scholarly journals A Morphometric Study of the Maxillary Artery and Lingula in Relation to Mandibular Ramus Osteotomies and TMJ Surgery

2010 ◽  
Vol 04 (02) ◽  
pp. 166-170 ◽  
Author(s):  
Huseyin Avni Balcioglu ◽  
Cenk Kilic ◽  
Altan Varol ◽  
Hasan Ozan ◽  
Necdet Kocabiyik ◽  
...  
Keyword(s):  
Infratemporal Fossa ◽  
Postoperative Hemorrhage ◽  
Morphometric Study ◽  
Maxillary Artery ◽  
Mandibular Ramus ◽  
Main Trunk ◽  
Tmj Ankylosis ◽  
Bony Landmarks ◽  
Inferior Border ◽  
Mandibular Notch

Objectives: Mandibular osteotomies and resection of the temporomandibular joint (TMJ) ankylosis are the mostly performed surgical procedures in the infratemporal fossa, which is in close proximity with the main trunk of the maxillary artery (MA). It is imperative to avoid the trunk or branches of the maxillary artery, otherwise, massive intraoperative or postoperative hemorrhage may develop. The goal of the study was to investigate the position of the maxillary artery in the infratemporal fossa and the lingula of the mandible.Methods: Significant landmarks were selected on the mandibles of formalin fixed cadavers, and the distances were measured between the maxillary artery and the bony landmarks with a digital caliper.Results: The average distances between the MA and the articular eminence, the medial cortex of the mandibular ramus, the inferior border of the pterygoid fovea and the mandibular notch were 1.67±0.48 mm, 5.38±2.47 mm, 16.84±1.74 mm, 2.94±0.52 mm, respectively. Course pattern of the MA at the subcondylar level was also mapped. In order to determine the position of the lingula, the average distances between the tip of the lingula and the mandibular notch, the inferior border of the ramus, the anterior margin of the ramus and posterior margin of the ramus were measured and found as 15.4±2.1 mm, 49.5±4.3 mm, 18.1±2.7 mm, 16.6±2.5 mm, respectively. No significant differences were found between the right and left sides, for all parameters.Conclusions: The studied parameters will assist and navigate clinicians to determine the anatomic proximity to the maxillary artery, and, minimize the risk of damaging the vessel. (Eur J Dent 2010;4:166-169)

scholarly journals Topographical Landmarks for Identification of Inferior Alveolar Nerve and its Surgical Implications - a Cadaveric Study

2021 ◽  
Author(s):  
Ariyanachi K ◽  
Sushma P
Keyword(s):  
Nerve Block ◽  
Inferior Alveolar Nerve ◽  
Inferior Alveolar Nerve Block ◽  
Mandibular Ramus ◽  
Nerve Blocks ◽  
Mandibular Foramen ◽  
Bony Landmarks ◽  
Posterior Division ◽  
Mandibular Notch ◽  
Formalin Fixed

Abstract Background: Inferior alveolar nerve, which arises from the posterior division of the mandibular nerve, contains both sensory and motor fibres. The intraosseous course of the nerve is variable. Mandibular foramen is situated on the medial surface of the mandibular ramus. It is an important anatomical landmark for procedures like sagittal split osteotomies and inferior alveolar nerve block.Methods: The precise location of mandibular foramen was studied by the dissection of formalin fixed cadavers available for undergraduate dissection for a period of two years fron 2014-2016. Results: The mandibular foramen was 21±3.33 mm superior to the gonion at an angle of 980±50 with the base of the mandible. The mandibular foramen was 20.13±3.1 mm inferior to the lowest point of the mandibular notch. Accessory mandibular foramen was observed in 9.37% of the samples dissected.Conclusion: The present study explains the position of mandibular foramen in relation to prominent bony landmarks and the knowledge about the mandibular foramen, helps dental surgeons during inferior alveolar nerve blocks and split osteotomies.Practical implications: Failure rate of the inferior alveolar nerve block has been reported to be approximately 20-25%. A thorough anatomical knowledge of the mandibular ramus is essential for inferior alveolar nerve blocks and sagittal split osteotomies, since they are technically difficult procedures and as they are also associated with a higher incidence of complications.

scholarly journals PERFORATION OF INFERIOR ALVEOLAR NERVE BY MAXILLARY ARTERY. Perforation of inferior alveolar nerve by maxillary artery

2016 ◽  
Vol 3 (3) ◽  
pp. 124-129
Author(s):  
Prakash B Billakanti
Keyword(s):  
Infratemporal Fossa ◽  
Maxillofacial Surgery ◽  
Inferior Alveolar Nerve ◽  
Anatomical Variations ◽  
Clinical Implications ◽  
Maxillary Artery ◽  
Foramen Ovale ◽  
Anesthetic Agents ◽  
Male Cadaver ◽  
Anatomical Area

La fosa infratemporal es un área anatómica clínicamente importante para la administración de agentes anestésicos locales en odontología y cirugía maxilofacial. Fueron estudiadas variaciones en la anatomía del nervio alveolar inferior y la arteria maxilar en la disección infratemporal. Durante la disección rutinaria de la cabeza en el cadáver de un varón adulto, fue observada una variación excepcional en el origen del nervio alveolar inferior y su relación con las estructuras circundantes. El nervio alveolar inferior se originaba en el nervio mandibular por dos raíces y la primera parte de la arteria maxilar estaba incorporada entre ambas. El origen embriológico de esta variación y sus implicaciones clínicas es debatido. Dado que la arteria maxilar transcurría entre las dos raíces del nervio alveolar inferior, y el nervio estaba fijado entre el foramen oval y el foramen mandibular, el atrapamiento vásculo-nervioso pudo causar entume-cimiento o dolor de cabeza e interferir con la inyección de anestésicos locales en la fosa infratemporal.  Variaciones anatómicas en esta región deben ser tenidas en cuenta, especialmente en casos de tratamiento fallido de neuralgia del trigémino. Infratemporal fossa is clinically important anatomical area for the delivery of local anesthetic agents in dentistry and maxillofacial surgery. Variations in the anatomy of the inferior alveolar nerve and maxillary artery were studied in infratemporal dissection. During routine dissection of the head in an adult male cadaver an unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originated from the mandibular nerve by two roots and the first part of the maxillary artery was incorporated between them. An embryologic origin of this variation and its clinical implications is discussed. Because the maxillary artery runs between the two roots of the inferior alveolar nerve, and the nerve was fixed between the foramen ovale and mandibular foramen, neurovascular entrapment may cause pain numbness or headache and may interfere with the injection of local anesthetics into the infratemporal fossa. Anatomical variations in this region should be kept in mind, particularly in cases of failed treatment of trigeminal neuralgia.

Endoscopic transorbital approach to the infratemporal fossa and parapharyngeal space: a cadaveric study

2020 ◽  
Vol 133 (6) ◽  
pp. 1948-1959 ◽  
Author(s):  
Mina M. Gerges ◽  
Saniya S. Godil ◽  
Iyan Younus ◽  
Michael Rezk ◽  
Theodore H. Schwartz
Keyword(s):  
Carotid Artery ◽  
Parapharyngeal Space ◽  
Infratemporal Fossa ◽  
Middle Meningeal Artery ◽  
Endoscopic Approach ◽  
Surgical Approaches ◽  
Maxillary Artery ◽  
Lateral Pterygoid Muscle ◽  
Endoscopic Techniques ◽  
Endoscopic Transorbital

OBJECTIVEThe infratemporal fossa (ITF) and parapharyngeal space are anatomical regions that can be challenging to access without the use of complex, cosmetically disfiguring approaches. With advances in endoscopic techniques, a new group of surgical approaches to access the intracranial space through the orbit has been recently referred to as transorbital neuroendoscopic surgery (TONES). The objective of this study was to establish a transorbital endoscopic approach utilizing the inferior orbital fissure (IOF) to gain access to the ITF and parapharyngeal space and provide a detailed endoscopic anatomical description of this approach.METHODSFour cadaveric heads (8 sides) were dissected using a TONES approach through the IOF to reach the ITF and parapharyngeal space, providing stepwise dissection with detailed anatomical findings and a description of each step.RESULTSAn inferior eyelid approach was made with subperiosteal periorbital dissection to the IOF. The zygomatic and greater wing of the sphenoid were drilled, forming the boundaries of the IOF. The upper head of the lateral pterygoid muscle in the ITF and parapharyngeal space was removed, and 7 distinct planes were described, each with its own anatomical contents. The second part of the maxillary artery was mainly found in plane 1 between the temporalis laterally and the lateral pterygoid muscle in plane 2. The branches of the mandibular nerve (V3) and middle meningeal artery (MMA) were identified in plane 3. Plane 4 was formed by the fascia of the medial pterygoid muscle (MTM) and the tensor veli palatini muscle. The prestyloid segment, found in plane 5, was composed mainly of fat and lymph nodes. The parapharyngeal carotid artery in the poststyloid segment, found in plane 7, was identified after laterally dissecting the styloid diaphragm, found in plane 6. V3 and the origin of the levator and tensor veli palatini muscles serve as landmarks for identification of the parapharyngeal carotid artery.CONCLUSIONSThe transorbital endoscopic approach provides excellent access to the ITF and parapharyngeal space compared to previously described complex and morbid transfacial or transcranial approaches. Using the IOF is an important and useful landmark that permits a wide exposure.

scholarly journals MORPHOMETRIC ANALYSIS OF MANDIBULAR FORAMEN AND INCIDENCE OF ACCESSORY MANDIBULAR FORAMINA IN ADULT HUMAN MANDIBLES OF AN INDIAN POPULATION. Análisis morfométrico del foramen mandibular e incidencia de la foramina mandibular accesoria en mandíbulas adult

2016 ◽  
Vol 5 (2) ◽  
pp. 60-66 ◽  
Author(s):  
Prajna Paramita Samanta ◽  
Poonam Kharb
Keyword(s):  
Indian Population ◽  
Average Distance ◽  
Inferior Alveolar Nerve ◽  
Anatomical Location ◽  
Mandibular Ramus ◽  
Oral Surgical Procedures ◽  
Mandibular Foramen ◽  
Adult Human ◽  
Para Determinar ◽  
Mandibular Notch

El foramen mandibular es un importante hito anatómico. Para procedimientos como el bloqueo alveolar inferior del nervio, el tratamiento con implantes y osteotomías mandibulares, un profundo conocimiento de la ubicación del foramen mandibular (MF) y el foramen mandibular accesorio (AMF) es un requisito previo. Hay pocas referencias en la literatura con respecto a la localización anatómica exacta del foramen mandibular. Por lo tanto, el presente estudio tuvo como objetivo identificar la ubicación exacta de la MF y la incidencia de la AMF alrededor MF en una población india. Sesenta (60) mandíbulas humanas adultas fueron estudiadas para determinar la distancia del LV de la los anteriores, bordes posteriores de la rama mandibular, maxilar inferior categoría y el ángulo de la mandíbula. AMF todo el MF también fueron estudiados por su presencia y números. La distancia media de MF del borde anterior de rama mandibular fue 15,72 ±2,92 mm(lado derecho), 16,23 ±2,88 mm(lado izquierdo), de borde posterior fue 13,29 ±1,74 mm(lado derecho) y 12,73 ±2,04 mm(a la izquierda lado). La MF se encuentra 22,70 ±3 mm(lado derecho) y 22, 27 ± 2,62 mm(lado izquierdo) de la muesca mandibular. La distancia de MF de ángulo de la mandíbula fue 21,54 ±2,92 mm(lado derecho) y 21,13 ±3.43 mm(lado izquierdo). AMF estuvieron presentes en el 16, 66% de las mandíbulas. En 10% de las mandíbulas una sola AMF estaba presente y en el 6,66% hubo dos agujeros presentes. La ubicación del MF y AMF es importante para evitar compli-caciones como hemorragia y parestesia durante los procedimientos quirúrgicos orales y también para los radioterapeutas en la planificación de la radioterapia.  The mandibular foramen is an important anatomical land mark. For procedures like inferior alveolar nerve block, implant treatment and mandibular osteotomies, a thorough knowledge of the location of the mandibular foramen (MF) and accessory mandibular foramina (AMFs) is a prerequisite. There are few references in the literature regarding the exact anatomical location of the mandibular foramen. Therefore, the present study was aimed to identify the precise location of the MF and the incidence of AMFs around MF in an Indian population. Sixty (60) adult human mandibles were studied to determine the distance of the MF from the anterior, posterior borders of the mandibular ramus, mandibular notch and angle of the mandible. AMFs around the MF were also studied for their presence and numbers. The average distance of MF from the anterior border of mandibular ramus was 15.72 ±2.92 mm(right side), 16.23 ±2.88 mm(left side), from posterior border was 13.29  ±1.74 mm(right side) and 12.73 ±2.04 mm(left side).The MF was located 22.70 ±3 mm(right side) and  22.27 ±2.62 mm(left side) from mandibular notch. The distance of MF from angle of mandible was 21.54 ±2.92 mm(right side) and 21.13 ±3.43 mm(left side). AMFs were present in 16.66% of mandibles. In 10% mandibles a single AMF was present and in 6.66 % double foramina were present. Location of MF and AMF is important to avoid complications like hemorrhage and paresthesia during oral surgical procedures and also for radiotherapists in planning radiation therapy. 

Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis

1992 ◽  
Vol 106 (6) ◽  
pp. 507-510 ◽  
Author(s):  
Bharath Singh ◽  
M. Med
Keyword(s):  
Arterial Occlusion ◽  
Nasal Packing ◽  
Medium Size ◽  
Maxillary Artery ◽  
Arterial Ligation ◽  
Main Trunk ◽  
Standard Management ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Intractable Epistaxis

AbstractWhilst it is generally accepted that the standard management for anterior or benign epistaxis is either cautery or anterior nasal packing, that of posterior or intractable epistaxis remains controversial. Various modalities of treatment, ranging from posterior nasal packing to arterial ligation and embolization, have been advocated but none have been unanimously accepted as the treatment of choice.The purpose of this paper was to determine the efficacy of internal maxillary arterial ligation versus combined internal maxillary arterial ligation and anterior ethmoid arterial coagulation in intractable epistaxis.Over a six year period, from 1985 to 1990,454 patients were admitted and treated for epistaxis. Forty-seven patients were diagnosed as having intractable epistaxis on the basis that the epistaxis failed to settle on anterior nasal packing. They were moved to the next step in management, which was combined anterior and posterior nasal packing. There were 30 failures, one was found to have choriocarcinoma of the maxilla, and was treated wtih cytotoxics, and the other 29 were moved to the next step, which was arterial ligation. Fifteen patients had internal maxillary arterial ligation, and 14 combined internal maxillary arterial ligation and anterior ethmoidal arterial coagulation.Large windows were created in both the anterior and posterior walls of the maxillary sinuses and all identifiable branches of the internal maxillary artery were dissected out carefully and two medium size ligating clips were placed over the main trunk, the sphenopalatine and the descending palatine branches. Single clips were placed on all other identifiable branches. Coagulation of the anterior ethmoidal artery was performed with a bipolar cautery. There were three (20 per cent) failures in the internal maxillary arterial ligation group and none in the combined internal maxillary arterial ligation and anterior ethmoidal arterial coagulation group. Furthermore, the three failures were successfully treated with anterior ethmoidal arterial coagulation. The conclusion is that combined internal maxillary and anterior ethmoidal arterial occlusion is the treatment of choice in intractable epistaxis.

Morphometric Study of Mandibular Ramus Related to Sagittal Ramus Split Osteotomy and Osteosynthesis

2012 ◽  
Vol 23 (5) ◽  
pp. 1484-1487 ◽  
Author(s):  
Marcelo Vinicius de Oliveira ◽  
Paulo Hemerson de Moraes ◽  
Sergio Olate ◽  
Maria Beatriz C. Alonso ◽  
Plauto Christopher Aranha Watanabe ◽  
...  
Keyword(s):  
Morphometric Study ◽  
Mandibular Ramus

In Reply: Minimally Invasive Exposure of the Maxillary Artery at the Anteromedial Infratemporal Fossa

2018 ◽  
Vol 16 (3) ◽  
pp. E111-E112
Author(s):  
Roberto Rodriguez Rubio ◽  
Olivia Kola ◽  
Michael T Lawton ◽  
Arnau Benet
Keyword(s):  
Minimally Invasive ◽  
Infratemporal Fossa ◽  
Maxillary Artery

scholarly journals Morphometric Study of Pterion in Dry Human Skull at Medical College of Eastern Nepal

2019 ◽  
Vol 2 (3) ◽  
pp. 214-219
Author(s):  
Umesh Kumar Mehta ◽  
Arun Dhakal ◽  
Surya Bahadur Parajuli ◽  
Sanjib Kumar Sah
Keyword(s):  
Cross Sectional Study ◽  
Surgical Approaches ◽  
Morphometric Study ◽  
Lateral Side ◽  
Lateral Aspect ◽  
Cross Sectional ◽  
Medical College ◽  
Bony Landmarks ◽  
Human Skulls ◽  
The Right

Background: The pterion is defined as an H shaped sutural confluence present on the lateral side of the skull. This pterion junction has been used as a common extra-cranial landmark for surgeons in microsurgical and surgical approaches towards important pathologies of this region. Methods:This is ananalytical cross sectional study conducted at Department of Anatomy, Birat Medical College & Teaching Hospital, Tankisinuwari, Morang, Nepal. Total enumeration technique was used to collect samples where 31 dry human skulls of unknown age and sex were taken. The sutural pattern and location of the pterion was determined and measured on both sides of each skull using digitalvernier caliper. Results: Three types of sutural patterns of pterion were observed. Among them, Sphenoparietal type was higher in frequency.The frequency was 26 (83.8%) on the right side and 24 (77.4%) on the left side. The distance between the centre of pterion to the midpoint of upper border of zygomatic arch was 3.82±0.3 cm on the right side and 3.8±0.29 cm on the left side. The distance between the centre of pterion to the postero-lateral aspect of fronto-zygomatic suture was 3.02±0.23 cmon the right side and 3.0±0.23 cm on the left side. Conclusions: The information of thesutural pattern and the location of the pterion from the different bony landmarks of our study may be useful for anthropologists and neurosurgeons.

The Distal Course of the Sural Nerve and its Significance for Incisions around the Lateral Hindfoot

Foot & Ankle ◽  
1992 ◽  
Vol 13 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Deborah M. Eastwood ◽  
Isiahs Irgau ◽  
Roger M. Atkins
Keyword(s):  
Sural Nerve ◽  
Nerve Trunk ◽  
Confidence Limits ◽  
Main Trunk ◽  
Anterior Branch ◽  
Bony Landmarks ◽  
The Mean

Twenty preserved cadaver limbs were dissected to show the distal course of the sural nerve and the number and site of origin of its branches. The mean position of the main nerve trunk was calculated at various points related to bony landmarks of the fibula and the fifth metatarsal base. Ninety-five percent confidence limits for the course of the main nerve trunk could be described. A fibula incision may damage the nerve if it extends more than 7 mm inferior to the lateral malleolar tip with the foot in equinus. Dorsolateral foot incisions may damage both the main trunk and the major anterior branch.

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