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Anomalous course of maxillary artery Rev Arg de Anat Clin; 2013, 5 (3): 235-239 __________________________________________________________________________________________ Case Report COURSE OF THE MAXILLARY ARTERY THROUGH THE LOOP OF THE AURICULOTEMPORAL NERVE Kavya Bhat, Sampath Madhyastha*, Balakrishnan R Department of Anatomy, Kasturba Medical College, Bejai Campus, Mangalore, Manipal University, India RESUMEN INTRODUCTION Las variaciones en el curso de la arteria maxilar se describen a menudo, con sus relaciones con el Maxillary artery is one of the larger terminal músculo pterigoideo lateral. En el presente caso branches of the external carotid artery, arises informamos una variación exclusiva en el curso de la behind the neck of the mandible, within the arteria maxilar que no fue publicada antes. En un substance of the parotid gland. It then crosses cadáver masculino de 75 años arteria maxilar derecho the infratemporal fossa to enter the pterygo- estaba pasando por el bucle del nervio auriculo- palatine fossa through pterygo-maxillary fissure. temporal. La arteria meníngea media provenía de la The course of the artery is divided into three arteria maxilar con un bucle del nervio auriculo- temporal. La arteria maxilar pasaba profunda con parts by the lateral pterygoid muscle. The first respecto al nervio dentario inferior pero superficial al (mandibular) part runs horizontally, parallel to nervio lingual. El conocimiento de estas variaciones es and slightly below the auriculo-temporal nerve. importante para el cirujano y también serviría para This part of the artery runs superficial (lateral) to explicar la posible participación de estas variaciones the lower head of lateral pterygoid muscle. The en la etiología del dolor mandibular. second (pterygoid) part passes between the two Palabras clave: Nervio aurículotemporal; arteria heads of lateral pterygoid muscle to reach the maxilar; variaciones pterygo-maxillary fissure before it passes into the pterygo-palatine fossa, where it finishes as the third (pterygo-palatine) part of the maxillary artery ABSTRACT (Standring, 2008). Variations in the course of the maxillary artery are Anatomical variation in the course of the often described with its relations to the lateral pterygoid maxillary artery might complicate major muscle. In the present case we report a unique procedures such as radical maxillectomy and variation in the course of the maxillary artery which minor procedures such as nerve blocks (inferior was not reported before. In a 75 years old male alveolar or lingual nerve). cadaver the right maxillary artery passed through the loop of the auriculotemporal nerve. The middle meningeal artery was arising from the maxillary artery _________________________________________________ within the nerve loop of auriculotemporal nerve. Further the maxillary artery passed deep to the inferior * Correspondence to: Sampath Madhyastha, Department of alveolar nerve but superficial to the lingual nerve. The Anatomy. Kasturba Medical College, Bejai Campus, knowledge of these variations is important for Mangalore, Manipal University, India. surgeons and it would also explain the possible [email protected] involvement of these variations in etiology of the craniomandibular pain. Received: 9 September, 2013. Revised: 21 October, 2013. Accepted: 8 November, 2013. Key words: Auriculotemporal nerve; maxillary artery; variations 235 Todos los derechos reservados. Reg. Nº: 5104953 www.anatclinar.com.ar Anomalous course of maxillary artery Rev Arg de Anat Clin; 2013, 5 (3): 235-239 __________________________________________________________________________________________ Maxillary artery and its variations is of great regions (Otake et al, 2011). Here we report a importance while performing surgeries on face, case where the maxillary artery had a unique intra-arterial chemotherapy for head and neck course which was not documented before, to the cancers, diagnosis and treatment for diseases best of our knowledge. appearing in the maxillary artery dominating Figure 1 - 1-Common carotid artery, 2-External carotid artery, 3-First part of Maxillary artery, 3a-Inferior alveolar artery, 3b-Second part of maxillary artery, 4-Superficial temporal artery, 5-Middle meningeal artery, 6-Loop of the auriculotemporal nerve, 7-Inferior alveolar nerve, 8-Lingual nerve, 9-Buccal branch of the mandibular nerve. 236 Todos los derechos reservados. Reg. Nº: 5104953 www.anatclinar.com.ar Anomalous course of maxillary artery Rev Arg de Anat Clin; 2013, 5 (3): 235-239 __________________________________________________________________________________________ CASE REPORT Variations in the course of the maxillary artery were mainly focused on its relation to the lower This variation in the course of maxillary artery head of the lateral pterygoid muscle. According to was observed during routine dissection in the Compendium of Human Anatomic variation by department of anatomy, Kasturba Medical Bergman et al (1988) the maxillary artery was College, Mangalore in a 75 year old male found medial to the lateral pterygoid muscle in cadaver and the cause of death and patient’s 30.5% of the cases and lateral to it in 69.5%. In history is unknown. Zygomatic arch was divided, another study, the maxillary artery was deep masseter stripped from the ramus of the (medial) to the lateral pterygoid muscle in 46% of mandible exposing the temporalis. Further 447 dissections and superficial (lateral) to it in separating the coronoid process from the 54% (Bergman et al). In a study by Uysal et al mandible, neurovascular bundle and deeper (2011) the maxillary artery was found superficial structures of the infratemporal fossa were (lateral) to the lateral pterygoid muscle in 57.2% dissected carefully and variations were noted and of the cases. In another study by Hussain et al recorded using a digital camera. (2008) the artery was found lateral to the lower The origin of the maxillary artery on the right side head of the lateral pterygoid muscle (71% in men was normal and it passed deep to the lower head and 65% in women) and medial to the lower head of the lateral pterygoid muscle (the muscle had of the lateral pterygoid muscle in only 14 of the been removed), then the artery passed through cases (29% in men and 35% in women). The the loop of the auriculo-temporal nerve where it results of all these studies are consistent and gave the middle meningeal artery (Fig.1). The help to conclude that the maxillary artery more maxillary artery proceeded forward, deep to the often passed superficial (lateral) to the lower inferior alveolar nerve and superficial to the head of the lateral pterygoid muscle on its way to lingual nerve and finally entered the pterygo- pterygo-palatine fossa. Further referring to the maxillary fissure. The auriculo-temporal nerve is relations of maxillary artery to the branches of the formed by thick superior root and thin inferior root mandibular nerve, the commonest pattern was passing the maxillary artery between them and the artery passing lateral to the inferior alveolar also the origin of middle meningeal artery. The and lingual nerves (Standring, 2008). buccal branch of mandibular nerve passed deep An interesting report about the bifurcation of to the deep temporal nerve and superficial to the maxillary artery into unequal superficial (larger) third part of maxillary artery (Figure 1). A and deep (smaller) divisions was reported by communication was noticed between the inferior Claire et al (2011) where the superficial and deep alveolar and the lingual nerve. The other divisions joint to form a complete loop, before branching pattern of maxillary artery and giving the terminal branches in the pterygo- mandibular nerve was found to be normal and no palatine fossa. The entire arterial loop lied similar anomaly was observed on the left side. superficial to the branches of the mandibular nerve. Quain reported a case cited by Bergman et al (1988) about the maxillary artery providing two branches that entered the cranial cavity (one DISCUSSION branch through the foramen rotundum and the second through the foramen ovale) to The origin of maxillary artery is usually constant, compensate for the absence of the internal but very rarely it arises as a branch of the facial carotid artery. artery piercing the medial pterygoid muscle in its Variations in the course of the maxillary artery upward course into the zygomatic fossa are of importance in many surgical procedures. (Bergman et al, 1988). According to Susan Refractory epistaxis is managed by ligation of the Standring (2008) the first part of maxillary artery sphenopalatine artery via a transmaxillary - passes between the neck of mandible and transantral approach; there is a considerable risk sphenomandibular ligament parallel to and of complications associated with such invasive slightly below auriculo-temporal nerve but in the surgical approaches added on by variations in present case the artery was passing through the the course of the maxillary artery (Kwak et al, loop of auriculo-temporal nerve. Maxillary artery 2010). In cases of persistent epistaxis angio- then passed deep to lateral pterygoid muscle. It graphy guided arterial embolization of maxillary is often seen superficial to the branches of artery is mentioned as an efficient, alternate mandibular nerve but in the present case the method to arterial ligation (Uysal et al, 2011) but artery was passing deep (medial) to inferior knowledge of variations in the course of the alveolar nerve, superficial (lateral)
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