MANDİBULER KONDİL İLE KOMŞU ARTERİYEL YAPILAR ARASINDAKİ İLİŞKİNİN BİLGİSAYARLI TOMOGRAFİK ANJİYOGRAFİ İLE DEĞERLENDİRİLMESİ

Year 2023, Volume: 33 Issue: 1, 6 - 10, 29.03.2023

Mehmet Barburoğlu , Yusuf Emes , Halim İşsever , Aykut Öğreden , Buket Aybar , Serra Sencer

https://doi.org/10.26650/Tr-ENT.2023.1241279

Abstract

AMAÇ: Temporomandibuler ve retromandibular bölge cerrahileri sırasında internal maksiller arter (İMA) ve eksternal karotid arterin (ECA) iyatrojenik yaralanmaları, mortalite ve morbiditesi yüksek ciddi cerrahi komplikasyonlardır. Bu komplikasyonlardan kaçınmak için cerrahların bu vasküler yapıların seyrini ve mandibular kondil ile ramus arasındaki ilişkilerini iyi bilmesi önemlidir. Bu çalışmada baş boyun bilgisayarlı tomografik (BT) anjiyografi ile İMA ve ECA'nın mandibula ile ilişkisini ortaya koymayı amaçladık.

GEREÇ VE YÖNTEM: Yirmi altı hastanın (52 bölge) bilateral baş boyun BT anjiyografi verileri retrospektif olarak değerlendirildi. IMA ve ECA'nın mandibulaya uzaklığı her üç düzlemde de (IMAx, ECAx, IMAy, ECAy, IMAz, ECAz düzlemleri) hesaplandı. Vasküler tortiozite ve temas varlığı değerlendirildi.

BULGULAR: Internal maksiller artere ayrılmadan önce ECA'nın ramusa en yakın mesafesinin korpus mandibulanın alt kenarına teğet çizilen çizginin 32.5 ± 7.7 mm üzerinde olduğunu bulduk. İnternal maksiller arterin 52 anjiyografinin 39'unda mandibular kondilin medial kortikal yüzeyi ile temas halinde olduğu ölçülmüştür. Bu temas noktasının, ramusun arka kenarının 1,74 mm önünde olduğunu saptadık.

SONUÇ: Bu çalışma ile internal maksiller arterin mandibular kondil ile yakın ilişki içinde olduğunu radyolojik olarak doğrulamış olduk. Cerrahların bu komşuluğun farkında olması intraoperatif vasküler yapı yaralanmalarının önlenmesi açısından önemlidir.

Keywords

Internal maxillary artery, external carotid artery, temporomandibular joint surgery, computed tomography angiography.

Evaluation of the Relationship Between Mandibular Condyle and Related Arterial Structures by Computed Tomographic Angiography

Abstract

Objective: Iatrogenic injuries of internal maxillary artery (IMA) and external carotid artery (ECA) during temporomandibular and retromandibular region surgeries are serious surgical complications with high mortality and morbidity. In order to avoid this complication, it is important for surgeons to know these vascular structures’ course and their relationship with the mandibular condyle and ramus. The aim of this study was to reveal the relationship of the IMA and ECA with the mandible by head and neck computed tomography (CT) angiography. Materials and methods: Bilateral head and neck CT angiography data in 26 patients (52 region) were evaluated retrospectively. The spatial distance of IMA and ECA to the mandible was calculated in all three planes (IMAx, ECAx, IMAy, ECAy, IMAz, ECAz planes). The presence of vascular tortuosity and contact were also evaluated. Results: We have found that the nearest distance to the ramus of the ECA before giving a branch to IMA was 32.5±7.7 mm above the line drawn tangent to the lower border of corpus mandible. The internal maxillary artery was measured to be in contact with the medial cortical surface of the mandibular condyle in 39 of the 52 angiographies. This contact point was found to be 1.74 mm in front of the posterior margin of the ramus. Conclusion: In this study, we radiologically confirmed that the internal maxillary artery is in close association with the mandibular condyle. It is important for surgeons to be aware of this neighborhood in order to prevent intraoperative vascular injuries.

Keywords

Internal maxillary artery, external carotid artery, temporomandibular joint surgery, computed tomography angiography.

References

• 1. Peoples JR, Herbosa EG, Dion J. Management of internal maxillary artery hemorrhage from temporomandibular joint surgery via selective embolization. J Oral Maxillofac Surg 1988;46(11):1005-7. google scholar
• 2. Sidebottom AJ, Gruber E. One-year prospective outcome analysis and complications following total replacement of the temporomandibular joint with the TMJ Concepts system. Br J Oral Maxillofac Surg 2013;51(7):620-4. google scholar
• 3. Bouloux GF, Perciaccante VJ. Massive hemorrhage during oral and maxillofacial surgery: ligation of the external carotid artery or embolization? J Oral Maxillofac Surg 2009;67(7):1547-51. google scholar
• 4. Flint PW, Haughey BH, Robbins KT, Thomas JR, Niparko JK, Lund VJ, et al. Cummings otolaryngology-head and neck surgery e-book. Elsevier Health Sciences. 2014. p.2662-70. google scholar
• 5. Otake I, Kageyama I, Mataga I. Clinical anatomy of the maxillary artery. Okajimas Folia Anat Jpn 2011;87(4):155-64. google scholar
• 6. Sashi R. X-ray anatomy of the maxillary artery. Akita J Med 1989;16:817-31. google scholar
• 7. Tsuda K. Three Dimentional analysis of Arteriographs of the Maxillary Artery in Man-Part 1: The maxillary artery and its branches. J Jpn PRS 1991;11:188-98. google scholar
• 8. Tsuda K. Three Dimentional analysis of Arteriographs of the Maxillary Artery in Man-Part 2: Branching patterns of branches of the maxillary artery. J Jpn PRS 1991;11:683-90. google scholar
• 9. Lurje A. On the topographical anatomy of the internal maxillary artery. Acta Anat 1946;2(3-4):219-31. google scholar
• 10. Kitsuta H, Lin E, Kato T, Ide Y, Kaneko Y. The Procession of the N. Mandibularis, A Maxillaris and Vv.Maxillares of Japanese people during the Open-mouth Position. Shikwa gakuho 1985;85(11):1523-32. google scholar
• 11. Takarada T. Anatomical studies on the maxillary artery. Shikwa gakuho 1958;58:1-20. google scholar
• 12. Ikakura K. On the origin, course and distribution of the maxillary artery in Japanese. Arch Dept of Anat Tokyo Dent Coll. (Kouku Kaibou Kenkyu) 1961;18:91-122. google scholar
• 13. Ito H, Mataga I,Kageyama I, Kobayashi K. Clinical anatomy in the neck region; The position of external and internal carotid arteries may be reversed. Okajimas Folia Anat Jpn 2006;82(4):157-67. google scholar
• 14. Verma S, Fasil M, Murugan M, Sakkarai J. Unique variation in the course of maxillary artery in infratemporal fossa: a case report. Surg Radiol Anat 2014;36(5):507-9. google scholar
• 15. Metson R, Lane R. Internal maxillary artery ligation for epistaxis: an analysis of failures. Laryngoscope 1988;98(7):760-4. google scholar
• 16. Talebzadeh N, Rosenstein TP, Pogrel MA. Anatomy of the structures medial to the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88(6):674-8. google scholar