Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary.
Department of Medical Imaging, Semmelweis University, Budapest, Hungary.
Sci Rep. 2023 Feb 28;13(1):3401. doi: 10.1038/s41598-023-29975-1.
This study describes the clinical anatomical topography and relationship of the terminal branches of the maxillary artery to the bony wall of the maxillary sinus in the pterygopalatine fossa (PPF) to estimate the bleeding risk during surgical interventions. Using contrasted computer tomography records, (i) the route of the maxillary artery in the infratemporal fossa, (ii) the number of the arteries in the critical PPF surgery plane, (iii) the diameter of the largest artery in the area and (iv) its relation to the posterior wall of the maxillary sinus were examined. Furthermore, measurements were extended with (v) the minerality of the bony posterior wall of the maxillary sinus on bone-window images. For statistical analyses Student's t- and Fisher-test were applied. 50 patients (n = 50, 100 cases including both sides) were examined in this study. The maxillary artery reached the pterygomaxillary fissure on the lateral side of the lateral pterygoid muscle in 56% of the cases (n = 32), in 37% (n = 23) on its medial side and in 7% (n = 4) on both sides. The number of arteries at the level of the Vidian canal in the PPF varied between 1 and 4 with a median of 2. The diameter of the biggest branch was 1.2-4.7 mm, the median diameter was 1.90 mm. In 41% (n = 30) of the cases the biggest artery directly contacted the posterior wall of the maxillary sinus, and the mineral density of the posterior wall was decreased in 14.3% (n = 12) of all investigated cases. The present description and statistical analysis of the vasculature of the PPF optimizes operative planning-like clip size or the type and direction of the surgical approach-in this hidden and deep head/neck region.
本研究描述了翼腭窝（PPF）内上颌动脉终末支与上颌窦骨壁的临床解剖学位置关系，以评估手术干预期间的出血风险。使用对比计算机断层扫描记录，（i）检查上颌动脉在颞下窝的路径，（ii）在关键 PPF 手术平面内的动脉数量，（iii）该区域内最大动脉的直径，以及（iv）其与上颌窦后壁的关系。此外，还在骨窗图像上扩展了（v）上颌窦后壁的骨质矿化程度的测量。统计学分析采用 Student's t 检验和 Fisher 检验。本研究共检查了 50 名患者（n=50，包括双侧共 100 例）。56%（n=32）的病例上颌动脉在翼外肌的外侧到达翼上颌裂，37%（n=23）位于内侧，7%（n=4）位于双侧。PPF 内位于翼管水平的动脉数量在 1 到 4 之间，中位数为 2。最大分支的直径为 1.2-4.7mm，中位数直径为 1.90mm。在 41%（n=30）的病例中，最大的动脉直接接触上颌窦后壁，在所有调查的病例中，后壁的矿化密度降低了 14.3%（n=12）。本研究对面部 PPF 血管的描述和统计分析优化了手术计划，如夹的大小或手术入路的类型和方向，以应对这个隐藏而深在的头颈部区域。
