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Clinical Anatomy of the Maxillary Artery

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Clinical Anatomy of the Maxillary Artery Okajimas CnlinicalFolia Anat. Anatomy Jpn., 87 of(4): the 155–164, Maxillary February, Artery 2011155 Clinical Anatomy of the Maxillary Artery By Ippei OTAKE1, Ikuo KAGEYAMA2 and Izumi MATAGA3 1 Department of Oral and Maxilofacial Surgery, Osaka General Medical Center (Chief: ISHIHARA Osamu) 2 Department of Anatomy I, School of Life Dentistry at Niigata, Nippon Dental University (Chief: Prof. KAGEYAMA Ikuo) 3 Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Niigata, Nippon Dental University (Chief: Prof. MATAGA Izumi) –Received for Publication, August 26, 2010– Key Words: Maxillary artery, running pattern of maxillary artery, intraarterial chemotherapy, inner diameter of vessels Summary: The Maxillary artery is a component of the terminal branch of external carotid artery and distributes the blood flow to upper and lower jawbones and to the deep facial portions. It is thus considered to be a blood vessel which supports both hard and soft tissues in the maxillofacial region. The maxillary artery is important for bleeding control during operation or superselective intra-arterial chemotherapy for head and neck cancers. The diagnosis and treatment for diseases appearing in the maxillary artery-dominating region are routinely performed based on image findings such as CT, MRI and angiography. However, validations of anatomical knowledge regarding the Maxillary artery to be used as a basis of image diagnosis are not yet adequate. In the present study, therefore, the running pattern of maxillary artery as well as the type of each branching pattern was observed by using 28 sides from 15 Japanese cadavers. In addition, we also took measurements of the distance between the bifurcation and the origin of the maxillary artery and the inner diameter of vessels. These findings thus obtained could contribute to knowledge of improved accuracy of image diagnosis as an index for embolization and for knowledge of an adequate super- selective intra-arterial chemotherapy. Introduction Subjects and Methods The maxillary artery along with the superficial tem- Subjects poral artery is a terminal branch of the external carotid We studied 28 sides of symmetrically dissected heads artery. Its branches extended into the deep parts of the of 15 Japanese cadavers (21 sides in 11 men and 7 sides face, including the maxilla, mandible, cerebral dura mater, in 4 women) in which the maxillary artery could be and the nasal cavity. Clinically, the maxillary artery plays closely examined and measured. All the cadavers were an important role in superselective intra-arterial infusion preserved at Department of Anatomy, the Nippon Dental chemotherapy for head and neck cancers1, 2), arterial University School of Life Dentistry at Niigata. The mean embolization therapy for vascular lesions such as arte- age was 69.1 ± 16.9 years (range, 22 to 90). riovenous malformation and refractory nasal bleeding3–7), and reconstruction after tumor resection8, 9). Methods Studies of the maxillary artery have a long history, The coronoid process was transected, and the tem- dating back to reports by Thomson10), Lauber11), Adachi12), poral muscle was turned superiorly to expose the infra- Fujita13), and Lasker14). Recently, Japanese researchers temporal fossa. After confirming the relation between such as Sashi15) and Tsuda16–18) have evaluated the maxil- the lateral pterygoid muscle and the maxillary artery, the lary artery angiographically, whereas Kitsuta et al. (19) lateral pterygoid muscle was removed, and the maxillary have macroscopically studied anatomic characteristics. artery, its branches, and the surrounding nerves were We macroscopically studied the origins, courses, branch- photographed and sketched in detail. The region extend- ing patterns, and the luminal diameters of the maxillary ing from the origin of the maxillary artery to the point artery and its branches in Japanese cadavers. of entry into the pterygopalatine fossa was carefully removed. The distances between each of the branches and the luminal diameters of the main branches were Corresponding author: Ippei Otake, Osaka General Medical Center, Sumiyoshi-ku, Osaka, 558-8558 Japan. E-mail: [email protected] 156 I. Otake et al. ECA: external carotid a. ST: superficial temporal a. Mx: maxillary a. MM: middle meningeal a. AM: accessory meningeal a. IA: inferior alveolar a. PT: posterior deep temporal a. B: buccal a. AT: anterior deep temporal a. PSA: posterior superior alveolar a. IO: infraorbital a. SP: sphenopalatal a. TM: temporal m. LP: lateral pterygoid m. MP: mesial pterygoid m. ATN: auriculotemporal n. IAN: inferior alveolar n. LN: lingual n. BN: buccal n. FO: foramen ovale FS: foramen spinosum (a.: artery, m.: muscle, n.: nerve) Fig. 1. Measuring points. measured. The following examinations and measure- ments were performed. 1) Levels of maxillary artery branches The distance between the origin of the maxillary artery and the superior margin of the external auditory canal was measured along a line parallel to the axis of the body (Fig. 1). The height of the origin of the maxillary artery was distinguished from the height of the bifurcation of the common carotid artery was classified into 3 groups as described in the following by Ito et al.20): a higher than average bifurcation, located near the region from the 2nd to 3rd cervical vertebrae; a standard bifurcation, located near the region from the 3rd to 4th cervical vertebrae; and a lower than average bifurcation, located near the region from the 4th to 5th cervical vertebrae. 2) Course of the main trunk of the maxillary artery The course of the main trunk of the maxillary artery was classified as following with respect to the lateral pterygoid muscle: with an external course pattern, if the main trunk ran superficial to the lateral pterygoid muscle; or with an internal course pattern, if the main trunk ran deep to the lateral pterygoid muscle (Fig. 2). The positional relation between the maxillary artery and the mandibular nerve was classified as described by Fujita (Fig. 3). Fig. 2. Positional relationship between Mx and lateral pterygoid. Cnlinical Anatomy of the Maxillary Artery 157 Fig. 3. Positional relationship between Mx, lateral pterygoid, and mandibular nerve 3) Orders of branches arising from the maxillary artery fossa was regarded as 100%, the relative distances of the The orders of the branches arising from the maxillary origins of each of the branches from the main trunk of artery were classified as described by Ikakura21). In Type the maxillary artery were calculated. I, after arising from the external carotid artery the maxil- lary artery gives off branches in the following order: the 5) Luminal diameters of the main trunk of the maxillary middle meningeal artery, the inferior alveolar artery, the artery and its branches posterior deep temporal artery, the buccal artery, the ante- The following 9 arteries were studied: the main trunk rior deep temporal artery, the posterior superior alveolar of the maxillary artery, the middle meningeal artery, artery, the infraorbital artery, the descending palatine the inferior alveolar artery, the posterior deep temporal artery, and the sphenopalatine artery. In Type II, the order artery, the buccal artery, the anterior deep temporal artery, of the middle meningeal artery and the inferior alveolar the posterior superior alveolar artery, the infraorbital artery is reversed. In Type III, the buccal artery is absent. artery, and the sphenopalatine artery. A section 1 mm in If the posterior superior alveolar artery and infraorbital width was cut 1 cm distal to the origin of each branch. artery arise from a common trunk, each type is classified Each specimen was cut open parallel to the course of the as type Ia, type IIa, and type IIIa, respectively (Fig. 4). vessel and mounted on a slide glass. The length between the two ends was measured with the use of a stereo- 4) Distances of the branches from the main trunk of the microscope (Stereo Photo SMZ-10, Nikon Co., Tokyo maxillary artery Japan) and a digital vernier caliper (Digimatic Caliper The distance from the main trunk of the maxillary 500–110, Sankin Co., Ltd., Tokyo, Japan) to derive the artery to each of its branches was measured as described lumen diameter. The same site was measured 3 times, by Shimada et al.22) A silk thread was placed along the and the mean value was calculated. If branches arose course of the vessel and extended in a straight line to from a common trunk, the site 1 cm distal to the origin measure the distance from the main trunk to each branch. of the common trunk was measured. The Wilcoxon rank- The proportional distance from the origin of the maxil- sum test was used for statistical analysis. lary artery to the point of entry into the pterygopalatine 158 I. Otake et al. Fig. 4. Classification on the derivative order of branches of Mx. Results Table 1. Distance between superior margin of external auricular me- atus and origin of Mx 1) Height of the origin of the maxillary artery (n = 28/mm) The vertical height of the origin of the maxillary Right Left artery from the superior margin of the external auditory Male 24.3 ± 5.6 23.2 ± 3.6 canal ranged from 15.4 mm to 32.7 mm (mean, 23.4 ± (15.4~32.7) (17.4~28.7) 5.1 mm) on the right side and from 12.5 mm to 28.7 mm Female 21.2 ± 3.2 20.2 ± 7.3 (mean, 22.6 ± 4.5 mm) on the left (Table 1). The height (18.4~28.7) (12.5~26.8) of the bifurcation of the common carotid artery was stan- Average 23.4 ± 5.1 22.6 ± 4.5 dard in 15 patients (53.5%), high in 9 (32.2%), and low (15.4~32.7) (12.5~28.7) in 1 (3.6%) (Table 2). 2) Course of the main trunk of the maxillary artery Table 2.
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