Orra Susan, Tierney William S, Capone Avery C, Gharb Bahar Bassiri, Papay Frank A, Doumit Gaby
Cleveland, Ohio; and Montreal, Quebec, Canada.
From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.
Plast Reconstr Surg. 2017 Mar;139(3):701-709. doi: 10.1097/PRS.0000000000003084.
Le Fort III osteotomy represents the foundation of surgical correction for midface hypoplasia. One serious complication of Le Fort III osteotomy is severing the internal maxillary artery or its branches during osteotome advancement for pterygomaxillary dysjunction. This study sought to characterize the relevant surgical anatomy of the infratemporal fossa and of the internal maxillary artery as it enters the pterygomaxillary fissure.
Bilateral midface dissections were performed on 15 fresh, normocephalic adult cadavers (30 hemifaces). Four superficial anatomical measurements were performed on the surface of the face, followed by 10 deep measurements of the internal maxillary artery and its branches relative to the infratemporal fossa and its surrounding bony landmarks.
The distance from the anterosuperior aspect of the zygomatic arch to the sphenopalatine artery entering the pterygomaxillary fissure was 38.9 ± 3.2 mm. The distance from the alveolar process of the maxillary bone to the sphenopalatine artery entry into the pterygomaxillary fissure was 30.3 ± 6.4 mm. The zygomaticofrontal suture was 43.4 ± 8.5 mm from the sphenopalatine artery entry into the pterygomaxillary fissure, 58.8 ± 8.0 mm from the pterygomaxillary junction, and 74.9 ± 6.5 mm from the maxillary alveolar process. The distance from the sphenopalatine artery to the posterior superior alveolar artery was 14.4 ± 4.1 mm. Elevation of the internal maxillary artery from the lateral pterygoid plate was 5.8 ± 2.5 mm.
This study characterizes the surgical anatomy of the infratemporal fossa in the context of Le Fort III osteotomies and their associated pterygomaxillary dysjunctions.
勒福Ⅲ型截骨术是治疗面中部发育不全手术矫正的基础。勒福Ⅲ型截骨术的一个严重并发症是在翼上颌离断时使用骨凿推进过程中切断上颌内动脉或其分支。本研究旨在描述颞下窝以及上颌内动脉进入翼上颌裂处的相关手术解剖结构。
对15具新鲜、正常头颅的成年尸体（30个半侧面部）进行双侧面中部解剖。在面部表面进行四项浅表解剖测量，随后对相对于颞下窝及其周围骨性标志的上颌内动脉及其分支进行10项深部测量。
颧弓前上缘至进入翼上颌裂的蝶腭动脉的距离为38.9±3.2毫米。上颌骨牙槽突至进入翼上颌裂的蝶腭动脉的距离为30.3±6.4毫米。颧额缝距进入翼上颌裂的蝶腭动脉43.4±8.5毫米，距翼上颌连接处58.8±8.0毫米，距上颌牙槽突74.9±6.5毫米。蝶腭动脉至后上牙槽动脉的距离为14.4±4.1毫米。上颌内动脉从翼外板抬起的高度为5.8±2.5毫米。
本研究描述了在勒福Ⅲ型截骨术及其相关翼上颌离断情况下颞下窝的手术解剖结构。
