Manchella Sankar, Thomas Aaron, Su Shu, Botev Zdravko, Mitchell Peter, Nastri Alf
Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Victoria, Australia.
Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Victoria, Australia.
Br J Oral Maxillofac Surg. 2023 May;61(4):267-273. doi: 10.1016/j.bjoms.2022.11.004. Epub 2022 Nov 7.
The maxillary artery (MA) is a key structure at risk of injury in numerous oral and maxillofacial surgical (OMS) procedures. Knowledge of safe distances from this vessel to surgically familiar bony landmarks could improve patient safety and prevent catastrophic haemorrhage. Distances between the MA and bony landmarks on the maxilla and mandible were measured using CT angiograms on 100 patients (200 facial halves). The vertical height of the pterygomaxillary junction (PMJ) was mean (SD) measurement of 16 (3) mm. The MA enters the pterygomaxillary fissure (PMF) a mean (SD) distance of 29 (3) mm from the most inferior point of the PMJ. The mean (SD) shortest distance between the MA and medial surface of the mandible was 2 (2) mm (with the vessel directly contacting the mandible in 17% of cases). The branchpoint (bifurcation of the superficial temporal artery (STA) and MA) was directly in contact with the mandible in 5% of cases. The mean (SD) distances between this bifurcation point and the medial pole of the condyle were 20 (5) mm and 22 (5) mm, respectively. A horizontal plane through the sigmoid notch perpendicular to the posterior border of the mandible is a good approximation of the trajectory of the MA. The branchpoint is usually within 5 mm of this line and inferior in 70% of cases. Surgeons should take note that both the branchpoint and the MA contact the surface of the mandible in a significant number of cases.
上颌动脉（MA）是众多口腔颌面外科（OMS）手术中存在损伤风险的关键结构。了解该血管与手术中熟悉的骨性标志之间的安全距离，有助于提高患者安全性并预防灾难性出血。通过对100例患者（200侧面部）的CT血管造影测量上颌骨和下颌骨上MA与骨性标志之间的距离。翼上颌交界（PMJ）的垂直高度平均（标准差）测量值为16（3）mm。MA进入翼上颌裂（PMF）时，距离PMJ最下端的平均（标准差）距离为29（3）mm。MA与下颌骨内侧表面之间的平均（标准差）最短距离为2（2）mm（17%的病例中血管直接接触下颌骨）。在5%的病例中，分支点（颞浅动脉（STA）和MA的分叉处）直接接触下颌骨。该分叉点与髁突内侧极之间的平均（标准差）距离分别为20（5）mm和22（5）mm。通过乙状切迹且垂直于下颌骨后缘的水平面可很好地近似MA的走行轨迹。分支点通常在该线的5mm范围内，且70%的病例中位于该线下方。外科医生应注意，在相当数量的病例中，分支点和MA都会接触下颌骨表面。
