery (IMax) - middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report. J Cerebrovasc Endovasc Neurosurg 2024; 26:51-57. [PMID: 37997040 PMCID: PMC10995475 DOI: 10.7461/jcen.2023.e2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 12/06/2023] Open
Abstract
Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft's free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.
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Affiliation(s)
- Javier Degollado-García
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Martin R. Casas-Martínez
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Bill Roy Ferrufino Mejia
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Juan C. Balcázar-Padrón
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Héctor A. Rodríguez-Rubio
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Edgar Nathal
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
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Oliveira LDB, Cieslak PH, Marques GN, Batista S, Andreão FF, Palavani LB, Bocanegra-Becerra JE, Bertani R, Rabelo NN, Welling LC, Figueiredo EG. Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis. Neurosurg Rev 2024; 47:41. [PMID: 38206429 DOI: 10.1007/s10143-023-02265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3-53.1). The post-operation patency rate was 99% (95% CI: 97-100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68-96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9-32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0-2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81-96%; I2=0%), and only 3% experienced ischemia (95% CI: 0-6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.
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Affiliation(s)
- Leonardo de Barros Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil.
| | - Pedro Henrique Cieslak
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
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Iwai T, Sugiyama S, Honda K, Mitsudo K. Endoscopically-assisted intraoral vertical ramus osteotomy to prevent injury of the maxillary artery and mandibular neurovascular bundle. J Dent Sci 2024; 19:671-672. [PMID: 38303795 PMCID: PMC10829699 DOI: 10.1016/j.jds.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/10/2023] [Indexed: 02/03/2024] Open
Affiliation(s)
- Toshinori Iwai
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Satomi Sugiyama
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Koji Honda
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery/Orthodontics, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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Botella-Casas G, Marqués-Mateo M, Miragall-Alba L, Río-Vega DM, González-Soler E, Puche-Torres M. Management of pseudoaneurysms of the internal maxillary artery derived from orthognathic surgery based on one case. Oral Maxillofac Surg 2023:10.1007/s10006-023-01197-9. [PMID: 37981623 DOI: 10.1007/s10006-023-01197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE The purpose of this article is to highlight the risk of pseudoaneurysms formation after orthognathic surgery, their clinical features and management. METHODS A case report of a 24-year-old man who suffered a pseudoaneurysm of the internal maxillary artery after sagittal osteotomy during orthognathic is reported. After three bleeding episodes, a pseudoaneurysm was diagnosed with a computed tomography angiogram (CTA) and treated with an embolization of the internal maxillary artery with polyvinyl alcohol (PVA) successfully. RESULTS Pseudoaneurysms derived from the external carotid artery are an uncommon complication of orthognathic surgery, especially related to sagittal osteotomy instead of LeFort I osteotomy. CONCLUSION Pseudoaneurysms derived from external carotid artery branches must be suspected when patients show multiple episodes of bleeding (epistaxis or through the surgical approach) within the first two weeks after orthognathic surgery. If so, vascular CT or angiography should be performed to rule out the presence of vascular injuries. In case a pseudoaneurysm is identified, vascular embolization with N-butyl-cyanoacrylate seems to be the best treatment if available. If this treatment is not available or bleeding cannot be controlled, surgical ligature of the injured vessel is a valid treatment.
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Affiliation(s)
- Gonzalo Botella-Casas
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain.
| | - Mariano Marqués-Mateo
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain
| | - Luis Miragall-Alba
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain
| | - Daniela María Río-Vega
- Maxillofacial Surgery Service, Hospital Clinico Universitario of Valencia, Valencia, Spain
| | - Eva González-Soler
- Department of Anatomy and Embryology, University of Valencia, Valencia, Spain
| | - Miguel Puche-Torres
- Head of Service of Maxillofacial Surgery, Hospital Clinico Universitario of Valencia, INCLIVA, Valencia, Spain
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Komiyama M. Embryological consideration of the inferolateral trunk. Interv Neuroradiol 2023:15910199231169847. [PMID: 37050860 DOI: 10.1177/15910199231169847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Inferolateral trunk (ILT), also called inferior or lateral cavernous branch, of the internal carotid artery is an important artery during neuro-intervention and neurosurgery. However, its embryological background is not well elucidated. Review of the developmental biology of this small artery indicated that the alleged nomenclatures of the remnant of the primitive maxillary artery of Sabin (1917) and primitive dorsal ophthalmic artery of Lasjaunias (1977) are misnomers because the primordium of the ILT does not nourish the maxilla or retina essentially, but it supplies the premandibular region where the premandibular (prechordal) mesoderm and its surrounding premandibular trigeminal neural crests are distributed. Thus, this embryological artery might be called the primitive premandibular artery more appropriately, and its remnant, i.e., the ILT, might be recognized as the remnant of the primitive premandibular artery.
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Affiliation(s)
- Masaki Komiyama
- Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Japan
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Iwanaga J, Ibaragi S, Okui T, Hur MS, Kageyama I, Tubbs RS. An anatomical study of the blood supply to the mylohyoid muscle: the so-called "mylohyoid branch" of the inferior alveolar artery is an arterial anastomosis. Ann Anat 2021; 240:151852. [PMID: 34767931 DOI: 10.1016/j.aanat.2021.151852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to clarify the morphology of the mylohyoid branch of the inferior alveolar artery and the main blood supply to the mylohyoid muscle. METHODS The maxillary artery (MA) and inferior alveolar artery (IAA) within the infratemporal fossa, the facial and submental arteries within the submandibular triangle, and the nerve to the mylohyoid muscle and related artery were dissected in twelve sides from embalmed cadaveric heads. The main blood supply to the extraoral (inferior) surface of the mylohyoid muscle was recorded. RESULTS The mylohyoid branch of the inferior alveolar artery was an anastomosis of the descending branch of either the inferior alveolar or maxillary artery and the ascending branch of either the submental or facial artery. The anastomosis was classified into four types according to the origins of the arteries. The main blood supply to the extraoral surface of the mylohyoid muscle was the submental artery. CONCLUSIONS The results of this study indicate that the mylohyoid branch of the IAA in human adults is an anastomosis of branches of the maxillary and facial arteries.
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Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Mi-Sun Hur
- Department of Anatomy, Catholic Kwandong University College of Medicine, Gangneung, Korea
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry, The Nippon Dental University, Niigata, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgey, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
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Ottone NE, Sandoval C, Cid-Gutierrez P, Vásquez-Balboa ML, Tubbs RS, Fuentes R. Systematic review and meta-analysis of the anatomy of the maxillary artery using the Anatomical Quality Assurance (AQUA) checklist. Surg Radiol Anat 2021; 43:1875-1886. [PMID: 34480213 DOI: 10.1007/s00276-021-02825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The maxillary artery (MA) is one of the terminal branches of the external carotid artery (ECA) and through its branches, it is responsible for vascularizing several organs and muscles of the head and neck, including their surrounding soft tissues, the oral and sinonasal cavities, dura mater, and various cranial nerves. The aim of this study was to conduct a systematic review and meta-analysis of maxillary artery anatomy according to the Anatomical Quality Assurance (AQUA) checklist. METHODS We conducted a systematic search through PubMed, EMBASE, Scopus, ScienceDirect, Web of Science, SciELO, Springerlink, WILEY and BIREME databases. We applied the Anatomical Quality Assurance (AQUA) checklist for analysis the methodological quality of the articles. RESULTS From a total of 11,759 articles found in the first search, and after applying the inclusion/exclusion criteria, in addition to eliminating duplicate articles, a final number of 24 articles were identified. The information on the maxillary artery was analyzed from each study regarding its course in relation to the lateral pterygoid muscle, the intra- and extraluminal diameters of the maxillary artery and its branches, and the types of branching of the maxillary artery in the pterygopalatine fossa. CONCLUSION From this study, it was possible to conclude the importance of anatomical knowledge of the maxillary artery, for its application in the clinical study of the head and neck, as well as the need to apply the AQUA checklist in the development of systematic anatomical reviews to ensure accurate reliability and a better assessment of the effect of anatomical publications.
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Affiliation(s)
- Nicolás E Ottone
- Laboratory of Plastination and Anatomical Techniques, Centre for Research in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile. .,Department of Integral Adults Odontology, Dental School, Universidad de La Frontera, Temuco, Chile. .,Center of Excellence in Morphological and Surgical Studies (CEMyQ), School of Medicine, Universidad de La Frontera, Temuco, Chile.
| | - Cristian Sandoval
- Escuela de Tecnología Médica, Facultad de Salud, Universidad Santo Tomás, Los Carreras 753, Osorno, Chile.,Departamento de Ciencias Preclínicas, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | | | | | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ramón Fuentes
- Laboratory of Plastination and Anatomical Techniques, Centre for Research in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile.,Department of Integral Adults Odontology, Dental School, Universidad de La Frontera, Temuco, Chile
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Schönegg D, Ferrari R, Ebner J, Blumer M, Lanzer M, Gander T. Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography. Oral Maxillofac Surg 2021. [PMID: 34024006 DOI: 10.1007/s10006-021-00960-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/17/2021] [Indexed: 11/15/2022]
Abstract
Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.
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Kanno C, Masubuchi T, Fushimi C, Kitani Y, Niwa K, Takeishi E, Kaneko T, Yamazaki M, Hasegawa H, Kamata SE, Miura K, Tada Y. A novel technique of arterial blood flow modification in intra-arterial chemoradiotherapy of maxillary sinus squamous cell carcinoma. Oral Oncol 2020; 109:104873. [PMID: 32604059 DOI: 10.1016/j.oraloncology.2020.104873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Intra-arterial chemoradiotherapy via a superficial temporal artery is reportedly a useful organ-preserving treatment for maxillary sinus squamous cell carcinoma. This study aimed to determine whether blood flow modification facilitates sufficient drug delivery to the entire carcinoma via the maxillary artery alone, even for advanced tumors. MATERIALS AND METHODS A retrospective study of 10 patients who were diagnosed with locally advanced carcinoma (4 [40%] at stage T3, 5 [50%] at T4a, and 1 [10%] at T4b) from August 2016 to July 2018, with tumor blood flow from both the maxillary and facial arteries, was conducted. Patients underwent intra-arterial chemoradiotherapy, which involved chemotherapy with weekly cisplatin administration (40 mg/m2) and radiotherapy (70 Gy/35 fr), with facial artery ligation. The success rate of blood flow modification, as well as its therapeutic effects and safety, were evaluated, with a median follow-up period of 14.4 months (range: 12.3-35 months). RESULTS The blood flow surrounding the tumor was changed from both the maxillary and facial arteries to the maxillary artery alone in all patients. A median of 9 chemotherapy courses (range: 8-10) were administered; the median total cisplatin dose was 350 mg/m2 (range: 320-360 mg/m2). Radiotherapy of 70 Gy/35 fr was used to treat all patients. Grade 3 oral mucositis (80%) and irradiation field dermatitis (40%) were observed. In all patients, complete response was achieved, and local recurrence was not observed for at least 1 year. CONCLUSION Simplifying the blood flow around the tumor facilitates more standardized intra-arterial chemoradiotherapy via a superficial temporal artery procedure.
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Affiliation(s)
- Chihiro Kanno
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Tatsuo Masubuchi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Chihiro Fushimi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yosuke Kitani
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Kazutomo Niwa
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Etsuro Takeishi
- Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Tetsuharu Kaneko
- Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Morio Yamazaki
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Hiroshi Hasegawa
- Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Shin-Etsu Kamata
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.
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Bhattacharya A, Sharma R, Armstrong C, Solis L. Case report of unique anastomosis between facial and inferior alveolar arteries. Surg Radiol Anat 2020; 42:603-6. [PMID: 31707432 DOI: 10.1007/s00276-019-02375-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Understanding anatomical variations of the facial artery and its branches is important for dental and medical practitioners. METHODS Routine cadaveric dissection of the head and neck was performed to demonstrate the origin and branches of the facial artery. RESULTS Facial artery emerged from a common linguofacial trunk off the external carotid artery. On the face, the facial artery first gave off a pre-masseteric branch. Immediately after, an aberrant artery emerged from the facial artery that coursed along the ramus of the mandible, which upon further dissection and examination was found to anastomose with inferior alveolar artery within the ramus of the mandible. CONCLUSIONS We report a unique anastomosis between facial and inferior alveolar arteries, vessels that have not been previously shown to communicate. This case report may provide useful information for oral and maxillofacial surgeons as well as dentists performing inferior alveolar nerve blocks.
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Iwanaga J, Kikuta S, Ibaragi S, Watanabe K, Kusukawa J, Tubbs RS. Clinical anatomy of the accessory mandibular foramen: application to mandibular ramus osteotomy. Surg Radiol Anat 2020; 42:41-7. [PMID: 31541271 DOI: 10.1007/s00276-019-02343-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE An accessory foramen around the mandibular foramen is called an accessory mandibular foramen (AMF). The clinical anatomy of the AMF has not been well described. The aim of this study was to reveal the clinical anatomy of the AMF for a better understanding of its implication during ramus surgeries. METHODS Twenty-two sides fresh-frozen cadaveric heads with a mean age of 76.2 ± 14.4 years at death underwent dissection. The neurovascular bundles passing through the AMF were observed. Additionally, a hemi-face of a latex injected embalmed cadaver was dissected medially to laterally and the neurovascular bundles of the AMF investigated. RESULTS A unilateral foramen, bilateral foramina, and absence of foramina were found in 45.4%, 18.2%, and 36.4%, respectively. The origin of the neurovascular bundle entering the AMF was a branch of the maxillary artery in 20% and a tributary of the inferior alveolar vein in 80%. In the latex embalmed cadaver, the AMF was found to contain a branch from the maxillary artery and a tributary of the maxillary vein. CONCLUSION Given the practical meaning of the specific AMF located in the operative field of the ramus osteotomy, we suggest these be named "foramina for ramus osteotomy."
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Chun JJ, Choi CY, Wee SY, Song WJ, Jeong HG. Embolization for treating posttraumatic pseudoaneurysm of the sphenopalatine artery. Arch Craniofac Surg 2019; 20:251-254. [PMID: 31462017 PMCID: PMC6715553 DOI: 10.7181/acfs.2019.00227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
Posttraumatic pseudoaneurysms of the sphenopalatine artery are rare. Only a few cases have been reported. We report two cases of hemorrhage due to pseudoaneurysm of the sphenopalatine artery. The hemorrhage was uncontrollable. It required embolization. Two patients visited our hospital for treatment of zygomaticomaxillary complex fracture. At the emergency room, patients presented with massive nasal bleeding which ceased shortly. After reduction of the fracture, patients presented persistent nasopharyngeal bleeding. Under suspicion of intracranial vessel injury, we performed angiography. Angiograms revealed pseudoaneurysms of the sphenopalatine artery. Endovascular embolization was performed, leading to successful hemostasis in both patients. Due to close proximity to pterygoid plates, zygomaticomaxillary complex fracture involving pterygoid plates may cause injury of the sphenopalatine artery. The only presentation of sphenopalatine artery injury is nasopharyngeal bleeding which is common. Based on our clinical experience, although pseudoaneurysm of maxillary artery branch after maxillofacial trauma has a low incidence, suspicion of injury involving deeply located arteries and early imaging via angiogram are recommended to manage recurrent bleeding after facial trauma or surgery.
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Affiliation(s)
- Jeong Jin Chun
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Chang Yong Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Syeo Young Wee
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Woo Jin Song
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Hyun Gyo Jeong
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Gumi, Korea
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15
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Olivetto M, Bettoni J, Duisit J, Chenin L, Bouaoud J, Dakpé S, Devauchelle B, Lengelé B. Endosteal blood supply of the mandible: anatomical study of nutrient vessels in the condylar neck accessory foramina. Surg Radiol Anat 2019; 42:35-40. [PMID: 31451905 DOI: 10.1007/s00276-019-02304-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 08/12/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE In the mandible, the condylar neck vascularization is commonly described as mainly periosteal; while the endosteal contribution is still debated, with very limited anatomical studies. Previous works have shown the contribution of nutrient vessels through accessory foramina and their contribution in the blood supply of other parts of the mandible. Our aim was to study the condylar neck's blood supply from nutrient foramina. METHODS Six latex-injected heads were dissected and two hundred mandibular condyles were observed on dry mandibles searching for accessory bone foramina. RESULTS Latex-injected dissections showed a direct condylar medular arterial supply through foramina. On dry mandibles, these foramina were most frequently observed in the pterygoid fovea in 91% of cases. However, two other accessory foramina areas were identified on the lateral and medial sides of the mandibular condylar process, confirming the vascular contribution of transverse facial and maxillary arteries. CONCLUSIONS The maxillary artery indeed provided both endosteal and periosteal blood supply to the condylar neck, with three different branches: an intramedullary ascending artery (arising from the inferior alveolar artery), a direct nutrient branch and some pterygoid osteomuscular branches.
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Affiliation(s)
- Matthieu Olivetto
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Avenue René Laennec, 80000, Amiens, France.
| | - Jérémie Bettoni
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Avenue René Laennec, 80000, Amiens, France
| | - Jérôme Duisit
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Department of Human Anatomy (MORF), UCLouvain, Avenue Mounier 52/B1.52.04, 1200, Brussels, Belgium
| | - Louis Chenin
- Laboratory of Anatomy and Morphogenesis, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France
| | - Jebrane Bouaoud
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Avenue René Laennec, 80000, Amiens, France
| | - Stéphanie Dakpé
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Avenue René Laennec, 80000, Amiens, France
- EA 7516 "CHIMERE" (UPJV), Facing Faces Institute, CHU SUD, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Bernard Devauchelle
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, Avenue René Laennec, 80000, Amiens, France
- EA 7516 "CHIMERE" (UPJV), Facing Faces Institute, CHU SUD, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Benoît Lengelé
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Department of Human Anatomy (MORF), UCLouvain, Avenue Mounier 52/B1.52.04, 1200, Brussels, Belgium
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16
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Maia FPA, de Sousa Filho GC, Pacífico FA, Albuquerque LCA, de Melo Vasconcelos AF, do Egito Vasconcelos BC. Proximity of the maxillary artery to the neck of the mandibular condyle: anatomical study. Oral Maxillofac Surg 2019; 23:423-427. [PMID: 31278592 DOI: 10.1007/s10006-019-00788-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/21/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study was to evaluate the anatomical distance of the maxillary artery, the most superior portion of the condyle and subcondyle in standardized coronal sections, acquired from 16 hemifaces in 8 cadavers. METHODS Measurements were taken to evaluate the distance between the uppermost portion of the mandibular condyle and the height of the maxillary artery (AB) and between the lateral (CD) and medial (EF) sides of the condylar neck to the artery. RESULTS The mean for AB was 21.1 mm hemiface right and 22.9 mm left on the anterior face, 22.5 mm and 20.7 mm, respectively, on the rear face. The CD measurement presented 6.7 mm right side in the anterior face and 6.3 mm left, and the posterior face was 6.3 mm right side and 5.4 mm left; EF presented a mean of 2.2 mm right and 1.5 mm left on the anterior face and 1.6 mm for both sides on the posterior face. CONCLUSIONS There was no statistically significant difference between hemifaces. The proximity of the maxillary artery to the medial face of the neck of the mandibular condyle is millimetric and presents risks of severe hemorrhage for interventions in the infratemporal fossa.
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Affiliation(s)
- Francisco Paulo Araújo Maia
- Department of Oral and Maxillofacial Surgery, University of Pernambuco-School of Dentistry (UPE/FOP), Av. General Newton Cavalcanti, 1650, Tabatinga, Camaragibe, PE, Brazil.
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17
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Iwanaga J, Wilson C, Lachkar S, Tomaszewski KA, Walocha JA, Tubbs RS. Clinical anatomy of the maxillary sinus: application to sinus floor augmentation. Anat Cell Biol 2019; 52:17-24. [PMID: 30984447 PMCID: PMC6449588 DOI: 10.5115/acb.2019.52.1.17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/10/2018] [Accepted: 10/21/2018] [Indexed: 12/26/2022] Open
Abstract
The anatomy of the maxillary sinus, especially its vascular anatomy, and its relationships with the teeth and alveolar processes have been well documented. The development of cone-beam computed tomography has resulted in dentists being more familiar with maxillary sinus floor augmentation procedures. This paper aims to revisit the classic anatomy of the maxillary sinus and review the newly published literature in order to help dentists diagnose in more detail and perform safer surgery of the maxillary sinus.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | | | | | | | - Jerzy A Walocha
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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18
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Touré G. Distribution of the maxillary artery in the deep regions of the face and the maxilla: Clinical applications. J Plast Reconstr Aesthet Surg 2019; 72:1020-4. [PMID: 30898500 DOI: 10.1016/j.bjps.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/26/2019] [Accepted: 02/17/2019] [Indexed: 11/20/2022]
Abstract
Composite tissue allotransplantation of the face has led to renewed interest in the vascularization of the maxilla. The maxillary artery, which is deep within the tissue and difficult to access, is considered the main artery of the maxilla. The objective of this study was to describe the distribution of the maxillary artery in the deep regions of the face and maxilla. Twenty-four maxillae were studied, of which 20 were injected with latex and four with India ink. The maxillary artery in the pterygopalatine fossa gave rise to the sphenopalatine artery, infraorbital artery, descending palatine artery, and posterior superior alveolar artery in all 24 cases. The posterior superior alveolar artery gave rise to a periosteal branch and an intraosseous branch (in the wall of the maxillary sinus) in 18 cases. The branch passed through part of the wall and the entire wall in eight and ten cases, respectively, and anastomosed at the anterior nasal spine and the infraorbital foramen. The descending palatine artery presented as a single trunk in four cases, a greater palatine artery and a lower palatine artery in 18 cases, and four branches in two cases. Intraosseous and periosteal anastomoses were found along with anastomosis through the incisive foramen, which were obstructed in three cases. The vascular territories were studied. The maxillary artery created an intraosseous and periosteal anastomotic network, explaining the supply pathways during different surgical procedures, risk of hemorrhage with orthognathic surgery (Le Fort type I) in a sinus lift for preimplant surgery, and the vascular territories.
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19
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Rusu MC, Măru N, Rădoi PM, Dincă D. Trifurcated external carotid artery and complete gamma-loop of its maxillary branch. Surg Radiol Anat 2018; 41:231-234. [PMID: 30483866 DOI: 10.1007/s00276-018-2142-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Abstract
The external carotid artery (ECA) normally bifurcates terminally with the superficial temporal artery (STA) and the maxillary artery (MA). From the horizontally coursing, mandibular segment of the MA leaves the middle meningeal artery (MMA). We hereby report a previously unknown anatomic possibility, incidentally found during an angio-CT scan in an adult female patient. Unilaterally, the ECA was terminally trifurcated, sending off the MA, STA, and MMA. On that side, the mandibular segment of the MA had a gamma-loop and the contralateral one had a U-loop; both these loops were inferior to the lateral pterygoid muscle, closely approaching the respective lingula of the mandible. These findings are relevant during surgery of the parotid gland and infratemporal fossa, approaches of the MMA, and inferior alveolar nerve blocks. The modified origin of the MMA could be explained by an altered development of the primitive stapedial artery.
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Affiliation(s)
- Mugurel Constantin Rusu
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd, 050474, Bucharest, Romania
| | - Nicoleta Măru
- Division of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd, 050474, Bucharest, Romania.
| | - Petrinel Mugurel Rădoi
- Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,National Institute of Neurology and Neurovascular Diseases, Bucharest, Romania
| | - Dănuţ Dincă
- Department II of Surgical Clinical Divisions, Faculty of Medicine, "Ovidius" University, Constanţa, Romania
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20
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Rahpeyma A, Khajehahmadi S. Maxillary artery based flaps for oral cavity reconstruction, a review. Ann Med Surg (Lond) 2017; 20:32-36. [PMID: 28702184 PMCID: PMC5487299 DOI: 10.1016/j.amsu.2017.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/12/2017] [Accepted: 06/17/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There are different flaps based on the branches of the maxillary artery. Flaps based on the maxillary artery branches can be used for oral cavity reconstruction in selected cases, but there is lack of comprehensive review in this topic. METHODS A literature review was performed on Medline for maxillary artery based flaps and oral cavity reconstruction. Surgical techniques for each possible variant of maxillary artery based flaps and an example of each situation for oral cavity reconstruction is explained. RESULT Five variants of soft tissue flaps based on maxillary artery branches are presented. Some of them such as temporal flap, superiorly based masseter flap, palatal flap and posteriorly based buccinator myomucosal flap are famous flaps, while posteriorly based inferior turbinate flap is less noticed for oral cavity reconstruction. Nasoseptal and infraorbital based flaps are two other maxillary artery based flaps but have no role in oral cavity reconstruction. CONCLUSION Maxillary artery based flaps should be considered as an option especially in previously radiotherapy/surgically operated patients with facial vessels sacrifice.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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21
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Alvernia JE, Hidalgo J, Sindou MP, Washington C, Luzardo G, Perkins E, Nader R, Mertens P. The maxillary artery and its variants: an anatomical study with neurosurgical applications. Acta Neurochir (Wien) 2017; 159:655-664. [PMID: 28191601 DOI: 10.1007/s00701-017-3092-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques. The dimensions, course and branching patterns of the MA were recollected. In addition, 20 three-dimensional reconstruction CT head and neck angiograms (3D CTAs) of actual patients were correlated with the cadaveric findings. RESULTS The MA can be divided in three segments: mandibular, pterygoid and pterygopalatine. Medial and lateral trunk variants regarding its course around the lateral pterygoid muscle can be found. The different branching patterns of the MA have a direct correlation with the course of its main trunk at the base of the skull. Branching and trunk variants on one side do not predict the findings on the contralateral side. CONCLUSION In this study the highly variable course, branching patterns and relations of the MA are illustrated and described in human cadaveric heads and 3D CTAs. MA 3D CTA with bone reconstruction can be useful preoperatively for the identification of the medial or lateral course variants of this artery, particularly its pterygoid segment, which should be taken into account when considering the MA as a donor vessel for an EC-IC bypass.
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Affiliation(s)
- Jorge E Alvernia
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Hidalgo
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marc P Sindou
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | - Chad Washington
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gustavo Luzardo
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eddie Perkins
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Remi Nader
- Texas Center for Neuroscience, Houston, TX, USA
| | - Patrick Mertens
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
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22
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Yağmurlu K, Kalani MYS, Martirosyan NL, Safavi-Abbasi S, Belykh E, Laarakker AS, Nakaji P, Zabramski JM, Preul MC, Spetzler RF. Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Exposure of the Maxillary Artery. World Neurosurg 2017; 100:540-50. [PMID: 28089839 DOI: 10.1016/j.wneu.2016.12.130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To define the maxillary artery (MaxA) anatomy and present a novel technique for exposing and preparing this vessel as a bypass donor. METHODS Cadaveric and radiologic studies were used to define the MaxA anatomy and show a novel method for harvesting and preparing it for extracranial to intracranial bypass. RESULTS The MaxA runs parallel to the frontal branch of the superficial temporal artery and is located on average 24.8 ± 3.8 mm inferior to the midpoint of the zygomatic arch. The pterygoid segment of the MaxA is most appropriate for bypass with a maximal diameter of 2.5 ± 0.4 mm. The pterygoid segment can be divided into a main trunk and terminal part based on anatomic features and use in the bypass procedure. The main trunk of the pterygoid segment can be reached extracranially, either by following the deep temporal arteries downward toward their origin from the MaxA or by following the sphenoid groove downward to the terminal part of the pterygoid segment, which can be followed proximally to expose the entire MaxA. In comparison, the prebifurcation diameter of the superficial temporal artery is 1.9 ± 0.5 mm. The average lengths of the mandibular and pterygoid MaxA segments are 6.3 ± 2.4 and 6.7 ± 3.3 mm, respectively. CONCLUSIONS The MaxA can be exposed without zygomatic osteotomies or resection of the middle fossa floor. Anatomic landmarks for exposing the MaxA include the anterior and posterior deep temporal arteries and the pterygomaxillary fissure.
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Lee W, Shim YS, Chung J. Endovascular Treatment to Stop Life-threatening Bleeding from Branches of the External Carotid Artery in Patients with Traumatic Maxillofacial Fracture. J Cerebrovasc Endovasc Neurosurg 2016; 18:83-89. [PMID: 27790397 PMCID: PMC5081502 DOI: 10.7461/jcen.2016.18.2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/29/2016] [Accepted: 05/30/2016] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures. Materials and Methods A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated. Results Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS (p = 0.016), lowest systolic blood pressure (p = 0.011), and lowest body temperature (p = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused (p = 0.030), the number of units of fresh frozen plasma transfused (p = 0.013), and the time from arrival to groin puncture (p < 0.001) showed significant negative correlation with good clinical outcomes. Conclusion It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.
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Affiliation(s)
- Woosung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Shik Shim
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.; Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
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Bendrihem R, Vacher C. Radiologic anatomy of the maxillary artery in the pterygopalatine area applied to Le Fort 1 osteotomies. Surg Radiol Anat 2016; 39:23-27. [PMID: 27192981 DOI: 10.1007/s00276-016-1697-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/12/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE In Le Fort 1 osteotomies there is a risk of injuring the maxillary artery, during the pterygomaxillary (PM) disjunction. To improve the knowledge of the relation between the maxillary artery and the PM suture, an anatomic study of the pterygopalatal fossa has been performed. METHODS The study was based on CT scan head with vascular injection of the supraaortic trunks in 92 patients. The vertical length of the PM junction and the position of maxillary artery in relation to PM junction have been measured on a parasagittal plane passing through the lateral surface of the PM junction, and on a plane where the PM suture is the highest. RESULTS The height of the PM junction on the plane passing through the lateral surface of the PM junction was 6.86 ± 2.67 mm, and the maxillary artery was located 18.22 ± 3.79 mm from the most inferior point of the PM junction. The maximum PM junction height was 13.96 ± 3.03 mm, and at this place the maxillary artery was located 18.85 ± 3.26 mm from the most inferior point of the PM junction. The distance between these two planes was 5.14 ± 2.02 mm. CONCLUSIONS According to our results, the height of the PM junction is less than 14 mm and during the PM disjunction there is a risk of injuring the maxillary artery 18 mm above the inferior extremity of the PM junction.
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Affiliation(s)
- Rivka Bendrihem
- Department of Anatomy, Faculté de Médecine Paris-Diderot, URDIA (EA4465), Paris, France
| | - Christian Vacher
- Department of Anatomy, Faculté de Médecine Paris-Diderot, URDIA (EA4465), Paris, France. .,Department of Oral and Maxillofacial surgery, Hôpital Beaujon, APHP, 100 Boulevard Général Leclerc, 92110, Clichy, France.
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Kim MH, Yoo JH, Kim SS, Yang WS. Massive Hemorrhage Facial Fracture Patient Treated by Embolization. Arch Craniofac Surg 2016; 17:28-30. [PMID: 28913249 PMCID: PMC5556719 DOI: 10.7181/acfs.2016.17.1.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/04/2015] [Accepted: 12/03/2015] [Indexed: 11/11/2022] Open
Abstract
Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate.
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Affiliation(s)
- Moo Hyun Kim
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Jae Hong Yoo
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Seung Soo Kim
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Wan Suk Yang
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
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Lee J, Kang N, Moon YM, Pang EK. Radiographic study of the distribution of maxillary intraosseous vascular canal in Koreans. Maxillofac Plast Reconstr Surg 2016; 38:1. [PMID: 26767186 PMCID: PMC4700055 DOI: 10.1186/s40902-015-0045-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate the distribution and prevalence of intraosseous loop (anastomosis between posterior superior alveolar artery and infraorbital artery) in Koreans detected on computed tomography (CT) images taken prior to sinus augmentation surgery. METHODS From the 177 patients who underwent sinus augmentation with lateral approach at Ewha Womans University Department of Implant Dentistry, 284 CT scans were evaluated. The canal height (CH), ridge height (RH), and canal height from the sinus floor (CHS) were measured on para-axial views at the first premolar, first molar, and second molar. The horizontal positions of the bony canals in the lateral wall were also classified. One-way analysis of variance (ANOVA) and t test were used to estimate the statistical differences (p < 0.05). RESULTS The intraosseous loops were detected in 92 CT scans (32 %). The mean vertical height of the bony canals from the alveolar crest (CH) was 23.45 ± 2.81, 15.92 ± 2.65, and 16.61 ± 2.92 mm at the second premolar, first molar, and second molar, respectively. In the horizontal positions of the bony canals, intraosseous type was the most predominant. The canal heights more than 15 mm and less than 17 mm were most prevalent (33.7 %) and those under 13 mm were 12.0 %. CONCLUSIONS The radiographic findings in this study could be used to decide the lateral osteotomy line avoiding potential vascular complication. However, only one third of the canals could be detected in CT scans; a precaution should be taken for the possibility of severe bleeding during lateral osteotomy.
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Affiliation(s)
- JuHyon Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry Jukjeon Dental Hospital, Dankook University, Yongin, South Korea
| | - Nara Kang
- Department of Oral and Maxillofacial Surgery, Kunkuk University Medical Center, Seoul, South Korea
| | - Young-Mi Moon
- Department of Conservative Dentistry, College of Dentistry Daejeon Dental Hospital, Wonkwang University, Deajeon, South Korea
| | - Eun-Kyoung Pang
- Department of Periodontology, Graduate School of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 158-710 South Korea
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Abstract
We describe an anatomical variation of the right maxillary artery. The variation loops deep, giving off a middle meningeal artery with an extremely short extracranial segment, then bifurcates into unequal branches. The smaller branch passes superficial to the lateral pterygoid head and distributes primarily to the masticatory muscles. The larger partially pierces the lateral pterygoid lower head, re-emerges superficially, branches again and passes into the pterygopalatine fossa. The larger lies superficial to the lingual and inferior alveolar nerves and deep to the buccal nerve. An embryonic development origin of the cranial arteries is suggested.
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Affiliation(s)
- R Claire Aland
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
- School of Rural Medicine, University of New England, Armidale, NSW, 2351, Australia.
| | - Vivien Shaw
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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Yang SM, Kye SB. Location of maxillary intraosseous vascular anastomosis based on the tooth position and height of the residual alveolar bone: computed tomographic analysis. J Periodontal Implant Sci 2014; 44:50-6. [PMID: 24778898 PMCID: PMC3999352 DOI: 10.5051/jpis.2014.44.2.50] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/18/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- Seung-Min Yang
- Department of Periodontology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Beom Kye
- Department of Periodontology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Barbalho JCM, Santos ES, Menezes JMS, Gonçalves FR, Chagas OL. Treatment of pseudoaneurysm of internal maxillary artery: a case report. Craniomaxillofac Trauma Reconstr 2010; 3:87-9. [PMID: 22110821 DOI: 10.1055/s-0030-1254378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Pseudoaneurysms are rare lesions secondary to blunt or penetrating trauma, temporomandibular joint surgery, or orthognathic surgery. Nonsurgical interventions are the treatment of choice for pseudoaneurysms. In the case reported here, endovascular injection of acrylic glue was successful in the treatment of a pseudoaneurysm of the internal maxillary artery secondary to fracture of the zygomatic bone.
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Balcioglu HA, Kilic C, Varol A, Ozan H, Kocabiyik N, Yildirim M. A Morphometric Study of the Maxillary Artery and Lingula in Relation to Mandibular Ramus Osteotomies and TMJ Surgery. Eur J Dent 2010; 4:166-70. [PMID: 20396448 PMCID: PMC2853823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Mandibular osteotomies and resection of the temporomandibular joint (TMJ) ankylosis are the mostly performed surgical procedures in the infratemporal fossa, which is in close proximity with the main trunk of the maxillary artery (MA). It is imperative to avoid the trunk or branches of the maxillary artery, otherwise, massive intraoperative or postoperative hemorrhage may develop. The goal of the study was to investigate the position of the maxillary artery in the infratemporal fossa and the lingula of the mandible. METHODS Significant landmarks were selected on the mandibles of formalin fixed cadavers, and the distances were measured between the maxillary artery and the bony landmarks with a digital caliper. RESULTS The average distances between the MA and the articular eminence, the medial cortex of the mandibular ramus, the inferior border of the pterygoid fovea and the mandibular notch were 1.67+/-0.48 mm, 5.38+/-2.47 mm, 16.84+/-1.74 mm, 2.94+/-0.52 mm, respectively. Course pattern of the MA at the subcondylar level was also mapped. In order to determine the position of the lingula, the average distances between the tip of the lingula and the mandibular notch, the inferior border of the ramus, the anterior margin of the ramus and posterior margin of the ramus were measured and found as 15.4+/-2.1 mm, 49.5+/-4.3 mm, 18.1+/-2.7 mm, 16.6+/-2.5 mm, respectively. No significant differences were found between the right and left sides, for all parameters. CONCLUSIONS The studied parameters will assist and navigate clinicians to determine the anatomic proximity to the maxillary artery, and, minimize the risk of damaging the vessel.
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Affiliation(s)
- Huseyin Avni Balcioglu
- Department of Anatomy, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.,Corresponding author: Dr. H. A. Balcioglu, Department of Anatomy, Faculty of Dentistry, Istanbul University, Capa, 34390, Istanbul, Turkey. Phone: +90 212 414 20 20, Fax: +90 212 531 22 30, E-mail:
| | - Cenk Kilic
- Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey
| | - Altan Varol
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Hasan Ozan
- Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey
| | - Necdet Kocabiyik
- Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey
| | - Mehmet Yildirim
- Department of Anatomy, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Kumar S, Bansal V, Agarwal R. An effective intra-operative method to control bleeding from vessels medial to the temporomandibular joint. J Maxillofac Oral Surg 2009; 8:371. [PMID: 23139546 DOI: 10.1007/s12663-009-0088-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 11/23/2009] [Indexed: 10/19/2022] Open
Abstract
The control of hemorrhage from the medial aspect of the TMJ can be troublesome and time-cosuming during ankylosis surgery. There could be a number of vessels which could lead to this inadvertent though sometimes unavoidable complication. We have found that simple compression against bone can be useful in controlling hemorrhage from this difficult to approach site. This short paper describes the technique which we follow in our unit for such situations.
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