Revista Română de Anatomie funcţională şi clinică, macro- şi microscopică şi de Antropologie Vol. XVII – Nr. 4 – 2018 UPDATES ANatOMICAL PARTICULARITIes OF THE DENTO-MAXILLARY SYsteM Corina Ciupilan1*, Alexandra Pangal2, Şt. Şelaru3, R. Maxim1, C.I. Stan1 “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania Faculty of Medicine 1. I-st Morpho-Functional Sciences Department 2. Mother and Child Department 3. Student ANATOMICAL PARTICULARITIES OF THE DENTO-MAXILLARY SYSTEM (Abstract): The entire circulatory system is essentially represented by an entry-exit mechanism, which is supple- mented by the management of the defence, stabilization and repair elements. In effect, these so intricate and complicated transport channels have the role of maintaining the other protected systems, viable and on-going. The arterial, venous and lymphatic vascularization of the dento- maxillary system presents many interesting problems, due to the wide variability of these vessels, their distribution territory and especially by the wide practical applicability in dentistry of these variants. Material and Method: In order to highlight the vascular pedicles in three old patients, we used 3 dead bodies 3 anatomical parts (head and neck) of the “Ion Iancu” Institute of Anato- my of the “Gr. T. Popa” University of Medicine and Pharmacy Iaşi. Results and discussions: The reports and its situation were quite constant, in the Carotid triangle, in the subangular mandibular region as well as in the parotid region. Conclusions: A single dead body showed the most varia- tions, both in the arterial system and in the lymphatic venous one. By correlating this fact with other circulatory system abnormalities in the same dead body, we can conclude that in this case we are talking about a congenital disorder of the circulatory system. Key-words: DENTO-MAX- ILLARY SYSTEM, CAROTID TRIANGLE, SUBANGULAR MANDIBULAR REGION, PA- ROTID REGION INTRODUCTION The external carotid artery starts laterally The arteries of the oral cavity and of the from the upper edge of the thyroid cartilage, at adjacent region come, with a few exceptions, the level of the intervertebral disc between the from the external carotid artery. The external third and fourth thoracic vertebra. It represents carotid artery is sometimes called the facial the artery of the face, neck and dura mater. It carotid, because of the vascularization of the is born in the upper edge of the thyroid cartilage superficial and deep structures of the face, (2, 3). while the internal carotid is often called by the The facial artery is also called the external name of the cerebral carotid, due to the fact maxillary artery; it comes from the outer ca- that in most of its part it vascularises the brain. rotid, slightly above the lingual. In terms of The left common carotid arteries are up to reports, the facial artery has two portions: the the back of the left sternoclavicular joint (1). cervical portion of the Farabeuf triangle area, The cervical part of the common carotid delimitated by the internal jugular vein, ante- arteries begins at the level of the sternoclavicu- rior to Farabeuf’s thyroid-lingual-pharynx-fa- lar joint and is identical for both common ca- cial trunk and above the nerve XII (4, 5). It rotid arteries: left and right. The arteries climb then arrives in the paratonsillar region and then up and outside to the upper edge of the thyroid in the sub-maxillary region, finding itself on cartilage, where they are divided into external the inside of the parotid gland, then passes to and internal carotid arteries. the front; in the facial area, the artery passes 277 Corina Ciupilan et al. over the buccinator muscles, the canine one, and deep bifurcation branch of the external the muscle lifting the upper lip and the common carotid artery. Although the temporal superfi- one of the upper lip and the nose’s wing, being cial continues the external carotid path upwards covered by the skin muscle of the neck and the from an embryological and phylogenetic point major and minor zygomatic one (6). of view, the internal maxillary is the continua- The facial vein is located behind the artery, tion of the external carotid. It is born at the forming the arc end described by the artery. level of the mandible’s condyle cervix, passes The lingual artery comes off the antero-in- through the Juvara’s retrocondylar buttonhole, ternal side of the external carotid, underneath accompanied by the auriculo-temporal nerve. the facial artery. The lingual artery tract can be The superficial temporal artery is the exter- divided into four portions: the first portion nal bifurcation branch of the external carotid extends to the posterior edge of the hyoglossus, artery (final branch). It is born in the parotid it lies in the Carotid portion in the Farabeuf lodge at the level of the mandible’s condyle. It triangle area, the second portion is in the lat- then comes out of the parotid lodge together eral suprahyoid region, the lingual artery being with the auriculo-temporal nerve located be- situated under the hyoglossus (first it is hori- hind it. It then faces the tragus, crosses the zontal and is located in Beclard’s triangle, then posterior root of the zygomatic arch, and 2-3 ascends being located in the Pirogoff triangle); cm above it divides into two terminal branches: the third part, very short, is found in the sub- anterior (frontal) and posterior (parietal). Dur- lingual region. The artery is very sinuous and ing its course, the artery is joined by the satel- comes in relation internally with the genioglos- lite vein, which can be found either anterior or sus, externally to the muscular hiatus delimited posterior and by the auriculo-temporal nerve, by genioglossus, mylohyoid and mucosa of the which is most often found behind the artery buccal floor (7, 8 ,9). By this hiatus, the ante- (13). rior extension of the sub-maxillary gland and The venous vascularization of the dento- Wharton’s canal passes, the fourth portion is maxillary system – the venous blood of the found in the thickness of the tongue, where the head and neck is drained almost entirely by the artery has the name of ranine artery (after it internal jugular vein, which connects with the has given the main collateral flank, the sublin- sternoclavicular vein behind the sternoclavicu- gual artery). lar joint to form the brachiocephalic venous The lingual artery ends at the tip of the trunk. The two trunks join together to form the tongue, where it is anastomosed with the same upper vein. Two superficial veins are added to artery on the opposite side, constituting May- the inner jugular vein: the external jugular vein er’s ranine arc (10). and the anterior jugular vein. At the root of the The ascending pharyngeal artery is the thin- neck, the two superficial veins flow into the nest collateral branch in the outer carotid ar- deep veins. The superficial and deep veins are tery. It is born from the internal face of this joined by a few anastomoses: they are joined artery, at the same level as the lingual one. It together, and the great variability of the veins turns vertically on the side wall of the pharynx, on the face and neck is caused by the large in which it branches. It is distributed to the number of possible drainages of venous blood. pharynx and especially to the upper and middle Thus, anastomotic branches can provide large constrictor (11). proportions of drainage, while typical veins The upward pharyngeal artery sends three may diminish in calibre (10, 14). pharyngeal arteries to the pharynx: upper, The intracranial veins, draining the blood of middle and inferior. In addition to these col- the brain, are connected by multiple anastomo- lateral branches, the ascending pharynx one ses with extracranial veins, allowing the blood also gives the following branches: the tym- to pass in both directions. panic branch, two meningeal branches, a pre- Anastomoses between the veins of the skull, vertebral branch, a lymph node branch, and a included in a rigid capsule, and extracranial tubular branch for the lower wall of the Eus- veins represent safety valves. Their existence tache tube (12). prevents an increase in intracranial pressure, The internal maxillary artery is the internal which may occur if the internal jugular vein, 278 Anatomical Particularities of the Dento-Maxillary System the main drainage of the cranial blood is com- open, favouring the entry of the air and the pro- pressed. In this case, the cerebral blood can be duction of gas embolism, almost always fatal (6). drained in many directions. The external jugular vein drains the regions These communications represent a potential that are vascularized by the internal maxillary of infection spread, primarily involving an ex- arteries and by the superficial temporal artery. tracranial vein, for example the facial vein, an The external jugular vein is formed by the un- infection that can reach the intracranial veins, ion of superficial temporal veins. with implications of the meninges and the brain. The superficial temporal artery and its The risk of retrograde spread of infection is branches are often accompanied by two veins. greatest, as the facial veins have few or no The two internal maxillary veins represent the valves, valves that prevent a retrograde spread exit of the large and dense pterygoid venous of the infection. This adds to the fact that the plexus that surrounds the internal maxillary intracranial veins are not collapsible (10, 15). artery in the infratemporal fossa. The sinuses of the cranial dura mater do not The anterior jugular vein represents the have their own walls, but there are spaces or second superficial vein of the neck (after the canals between the dura mater coatings.