Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis.

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.

Preoperative Arterial Coil Embolization for Temporomandibular Joint (TMJ) Surgery in Children with TMJ Ankylosis.

ABSTRACT: Temporomandibular joint (TMJ) ankylosis in children can alter facial development and affect oral hygiene and function. Surgical release of the ankylosis is the mainstay of treatment. The authors hypothesize that preoperative arterial coil embolization is safe and effective in preventing major blood loss during TMJ surgery (loss prompting blood transfusion or hemodynamic instability requiring vasoactive medication administration) in children with TMJ ankylosis. Patients < 16 years who were diagnosed with TMJ ankylosis (<15 maximal interincisal opening) and had embolization before surgery in the last 5 years were included. Out of 9 initial search results, 3 patients were excluded (age > 16). Information gathered were patient demographics, diagnostic imaging, procedural details, complications, and clinical outcomes. Six patients, mean age 11.14 years (range 7-15 years) year and a mean weight of 40.8 ± 19 kg were included. Underlying etiologies for TMJ ankylosis: Pierre Robin Syndrome (n = 2), juvenile rheumatoid arthritis (n = 1), Goldenhar's syndrome (n = 1), trauma (n = 1), and micrognathia (n = 1). Neck computed tomography angiogram before embolization demonstrated an intimate approximation between the internal maxillary artery (IMAX) and/or external carotid artery and ankylotic mass in all patients. Eight successful embolizations were performed without procedural complication. In 1 patient with angiographic evidence of surgical internal maxillary artery ligation, embolization was performed via collaterals. Surgery was performed within 48 hours of embolization. Airway access during surgery was via nasal intubation (n = 4), oral intubation (n = 3). The estimated blood loss (EBL) during surgery was 78.33 ± 47.08 ml. Three patients had subsequent TMJ surgery with a mean estimated blood loss of 73.33 ± 46.18 ml. After a mean follow-up of 17 ± 15 months, patients showed a 13.8mm mean increment of maximal interincisal opening with 95% CI (5.74-21.9), P < 0.007.

Systematic review and meta-analysis of the anatomy of the maxillary artery using the Anatomical Quality Assurance (AQUA) checklist.

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.

Cauterización transoral de la arteria maxilar interna en la fosa infratemporal: informe de un caso / Transoral cauterization of the internal maxillary artery in the infratemporal fossa: case report

Se describe el caso clínico de una paciente de 84 años que tuvo epistaxis recidivante por padecer enfermedad de Rendu-Osler-Weber. Tuvo antecedentes de diversos tratamientos quirúrgicos que incluyeron el cierre de la fosa nasal izquierda (operación de Young). Por la persistencia de epistaxis izquierda se indicó una angiografía y embolización. Esta última no se hizo porque se diagnosticaron anastomosis entre el sistema carotídeo externo y el interno. Se realizó un abordaje intraoral paramaxilar asistido con endoscopios para cauterizar la arteria maxilar interna en la fosa infratemporal y un abordaje externo para cauterizar la arteria etmoidal anterior solucionando la epistaxis. (AU)

The clinical case of an 84-year-old patient who had recurrent epistaxis due to Rendu-Osler- Weber disease is described. She had a history of various surgical treatments including closure of the left nostril (Young's operation).Due to the persistence of left epistaxis, angiography and embolization were indicated. The latter was not done because anastomosis between the external and internal carotid system was diagnosed. An intraoral paramaxillary approach assisted with endoscopes was performed to cauterize the internal maxillary artery in the infratemporal fossa and an external approach to cauterize the anterior ethmoidal artery solving the epistaxis. (AU)

Pterygopalatine Fossa: Microsurgical Anatomy and its Relevance for Skull Base Surgery

Introduction The purpose of this study was to define the anatomical relationships of the pterygopalatine fossa (PPF) and its operative implications in skull base surgical approaches. Methods Ten cadaveric heads were dissected at the Dianne and M Gazi Yasargil Educational Center MicrosurgicaLaboratory, in Little Rock, AK, USA. The PPF was exposed through an extended dissection with mandible and pterygoid plate removal. Results The PPF has the shape of an inverted cone. Its boundaries are the pterygomaxillary fissure; themaxilla, anteriorly; themedial plate of the pterygoid process, and greater wing of the sphenoid process, posteriorly; the palatine bone,medially; and the body of the sphenoid process, superiorly. Its contents are the maxillary division of the trigeminal nerve and its branches; the pterygopalatine ganglion; the pterygopalatine portion of the maxillary artery (MA) and its branches; and the venous network. Differential diagnosis of PPF masses includes perineural tumoral extension along the maxillary nerve, schwannomas, neurofibromas, angiofibromas, hemangiomas, and ectopic salivary gland tissue. Transmaxillary and transpalatal approaches require extensive resection of bony structures and are narrow in the deeper part of the approach, impairing the surgical vision and maneuverability. Endoscopic surgery solves this problem, bringing the light source to the center of the surgical field, allowing proper visualization of the surgical field, extreme close-ups, and different view angles. Conclusion We provide detailed information on the fossa's boundaries, intercommunications with adjacent structures, anatomy of the maxillary artery, and its variations. It is discussed in the context of clinical affections and surgical approaches of this specific region, including pterygomaxillary disjunction and skull base tumors.

Proximity of the maxillary artery to the neck of the mandibular condyle: anatomical study.

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.

Morphological and morphometric characterization of the "sphenoidal tubercle" / Caracterización morfológica y morfométrica del tubérculo esfenoidal

The sphenoidal tubercle is a bone elevation located in the anterior edge of the infratemporal crest of the sphenoid greater wing, where the temporal and lateral pterygoid muscles have their origin. This bone accident presents varied morphology so its description and denomination are a topic of discussion. 60 dry skulls obtained from the morphology laboratory of the Biomedical Basic Sciences Department of the University of Talca were used for a morphological and morphometric analysis of the sphenoidal tubercle including its morphology, diameters (anteroposterior, transverse and vertical) and the distance to the grooves for the maxillary artery and maxillary nerve. Sphenoidal tubercle had a prevalence of 98.4 % of all dry skulls analyzed with a bilateral presentation in the 76.6 % of the cases. According to its different forms of presentation established by Cáceres et al., (2016) the pyramidal form was the most frequent with a 25.7 %. The average diameters were of 4.12 mm anteroposterior, 5.50 mm transverse and 3.89 mm vertical. The average distance to the grooves of the maxillary artery and maxillary nerve were 9.04 mm and 7.6 mm, respectively. Sphenoidal tubercle is a constant bone accident with a variated morphology and measures. Due to its anatomical relations with important neurovascular elements such as the maxillary artery and the maxillary nerve, it may be used as a reference point for surgical access to the infratemporal fossa. From this analysis we establish that the denomination of "infratemporal process" is more accurate, because the development of this bone accident is from muscular traction performed by the lateral pterygoid muscle and the deep portion of the temporal muscle causing great variations in its morphology, probably due to external and functional parameters or even influenced by the biotype.

El tubérculo esfenoidal es una elevación ósea ubicada en el extremo anterior de la cresta infratemporal del ala mayor del hueso esfenoides, donde presta inserción al músculo temporal y pterigoideo lateral. Presenta morfología variada, por lo que su descripción y denominación resultan motivo de discusión. 60 cráneos secos obtenidos del Laboratorio de Morfología del Departamento de Ciencias Básicas Biomédicas de la Universidad de Talca, fueron utilizados para realizar un análisis morfológico y morfométrico del tubérculo esfenoidal evaluando forma, diámetros (anteroposterior, laterolateral y vertical) y distancia con el surco de la arteria y nervio maxilar. El tubérculo esfenoidal tuvo una prevalencia del 98,4 % del total de cráneos analizados, presentándose bilateralmente en el 76,6 % de los casos. De acuerdo a las diferentes formas de presentación establecidas por Cáceres et al (2016) la forma piramidal fue la más frecuente con un 25,7 %. Los diámetros promedio fueron de 4,12 mm anteroposterior, 5,50 mm laterolateral y 3,89 mm vertical. Las distancias promedio con el surco de la arteria y nervio maxilar fueron de 9,04 mm y 7,6mm, respectivamente. El tubérculo esfenoidal es un accidente óseo constante de morfología y dimensiones variadas. Debido a sus relaciones con elementos vasculares de importancia, tales como la arteria y nervio maxilar, podría ser utilizado como elemento de referencia para el acceso quirúrgico a la fosa infratemporal. A partir de su análisis planteamos que su denominación como "proceso infratemporal" sería más apropiado, debido a que se desarrollaría a partir de la tracción muscular ejercida por el musculo pterigoideo lateral y la porción profunda del músculo temporal, ocasionando variaciones notables en su morfología, probablemente debido a factores externos y funcionales o incluso influenciada por el biotipo.

Ruptured Pseudoaneurysm of the Maxillary Artery and Its Branches Following Le Fort I Osteotomy: Evidence-Based Guidelines.

BACKGROUND: Although rare, pseudoaneurysms (PA) can develop following Le Fort I osteotomy and lead to life-threatening hemorrhage. However, the typical presentation of a PA following a Le Fort I osteotomy is not well characterized. Evidence-based guidelines are not currently available for evaluation of PA following Le Fort I osteotomy. METHODS: A case report is presented of a 27-year-old man who underwent Le Fort I advancement and subsequently developed a bleeding PA. A comprehensive search of journal articles was performed using the MEDLINE/PubMed database between 1964 and April 2016. Keywords and phrases used were "(osteotomy OR craniofacial OR orthognathic) AND (pseudoaneurysm OR aneurysm OR epistaxis)." Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines were followed. RESULTS: The literature search yielded 13 reports of 18 patients. All 18 patients underwent Le Fort I osteotomy and subsequently developed a delayed postoperative bleeding PA. All studies were level IV or V evidence. Twenty-eight percent (N = 5) of the cases documented "excessive" intraoperative bleeding or more than 500 mL of estimated blood loss. The average time for the first bleeding episode and time until final bleed was 17.3 ±â€Š14.3 days (range: 3-62 days) and 27.8 ±â€Š21.2 days following surgery (range: 6-77 days), respectively. Sixty-seven percent (N = 12) had multiple episodes of bleeding. The duration between the bleeding events averaged 10.6 (± 7.9 days) with a range of 1 to 35 days. Bleeding PA's were treated with image-guided embolization (15/18 patients; 83.3%) or ligation or clamping (3/18 patients; 16.7%). CONCLUSION: In the setting of recurrent and/or delayed postoperative epistaxis following Le Fort I osteotomy, surgeons should maintain a high clinical suspicion for PA. Ruptured PA's are often preceded by multiple episodes of progressively worsening epistaxis. Based on the presented case report and pooled data from the literature, angiography is recommended to evaluate for PA in the setting of recurrent epistaxis following Le Fort I osteotomy, especially within the first 4 weeks following surgery.

Unusual origin and relations of the accessory meningeal artery: a case report / Origen inusual y relaciones de la arteria meníngea accesoria: reporte de un caso

SUMMARY: Accessory meningeal artery is a branch of the first part of the maxillary artery. It supplies the structures in the infratemporal fossa and the dura mater in the middle cranial fossa. Accessory meningeal artery arose from the middle meningeal artery, 25 mm below the base of the skull and entered the middle cranial fossa through the foramen ovale. The two roots of the auriculotemporal nerve looped around it. The knowledge of the variant origin and relations may be useful during the surgeries of the infratemporal fossa. It might also be useful to the radiologists.

RESUMEN: La arteria meníngea media es una rama accesoria que emerge al inicio de la arteria maxilar. Suministra la vascularización a nivel de la fosa infratemporal y la duramadre en la fosa craneal media. En este trabajo, surgió una arteria meníngea accesoria de la arteria meníngea media, a una 25 mm por debajo de la base del cráneo, accediendo en la fosa craneal media a través del foramen oval. Las dos raíces del nervio auriculotemporal la rodeaban. El conocimiento de esta variación y sus relaciones pueden ser útiles durante las cirugías de la fosa infratemporal, como así también puede ser útil para los radiólogos.

Avaliação do diâmetro do ramo intraósseo da artéria alveolar superior posterior e sua relação com a cirurgia de levantamento do seio maxilar ­ estudo transversal / Evaluation of intra-osseous branch of posterior superior alveolar artery diameter and its relation with the maxillary sinus

Objetivo: descrever a anatomia do ramo intraósseo da artéria alveolar superior posterior (riAASP) na parede lateral do seio maxilar. Material e métodos: 31 pacientes se encaixaram nos critérios de inclusão para a pesquisa. Avaliou-se a presença ou não do riAASP, sua distância até o assoalho do seio maxilar e até a crista alveolar, e seu diâmetro nas regiões dentais posteriores bilateralmente em maxila, comparando regiões dentadas com edentadas através de TCFCs. Resultados: o riAASP foi identificado em 21 pacientes (67,7%), sendo mais visualizado na região de primeiro molar. Foram avaliadas 248 regiões dentais de 31 pacientes, onde o riAASP foi visualizado e mensurado em 153 regiões (61,7%). Quanto mais posterior era a região, maior era o diâmetro do vaso, tanto para regiões dentadas quanto para as edentadas, e o diâmetro médio encontrado foi de 1,2 mm. A distância do riAASP até o assoalho do seio maxilar nas regiões dentadas não apresentou diferença estatisticamente significante nas diferentes regiões dentais. Já nas regiões edentadas, quanto mais posterior foi a região, menor foi esta distância. Em relação à distância da artéria até a crista alveolar, quanto mais anterior era a região dental, mais distante da crista o riAASP se posicionou. Conclusão: o conhecimento anatômico, a solicitação de exames de tomografi a computadorizada, a interpretação no planejamento pré-operatório e a habilidade do cirurgião poderão eliminar ou diminuir os acidentes relacionados à hemorragia do riAASP durante a cirurgia de levantamento do seio maxilar.

Objective: to define the anatomy of the intraosseous branch of the posterior superior alveolar artery (ioPSAA) in the lateral wall of the maxillary sinus. Material and methods: 31 patients meet the inclusion criteria for the study. The presence or absence of ioAASP, its distance to the floor of the maxillary sinus, to the alveolar crest and its diameter, were evaluated in the posterior dental regions bilaterally in the maxilla, comparing edentulos and dentate regions through CBCTs. Results: the ioPSAA was identifi ed in 21 patients (67.7%), being more visualized in the 1st molar region. A total of 248 dental regions of 31 patients were evaluated, where ioAASP was visualized and measured in 153 regions (61.7%). The diameter of the artery increases as it runs posteriorly in the maxilla, for both toothed and edentate regions. The mean diameter found was 1.2 mm. The distance from the ioPSAA to the maxillary sinus fl oor in the dentate regions did not present a statistically significant difference in the different dental regions. In the edentate regions, the more posterior the region, the smaller the distance to the sinus floor. Regarding the distance from the artery to the alveolar crest, the more anteror the dental anterior, the greater the distance of ioPSAA from the alveolar crest. Conclusion: anatomical knowledge, the need for CT scans, its interpretation in the preoperative planning, and the surgeon's ability, may eliminate or reduce the accidents related to riAASP hemorrhage during maxillary sinus surgery.

Evaluación de la arteria alveolo-antral mediante tomografía volumétrica en población mexicana y su relación con levantamiento del piso del seno maxilar / CBCT evaluation of the alveolar antral artery in a mexican cohort and its relationship to maxillary sinus floor lifting

Introducción: El conocimiento de la anatomía de la región maxilar debe ser esencial para el cirujano antes de realizar levantamiento del seno maxilar para evitar complicaciones. La arteria alveolo antral forma una anastomosis intraósea con la arteria infraorbitaria a nivel de la pared antero lateral del seno maxilar, aproximadamente a una distancia de entre 18.9 y 19.6 mm desde el reborde alveolar maxilar. La arteria alveolo antral es la encargada de dar vascularidad a la membrana mucosa del seno maxilar, pared antero lateral del seno y tejido perióstico subyacente.Objetivo: Describir y establecer la frecuencia, diámetro y localización dela anastomosis entre la arteria infraorbitaria y la arteria alveolar posterior superior, llamada arteria alveolo antral y su relación con la cresta ósea alveolar en una población mexicana. Material y métodos: Se realizaun protocolo de estudio observacional, descriptivo y transversal en una población de 1,116 pacientes derecho habientes del Instituto de Seguridad Social y Servicios para los Trabajadores del Estado (ISSSTE), en el oriente de la Ciudad de México, mediante la revisión de estudios de tomografía volumétrica computarizada. Resultados: Se encuentra la anastomosis arterial en el 90 por ciento de los estudios revisados, correspondiente a 1,005 estudios de tomografía.

Introduction: In order to avoid complications, it is essential for surgeonsto have a detailed knowledge of the anatomy of the superior maxillarybone prior to performing any sinus lift procedure. The alveolarantral artery forms an intraosseous anastomosis with the infraorbitalartery at the level of the anterolateral wall of the maxillary antrum at anapproximate distance of between 18.9 and 19.6 mm from the maxillaryalveolar ridge. The alveolar antral artery is responsible for providingvascularity to the mucous membrane of the maxillary sinus, the anteriorlateral wall of the sinus, and the underlying periosteal tissue. Objective:To analyze and establish the frequency, diameter, and locationof the anastomosis between the infraorbital artery and the posteriorsuperior alveolar artery known as the alveolar antral artery, and itsrelationship to the alveolar bone crest in a Mexican cohort. Materialand methods. We conducted a cross-sectional observational descriptivestudy involving a cohort comprised of 1,116 patients of the Institute forSocial Security and Services for State Workers (ISSSTE) on the eastside of Mexico City. The study consisted of a review of CBCT studies.Results: The arterial anastomosis was found in 90% of the 1,005 CBCTstudies reviewed, based on which the following values were determinedfor the distance between the alveolar ridge and the canal of the alveolarantral artery: for the fi rst premolar, 18.24 mm; second premolar,17.35 mm; fi rst molar, 16.96 mm, and for the second molar, 18.75 mm.Conclusions: We established the average measurements for the locationof the vascular bundle in question and the measurements neededto safeguard it along its course, which is important for the preservationand osseointegration of bone grafts placed during maxillary sinus liftprocedures, thus providing a margin of safety not previously reportedin the literature for a Mexican cohort.

Fístula arterioeenosa traumática de arteria temporal superficial "un caso infrecuene"" / Traumaticarterioovenous fistula of the superficial temporal artery "rare case" / Traumático ístulla arteriovenosa da artéria temporal superficial "caso raro"

su largo trayecto en el cuero cabelludo y relativa vulnerabilidad, sin embargo, las fístulas arteriovenosas del cuero cabelludo son una patología infrecuente. Presentamos un caso de una paciente femenina quien, 2 años después de un trauma lacerante del cuero cabelludo, presenta una fístula arteriovenosa traumática de la arteria temporal superficial. La lesión es tratada de manera exitosa mediante la extirpación quirúrgica, se realiza una revisión de la literatura con respecto a la etiología, manifestaciones clínicas, patogenia, diagnóstico y su tratamiento.

The superficial temporal artery is particularly vulnerable to trauma because of its long journey throughout the scalp and relative vulnerability; however, the scalp arteriovenous fistulas are an uncommon finding. We report a case of a female patient who 2 years after a scalp wounding injury presents with a superficial temporal artery (STA) traumatic arteriovenous fistula (TAVF), treated successfully by surgical removal. We review the literature regarding the etiology, clinical manifestations, pathogenesis, diagnosis and treatment.

A artéria temporal superficial é particularmente vulnerável ao trauma devido aoseulongotrajeto no courocabeludo e relativa vulnerabilidade, porém as fístulas arteriovenosas do courocabeludo são uma patologia infrequente. Apresentamos um caso de uma paciente feminina quem2anos apósde um trauma lacerante do courocabeludo a presenta uma fístula arteriovenosa traumática da artéria temporal superficial, tratada com sucesso mediante a extirpação cirúrgica , se realiza uma revisão da literatura a respeito à etiologia, manifestações clínicas, patogenia, diagnóstico eseutratamento.

Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT.

Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT). The study group consisted of 135 CBCT scans (270 sinuses) obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%). The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05). The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT

Assessment of the maxillary sinus anatomy before sinus augmentation is important for avoiding surgical complications, because of the close anatomical relationship between the posterior maxillary teeth and the maxillary sinus. The posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and overlying membrane. We evaluated the location of the PSAA and its relationship to the alveolar ridge and maxillary sinus using cone beam computed tomography (CBCT). The study group consisted of 135 CBCT scans (270 sinuses) obtained from the archive of the dentomaxillofacial radiology department at Yeditepe University Faculty of Dentistry, Istanbul, Turkey. The distance between the lower border of the artery and the alveolar crest, bone height from the sinus floor to the ridge crest, distance from the artery to the medial sinus wall, and the diameter and location of the artery were determined. The occurrence of septa and pathology were recorded from CBCT scans. The PSAA was observed in 89.3% of sinuses, and 71.1% of arteries were intraosseous with diameters mostly < 1 mm (68.9%). The prevalence of sinus septa was 55.2%, and that of sinus pathology was 57.4%. The mean age was 43.07 ± 17.55 years. There was a statistically significant difference between the location of the artery and gender (p < 0.05). The prevalence of sinus membrane thickening was 57.4%. Detailed knowledge about the location of the PSAA and sinus morphology may be obtained with CBCT before maxillary sinus surgery.

Clinical significance of maxillary artery and its branches: a cadaver study and review of the literature / Significado clínico de la arteria maxilar y sus ramas: un estudio en cadáver y la revisión de la literatura

The aim of this study was to investigate the anatomy of the maxillary artery (MA) and its branches. Fourteen sides of Turkish adult cadavers were dissected. The specimens were classified according to the relation between MA and the lateral pterygoid. After the removal of the lateral pterygoid, parts and branches of MA were exposed. We classified the branching patterns of MA in the pterygopalatine fossa. The calibers and lengths of the arteries, and the distance between the zygomatic arch and MA, and between the infratemporal crest and MA were measured. The MA was found superficial to the lateral pterygoid in 57.2 percent. The inferior alveolar artery (IA) was arisen from MA before the middle meningeal artery (MM) in 35.7 percent, after MM in 35.7 percent. The IA and MM were arisen from the same area of MA in 14.3 percent. In other two cases IA was arisen from the beginning of MA (14.3 percent). According to the contours of third portion of MA, we classified "Y" type (50 percent), "intermediate-T" type (14.3 percent), and "M" type (35.7 percent). This reinvestigation of the clinical anatomy of MA may provide useful information to the head and neck surgeons, dentists, neurosurgeons and radiologists related with this region.

El objetivo de este estudio fue investigar la anatomía de la arteria maxilar (AM) y sus ramas. Fueron disecados 14 hemicabezas de cadáveres turcos adultos. Las muestras fueron clasificadas de acuerdo a las relaciones entre AM y el músculo pterigoideo lateral. Después de la eliminación del músculo pterigoideo lateral, las partes y las ramas de AM fueron expuestas. Se clasificaron los patrones de ramificación de la AM en la fosa pterigopalatina. El calibre y la longitud de las arterias, la distancia entre el arco cigomático y la AM , y entre la cresta infratemporal y la AM fueron medidas. La AM se encuentra superficial al músculo pterigoideo lateral en el 57,2 por ciento. La arteria alveolar inferior (AI) se originó desde la AM antes que la arteria meníngea media (MM) en el 35,7 por ciento, y después de ésta en el 35,7 por ciento. La AI y MM se originaron en la misma zona de la AM en el 14,3 por ciento. En otros dos casos la AI se originó desde el inicio de AM (14,3 por ciento). De acuerdo con los contornos de la tercera porción de AM, se clasificaron como tipo "Y" (50 por ciento), tipo "intermedio-T" (14,3 por ciento), y de tipo "M" (35,7 por ciento). Esta investigación de la anatomía clínica de la AM puede proporcionar información útil a los cirujanos de cabeza y cuello, odontólogos, neurocirujanos y radiólogos relacionados con esta región.

Unilateral variation in the origin of the inferior alveolar and buccal arteries: a case report / Variación unilateral en el origen de las arterias alveolar inferior y bucal: reporte de un caso

The maxillary artery (MA) is one of the terminal branches of the external carotid artery (ECA) and is located in the infratemporal fossa (IF). Some of the branches in this region are the inferior alveolar artery (IAA) and the buccal artery (BA), both descending branches. Here, we report an unusual unilateral origin of the IAA and the BA from a common trunk directly from the ECA. We conducted a routine dissection of both IF in a 54-year-old hispanic male cadaver. Fixed with Universidad de los Andes® conservative solution and red latex for vascular filling. On each side, the MA is observed superficially located over the lateral pterygoid muscle. On the right side, the IAA and the BA originate from a common trunk from the ECA approximately 5 mm prior to the bifurcation into their terminal branches. On the left side, the IAA originates from the MA that is immediately next to its origin, making a common trunk with the pterygoid branches. Knowing the morphology of the MA and its branches at the IF is important for oral and maxillofacial surgery procedures; and any variation in the origin or course of these arteries may result in the patient's increased morbidity during some invasive procedure in the area.

La arteria maxilar (AM) es una rama terminal de la arteria carótida externa (ACE), y se ubica en la región infratemporal (RI). Algunas de sus ramas en esta región son la arteria alveolar inferior (AAI) y la arteria bucal (AB), ambas ramas descendentes. En este trabajo informamos de un inusual origen unilateral de la AAI y de la AB a partir de un tronco común desde la ACE. Se realizó una disección de rutina de ambas regiones infratemporales en un cadáver de 54 años, sexo masculino, caucásico. Fijado con solución conservadora Universidad de los Andes® y repleción vascular con látex rojo. A cada lado, se observa la AM en ubicación superficial sobre el músculo pterigoideo lateral. Al lado derecho, la AAI y la AB se originan de un tronco común desde la ACE aproximadamente 5 mm antes de la bifurcación en sus ramas terminales. Al lado izquierdo la AAI se origina de la AM inmediato a su origen, formando un tronco común con los ramos pterigoideos. El conocimiento de la morfología de la AM y de sus ramas en la RI es de importancia en procedimientos odontológicos, de cirugía oral y maxilofacial. Por lo que cualquier variación en el origen o trayecto de estas arterias puede predisponer a un paciente a una mayor morbilidad durante algún procedimiento invasivo en la zona.

Embolization of pseudoaneurysm of the internal maxillary artery after orthognathic surgery.

In orthognathic surgery, Le Fort I osteotomy is one of the most often used methods for the correction of dental-facial deformities and is considered technically safe. However, this procedure may lead to diverse complications, including uncommon vascular complications. A clinical case is described of late development of pseudoaneurysm in one of the branches of the maxillary artery in a 20-year-old patient who had undergone Le Fort I osteotomy, bilateral sagittal osteotomy of mandibular branch, and mentoplasty and subsequently treated with embolization. The main forms of treating vascular injuries are reviewed, and embolization is demonstrated to be a technically safe procedure with few complications.

Embolization as the treatment for a life-threatening mandibular arteriovenous malformation.

Mandibular arteriovenous malformation is a severe vascular pathological condition that may lead to life-threatening hemorrhages. In child and teenaged patients, a conservative treatment is preferred to avoid profuse blood loss and/or mutilating alterations in the still-growing patients' face. The aim of this article was to present a case of an 11-year-old boy with an arteriovenous malformation involving the left mandible and treated by means of endovascular embolization with direct lesional delivery of N-butyl-cyanoacrylate glue through transfemoral catheterization.

Estudio de variantes anatómicas de la arteria facial y su aplicación en la cirugía de colgajos faciales / A study of anatomical variants of the facial artery and their use in facial flap surgery

Introducción: Diversos estudios acerca de las variantes anatómicas de la arteria facial han sido descritos en la literatura. Sin embargo éstos no se han realizado en nuestro medio. Los colgajos basados en la arteria facial, tales como el descrito por Pribaz en 1992, son una buena alternativa en el manejo de las fístulas palatinas severas. Por otro lado, la reconstrucción de defectos faciales posresección de cáncer de piel son frecuentes y demandan de técnicas seleccionadas con la finalidad de mejorar los aspectos funcionales y estéticos en los pacientes. Aquí los colgajos basados en ramas de la arteria facial también son útiles. Nuestra experiencia en el uso de estos colgajos así como una nueva modificación propuesta es presentada, además, en este trabajo. Objetivo: mostrar las posibles variantes anatómicas en cadáveres peruanos y su aplicación en la cirugía de colgajos basados en esta arteria. Material y método: El presente es un estudio descriptivo analítico. Un total de 24 hemicaras de 12 cadáveres peruanos frescos (10 hombres y 2 mujeres) fueron disecados manualmente y observados macro y microscópicamente por el autor. La arteria facial fue disecada desde su aparición en la cara a nivel del borde inferior de la mandíbula hasta sus ramas terminales. Se describen las variantes en el trayecto y la posición de sus perforantes cutáneas. Un estudio retrospectivo de 23 pacientes operados de cirugía reconstructiva por diversas causas, utilizando colgajos basados en la arteria facial, es incluido en el presente artículo. Resultados: El estudio cadavérico mostró la predominancia del patrón nasal de la arteria facial en cadáveres peruanos (70,8%). Además, la disección cadavérica mostró un número variable de perforantes cutáneas distribuidas a lo largo de la trayectoria de la arteria facial en todos los casos. Los colgajos realizados para el tratamiento de defectos faciales y...

Introduction: Several reports about facial artery anatomy have been published in the literature, however none of such studies has ever been performed in our country. Flaps based on the facial artery, like those described by Pribaz in 1992, are a good alternative for the management of severe palatal fistula management. On the other hand, the reconstruction of facial wounds after skin cancer resection is commonly needed, and it requires selected surgical techniques in order to improve facial cosmetics and functioning in our patients. In this paper we describe our experience using these flaps and we propose a modification for the technique. Objetives: show the anatomical variants in facial artery anatomy in Peruvian cadavers and their application in facial flap surgery based on this artery. Material and method: This is an analytic and descriptive study. 24 half-faces from 12 Peruvian cadavers (10 men and two women) were manually dissected, and thy were macroscopically and microscopically observed by the author. The facial artery was dissected from its origin in the face, at the lower border of the mandible, up to its terminal branches. We describe the anatomical variants about the facial artery localization and its perforating cutaneous branches. Also, we include in this report a retrospective study performed in 23 patients who underwent reconstructive surgery for many different reasons using flaps based on the facial artery. Results: The study in cadavers showed the predominance of a nasal pattern in the way of the facial artery in Peruvian cadavers (70.8%). Also, the cadaver dissection showed a variable number of skin perforating branches distributed along the way of the facial artery in all cases. Flaps techniques used for facial wound repair and palatal fistulae had good outcomes in most of the cases. Conclusions: A nasal pattern for the way of the facial artery is the most commonly observed in our study performed in Peruvian cadavers...