Course of the Maxillary Vein and its Positional Relationship With the Mandibular Ramus Require Attention During Mandibuloplasty

Abstract

Purpose: The maxillary vein is associated with major hemorrhage, an intraoperative risk factor during mandibuloplasty. Our objectives in this study were to identify the anatomical course of the maxillary vein relative to the mandible, and to ascertain the relationship of its course with that of the maxillary artery. Methods: Thirteen sides of 13 cadavers in the possession of the Department of Anatomy of Tokyo Dental College were used. The maxillofacial region was first dissected, after which the upper part of the mandibular ramus was removed and the maxillary artery, maxillary vein, and pterygoid venous plexus were identified. The length of the maxillary vein and its height from the mandibular plane were then measured, and its anatomical course was recorded. Results: The maxillary vein ran downward along the inner aspect of the temporal muscle, then from the base of the coronoid process it ran horizontally near the bone surface of the inner aspect of the mandibular ramus. After joining the inferior alveolar vein, it joined the superficial temporal vein to form the retromandibular vein. The mean length of the maxillary vein was 22.2 ± 3.2 mm. At the posterior margin of the mandibular ramus, its mean height above the mandibular plane was 34.2 ± 5.4 mm. From the posterior margin of the mandibular ramus to the lowest point of the mandibular notch, the maxillary vein was located within the areolar connective tissue directly above the periosteum adjoining the inner aspect of the mandibular ramus. Conclusions: In the wide area from the center of the maxillary notch to the posterior margin of the mandibular ramus, the maxillary vein runs extremely close to the periosteum on the inner aspect of the mandibular ramus, suggesting that it may pose a risk of hemorrhage in various oral surgical procedures.

Retromandibular vein position and course patterns in relation to mandible: anatomical morphologies requiring particular vigilance during sagittal split ramus osteotomy

“…Major bleeding involves vessels such as the inferior alveolar, facial, and maxillary arteries and veins, and the retromandibular vein (RMV), and is related to surgical approach [3]. According to Sahoo et al [4], comparatively few instances of major bleeding in SSRO involve the inferior alveolar and maxillary arteries and veins [5]. Instead, the usual culprit is injury to the various vascular branches running along the medial surface and posterior border of the Original Article https://doi.org/10.5115/acb.20.236 pISSN 2093-3665 eISSN 2093-3673 mandibular ramus.…”

Minimal Access Retromandibular Approach to Fractures of Vertical Segment of the Mandible: A Versatile Technique

“…Additionally, the upper half of the mandible is in close relation with internal maxillary artery and pterygoid plexus of veins in the infratemporal fossa. 2,3 Any approach to this region of the mandible is fraught with risk of trauma to these vital structures with resultant paresis/paralysis of facial muscles and/or torrential bleeding. While in the years gone by, closed treatment of such fractures was the norm, 4 with better understanding of the anatomy and complications associated with closed treatment as well as better tools for osteosynthesis, open reduction and internal fixation (ORIF) of these fractures is generally recommended.…”

“…Nineteen were male and 1 was female. The etiology of trauma was road accident (8), fall from train (2), fall from height (5) and assault (5). Fifteen patients had unilateral fractures while 5 had bilateral fractures.…”

A Case of a Previously Unreported Drainage of the Maxillary Vein

“…The maxillary vein accompanies the maxillary artery [ 3 ]. It runs from behind the neck of the mandible and is derived from multiple tributaries of the pterygoid plexus.…”

“…There are various morphologies regarding the relationship between the retromandibular vein and the mandible ramus, which could influence the intraoperative bleeding risk during sagittal split ramus ostomies [ 6 ]. Since the facial vein and the retromandibular vein serve as important landmarks in magnetic resonance imaging (MRI) and computed tomography (CT) imaging, the maxillary vein’s proximity to the mandibular ramus and its same level at the lingula of the mandible are important for oral surgeries such as repairing mandibular deformities [ 3 ]. Surgeons should be aware of such venous anatomy when conducting orthognathic surgeries in order to prevent unnecessary hemorrhage when resecting the coronoid process [ 3 ].…”