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Trifurcation of External Carotid Artery and Variant Branches of First Part of Maxillary Artery N

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Trifurcation of External Carotid Artery and Variant Branches of First Part of Maxillary Artery N International Journal of Anatomy and Research, Int J Anat Res 2014, Vol 2(3):561-65. ISSN 2321- 4287 Case Report TRIFURCATION OF EXTERNAL CAROTID ARTERY AND VARIANT BRANCHES OF FIRST PART OF MAXILLARY ARTERY N. Shakuntala Rao *1, K. Manivannan 2. Gangadhara 3, H. R. Krishna Rao 4. *1 Professor, 2 Assistant Professor, 3 Associate Professor, 4 Professor and Head. Department of Anatomy, P E S Institute of Medical Sciences & Research, Kuppam, Andhra Pradesh, India. ABSTRACT The external carotid artery normally divides into two terminal branches at the level of the neck of the mandible. The terminal branches are usually the superficial temporal and maxillary arteries. The maxillary artery is described to be in three parts in relation to the lateral pterygoid muscle as the mandibular (first), pterygoid (second) and the pterygopalatine (third) parts. The second part passes behind the muscle. The branches that arise from the first part of the maxillary artery are the deep auricular, anterior tympanic, the middle meningeal, accessory meningeal and inferior alveolar arteries. The middle meningeal artery normally arises at the lower border of lateral pterygoid muscle from the first part of maxillary artery. It then ascends upwards, passes between the two roots of the auriculotemporal nerve and enters the foramen spinosum in the base of skull. During routine dissection of a male cadaver in the department of anatomy while teaching medical students variations were observed in the termination of the external carotid artery on the right side. The artery gave three branches at the termination, superficial temporal, maxillary and between the two the middle meningeal artery was seen arising close to the end of the external carotid artery. The middle meningeal artery did not pass between the two roots of the auriculotemporal nerve. The branches of first part of maxillary artery were variable. The deep auricular branch was absent and its territory may have been supplied by the posterior auricular and anterior auricular arteries. The anterior tympanic and accessory meningeal arteries arose from the middle meningeal artery. There were two inferior alveolar arteries 1.5 cm apart arising from the first part of maxillary artery. The first artery went to the mandibular canal along with the inferior alveolar nerve. The second artery accompanied the lingual nerve to the last molar tooth. Probably this artery may have been an additional supply to the gingiva around the last molar tooth. The other variations that were noted were the absence of mylohyoid branch from the inferior alveolar artery. To the best of our knowledge these variations in the arteries have not been previously reported. KEYWORDS: Trifurcation, External carotid artery, middle meningeal artery, double inferior alveolar arteries. Address for Correspondence: : Dr. N. Shakuntala Rao, Professor, Department of Anatomy, P E S Institute of Medical Sciences & Research, Kuppam 517 425, Andhra Pradesh, India. E-Mail: [email protected] Access this Article online Quick Response code Web site: International Journal of Anatomy and Research ISSN 2321-4287 www.ijmhr.org/ijar.htm Received: 19 Aug 2014 Peer Review: 19 Aug 2014 Published (O):30 Sep 2014 Accepted: 14 Sep 2014 Published (P):30 Sep 2014 INTRODUCTION with the transient artery called the ventral pharyngeal artery. The ventral pharyngeal artery The middle meningeal artery develops from the arises when the first and second arch arteries stapedial artery which arises from the dorsal begin to regress. It terminates by dividing into stem of the second arch artery. This connects mandibular and maxillary branches. A vessel Int J Anat Res 2014, 2(3):561-65. ISSN 2321-4287 561 N. Shakuntala Rao et al.. TRIFURCATION OF EXTERNAL CAROTID ARTERY AND VARIANT BRANCHES OF FIRST PART OF MAXILLARY ARTERY. from the dorsal stem of second arch artery Thus the proximal part of stapedial artery forms passes through the ring of stapes and anasto- the proximal part of middle meningeal artery. moses with the cranial end of ventral pharyn- The distal part of stapedial artery which is the geal artery. The stapedial artery follows the supraorbital division gives the intracranial divisions of the fifth nerve and its three segment of middle meningeal artery. corresponding branches are named mandibular, The external carotid artery normally divides into maxillary and supraorbital. The first two two terminal branches at the level of the neck branches have a common stem. The external of the mandible. The terminal branches are carotid artery arises from the base of the third usually the superficial temporal and maxillary arch. It incorporates the stem of the ventral arteries. The maxillary artery is described to be pharyngeal artery. The maxillary branch of in three parts in relation to the lateral pterygoid external carotid artery communicates with the muscle as the mandibular (first), pterygoid common trunk of origin of maxillary and (second) and the pterygopalatine ( third) parts. mandibular branches of stapedial artery. The The second part passes behind the muscle. proximal part of the common trunk forms the Thebranches that arise from the first part of the stem of the middle meningeal artery. Therefore maxillary artery are the deep auricular, anterior the middle meningeal artery has its origin in the tympanic, the middle meningeal, accessory stapedial artery originally. The proximal part of meningeal and inferior alveolar arteries. The supraorbital artery represents the distal part of middle meningeal artery normally arises at the the middle meningeal artery. The maxillary lower border of lateral pterygoid muscle from artery becomes the infraorbital vessel and the the first part of maxillary artery. It then ascends mandibular branch forms the inferior alveolar upwards, passes between the two roots of the artery. When the definitive ophthalmic artery auriculotemporal nerve and enters the foramen differentiates as a branch of the terminal part spinosum in the base of skull. of the internal carotid artery it communicates with the supraorbital branch of the stapedial MATERIALS AND METHODS artery. The distal part of which becomes the During routine dissection of an embalmed male lacrimal artery. The dorsal stem of the second cadaver in the department of Anatomy P.E.S. arch artery remains as a carotico-tympanic Medical College Kuppam, Andhra Pradesh, India, branch of the internal carotid artery. used for conventional teaching purposes as per In short the mandibular and maxillary branches the curriculum of first year medical students, which form the maxillofacial division of stapedial variations were found in the external carotid, artery are taken in by the developing external middle meningeal and the inferior alveolar carotid artery and the maxillary artery is formed. arteries. All the branches were traced to their This also forms the part of middle meningeal distal ends as much as possible and artery before it enters the cranial fossa. photographed. Fig. 1: Trifurcation of External Carotid Artery on Right Side. ECA- External Carotid Artery, STA- Superficial temporal artery, MMA-Middle meningeal artery, MA-Maxillary artery, ATA-Anterior tympanic artery, AMA-Acesssary meningeal artery, IAA-1-Inferior alveolar artery-1, IAA-2—Inferior alveolar artery-2. Int J Anat Res 2014, 2(3):561-65. ISSN 2321-4287 562 N. Shakuntala Rao et al.. TRIFURCATION OF EXTERNAL CAROTID ARTERY AND VARIANT BRANCHES OF FIRST PART OF MAXILLARY ARTERY. Fig. 2: Origin Of Double Inferior Alveolar Arteries. ECA- External Carotid Artery, STA- Superficial temporal artery, MMA-Middle meningeal artery, MA-Maxillary artery, IAA-1-Inferior alveolar artery-1, IAA-2—Inferior alveolar artery-2. DISCUSSION provide knowledge concerning the morphoge- The origin of middle meningeal artery at the nesis, variation, and clinical significances of the termination of the external carotid artery, close MMA, and to help promote future studies in this to the origin of the superficial temporal and area. Da Silva et al concluded that these maxillary arteries was observed. Developmen- variations are of clinical significance in fractures tally the middle meningeal artery has two parts. of the squamous and petrous parts of the The proximal part is from the common stem of temporal bones and in surgical interventions maxillary and mandibular branches of the involving the nerve of the pterygoid canal and stapedial artery. The distal is from the proximal maxillary artery. The review shall be useful for part of supraorbital branch of stapedial artery. clinicians, surgeons and academics. The stapedial artery is an artery of the second branchial arch. The maxillary division of external The MMA may take its origin as a branch of carotid which grows as a bud from the third arch, persistent stapedial artery (PSA) [3]. The MMA incorporates the common stem of the maxillary of stapedial origin is called the stapedial middle and mandibular branches to form the extracranial meningeal artery (SMMA). The first case was stem of the middle meningeal artery [1]. In this described by Hyrtl in 1836 as cited by Manjunath case it seems that the original stapedial artery K.Y [3]. itself had three separate branches the The PSA is a branch of the intrapetrous portion supraorbital,the maxillary and mandibular. Thus of the internal carotid artery, enters the tympanic the external carotid artery has directly cavity through its floor and passes through the incorporated the supraorbital branch of the obturator foramen of the stapes. Over the stapedial artery to form the stem of the middle promontory it is enclosed in a bony canal and meningeal artery. Thus the external carotid enters the facial canal. It emerges in to the artery has trifurcated in this case [figure -1]. middle cranial fossa under the dura and gives Da Silva[2] has described the probable off the middle meningeal branch (Altman 1947). embryological mechanism of the origin of the Altmann F has also described anomalous middle meningeal artery in their review article. development of ascending pharyngeal artery Da Silva et al in their study have said that from internal carotid artery[4].
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