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Radiological Analysis of Maxillary Artery Relationships to Key Bony Landmarks in Maxillofacial Surgery

Published:November 07, 2022DOI:https://doi.org/10.1016/j.bjoms.2022.11.004

      Abstract

      Introduction

      The maxillary artery (MA) is a key structure at risk of injury in numerous Oral and Maxillofacial surgical (OMS) procedures. Knowledge of safe distances from this vessel to surgically familiar bony landmarks could improve patient safety and prevent catastrophic haemorrhage

      Methods

      Distances between MA and bony landmarks on the maxilla and mandible were measured using CT angiograms on 100 patients (200 facial halves).

      Results

      The vertical height of the pterygomaxillary junction (PMJ) was 16 ± 3mm. The MA enters the pterygomaxillary fissure (PMF) 29 ± 3 mm from the most inferior point of the PMJ. The mean shortest distance between the MA and medial surface of mandible was 2 ± 2mm (with the vessel directly contacting the mandible in 17% of cases). The branchpoint (bifurcation of the superficial temporal artery (STA) and MA) was directly in contact with the mandible in 5% of cases. The average distances between this bifurcation point and the medial pole of the condyle were 20 ± 5mm and 22 ± 5mm, respectively.

      Conclusion

      A horizontal plane through the sigmoid notch perpendicular to the posterior border of the mandible is a good approximation of the trajectory of the MA. The branchpoint is usually within 5mm of this line and inferior in 70% of cases. Surgeons should take note that both the branchpoint and the MA contact the surface of the mandible in a significant number of cases.

      Keywords

      Abbreviations:

      BP (branch point (ECA terminates to STA and MA)), CT (Computed Tomography), ECA (external carotid artery), ICA (internal carotid artery), LP (lateral pterygoid), MA (maxillary artery), PBM (posterior border mandible), PMF (pterygomaxillary fissure), PMJ (pterygomaxillary junction), PPF (pterygopalatine fossa), SN (sigmoid notch), STA (superficial temporal artery), TP (tragal pointer), TOF-MRA (Time of flight-Magnetic Resonance Angiography)
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      References

      1. K. Panula, K. Finne and K. Oikarinen. Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg. 2001;59(10):1128-36; discussion 1137.

        • O'Regan B.
        • Bharadwaj G.
        Prospective study of the incidence of serious posterior maxillary haemorrhage during a tuberosity osteotomy in low level Le Fort I operations.
        Br J Oral Maxillofac Surg. 2007; 45: 538-542
        • Silva A.C.
        • O'Ryan F.
        • Beckley M.L.
        • Young H.Y.
        • Poor D.
        Pseudoaneurysm of a branch of the maxillary artery following mandibular sagittal split ramus osteotomy: case report and review of the literature.
        J Oral Maxillofac Surg. 2007; 65: 1807-1816
        • Yeo M.S.
        • Goh T.L.
        • Nallathamby V.
        • Cheong E.C.
        • Lim T.C.
        Maxillary artery injury associated with subcondylar mandible fractures: a novel treatment algorithm.
        Craniomaxillofac Trauma Reconstr. 2012; 5: 83-88
        • El A.S.
        • Guo W.
        • Loveless T.
        • Dhaliwal S.S.
        • Quereshy F.A.
        • Baur D.A.
        • Kaka N.S.
        Pseudoaneurysm of the external carotid artery secondary to subcondylar fracture.
        Int J Oral Maxillofac Surg. 2011; 40: 644-646
        • Lanigan D.T.
        • Hey J.
        • West R.A.
        Hemorrhage following mandibular osteotomies: a report of 21 cases.
        J Oral Maxillofac Surg. 1991; 49: 713-724
        • Apinhasmit W.
        • Methathrathip D.
        • Ploytubtim S.
        • Chompoopong S.
        • Ariyawatkul T.
        • Lertsirithong A.
        Anatomical study of the maxillary artery at the pterygomaxillary fissure in a Thai population: its relationship to maxillary osteotomy.
        J Med Assoc Thai. 2004; 87: 1212-1217
        • Orbay H.
        • Kerem M.
        • Unlu R.E.
        • Comert A.
        • Tuccar E.
        • Sensoz O.
        Maxillary artery: anatomical landmarks and relationship with the mandibular subcondyle.
        Plast Reconstr Surg. 2007; 120: 1865-1870
        • Balcioglu H.A.
        • 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: 166-170
        • Cheung L.K.
        • Fung S.C.
        • Li T.
        • Samman N.
        Posterior maxillary anatomy: implications for Le Fort I osteotomy.
        Int J Oral Maxillofac Surg. 1998; 27: 346-351
      2. F. P. A. Maia, G. C. de Sousa Filho, F. A. Pacifico, L. C. A. Albuquerque, A. F. de Melo Vasconcelos and B. C. do Egito Vasconcelos. Proximity of the maxillary artery to the neck of the mandibular condyle: anatomical study. Oral Maxillofac Surg. 2019;23(4):423-427.

        • Turvey T.A.
        • Fonseca R.J.
        The anatomy of the internal maxillary artery in the pterygopalatine fossa: its relationship to maxillary surgery.
        J Oral Surg. 1980; 38: 92-95
        • Hwang S.H.
        • Joo Y.H.
        • Seo J.H.
        • Kang J.M.
        Proximity of the maxillary artery to the mandibular ramus: an anatomic study using three-dimensional reconstruction of computer tomography.
        Clin Anat. 2014; 27: 691-697
        • Bendrihem R.
        • Vacher C.
        Radiologic anatomy of the maxillary artery in the pterygopalatine area applied to Le Fort 1 osteotomies.
        Surg Radiol Anat. 2017; 39: 23-27
        • Breeze J.
        • Verea Linares C.
        • Stockton P.
        Is an osteotome necessary for pterygomaxillary dysjunction or dysjunction through the tuberosity during Le Fort I osteotomy? A systematic review.
        Br J Oral Maxillofac Surg. 2016; 54: 248-252
        • Trimble L.D.
        • Tideman H.
        • Stoelinga P.J.
        A modification of the pterygoid plate separation in low-level maxillary osteotomies.
        J Oral Maxillofac Surg. 1983; 41: 544-546
        • Schonegg 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;
        • Gulses A.
        • Oren C.
        • Altug H.A.
        • Ilica T.
        • Sencimen M.
        Radiologic assessment of the relationship between the maxillary artery and the lateral pterygoid muscle.
        J Craniofac Surg. 2012; 23: 1465-1467
        • Fujimura K.
        • Segami N.
        • Kobayashi S.
        Anatomical study of the complications of intraoral vertico-sagittal ramus osteotomy.
        J Oral Maxillofac Surg. 2006; 64: 384-389
        • Hwang K.
        • Nam Y.S.
        • Han S.H.
        Vulnerable structures during intraoral sagittal split ramus osteotomy.
        J Craniofac Surg. 2009; 20: 229-232
        • Bouloux G.F.
        • Perciaccante V.J.
        Massive hemorrhage during oral and maxillofacial surgery: ligation of the external carotid artery or embolization?.
        J Oral Maxillofac Surg. 2009; 67: 1547-1551
        • Rosenberg I.
        • Austin J.C.
        • Wright P.G.
        • King R.E.
        The effect of experimental ligation of the external carotid artery and its major branches on haemorrhage from the maxillary artery.
        Int J Oral Surg. 1982; 11: 251-259
        • Yin N.T.
        Hemorrhage of the initial part of the internal maxillary artery treated by multiple ligations: report of four cases.
        J Oral Maxillofac Surg. 1994; 52: 1066-1071
        • Hossameldin R.H.
        • McCain J.P.
        • Dabus G.
        Prophylactic embolisation of the internal maxillary artery in patients with ankylosis of the temporomandibular joint.
        Br J Oral Maxillofac Surg. 2017; 55: 584-588
        • Susarla S.M.
        • Peacock Z.S.
        • Williams W.B.
        • Rabinov J.D.
        • Keith D.A.
        • Kaban L.B.
        Role of computed tomographic angiography in treatment of patients with temporomandibular joint ankylosis.
        J Oral Maxillofac Surg. 2014; 72: 267-276