Microsurgical anatomy of the maxillary artery for extracranial‐intracranial bypass in the pterygopalatine segment of the maxillary artery

Abstract

The extracranial-intracranial (EC-IC) bypass using the maxillary artery (MA) has been successfully completed using a radial artery (RA) graft but the complicated anatomy and narrow exposure make it difficult. The purpose of this article is to define the microsurgical exposure of the MA through the middle fossa and describe the branches, diameter, and length of the MA available for the EC-IC bypass in the sphenopalatine fossa and anterior part of the infratemporal fossa. 5 cadaveric specimens were dissected bilaterally (10 MA dissections) to define the microsurgical anatomy of the MA through an intracranial approach. The exposable branches of the MA at the level of the infratemporal and sphenopalatine fossae were the anterior deep temporal, posterior superior alveolar, and infraorbital arteries. The origin of each branch could be exposed. The available section of the MA for use as a donor vessel is between the origin of the anterior deep temporal artery and the infraorbital artery. The mean exposable length of the MA was 19.4 mm. The mean outer diameter of the donor MA was 3.2 mm. Tension-free EC-IC bypass was possible using a RA graft between the MA and the middle cerebral artery, the MA and the supraclinoid internal carotid artery (ICA), or the MA and the petrous ICA. Exposure of the MA at the infratemporal and sphenopalatine fossae is complicated but provides length and diameter suitable as a donor artery for the EC-IC bypass. Clin. Anat. 31:724-733, 2018. © 2017 Wiley Periodicals, Inc.

Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography

“…The course of the maxillary artery is known to be variable and tortuous [ 10 , 14 , 46 ]. Several authors have measured the distances between the maxillary artery and bony reference points.…”

Experience of Extracranial-Intracranial Bypass With Using Maxillary Artery

“…Но сложность анатомии подвисочной, крылонебной ямок, особенности хирургического доступа затрудняют использование ВЧА в качестве донора. ВЧА является одной из конечных ветвей наружной сонной артерии, начинается медиально от шейки нижней челюсти между мыщелковым отростком нижней челюсти и клиновидно-нижнечелюстной связкой [18].…”

Infra-Temporal and Pterygo-Palatine Fossae Tumors: A Frontier in Endoscopic Endonasal Surgery—Description of the Surgical Anatomy of the Approach and Report of Illustrative Cases

“…The structures of the ITF are mainly supplied by the maxillary artery, which originates from the external carotid artery near the posterior border of the condylar process of the mandible ( Figure 3 and Figure 4 ). Its course can be divided into three segments: mandibular, pterygoid, and pterygopalatine [ 29 , 30 ]. The mandibular segment of the maxillary artery passes medially to the condylar process of the mandible and laterally to the sphenomandibular ligament along the inferior border of the lower head of the lateral pterygoid muscle with a horizontal direction [ 29 , 30 ].…”

“…Its course can be divided into three segments: mandibular, pterygoid, and pterygopalatine [ 29 , 30 ]. The mandibular segment of the maxillary artery passes medially to the condylar process of the mandible and laterally to the sphenomandibular ligament along the inferior border of the lower head of the lateral pterygoid muscle with a horizontal direction [ 29 , 30 ]. In its course, it gives origin to the deep auricular artery (which pierces the anterior aspect of the cartilage of the external acoustic meatus to supply the canal itself and the tympanic membrane), the anterior tympanic artery (which enters into the tympanic cavity through the petrotympanic fissure to supply the mucosa of this region), the middle meningeal artery (which ascends medially to the lateral pterygoid muscle, entering the foramen spinosum, to provide the major supply to dura mater; eventually an accessory meningeal artery can be present, arising separately from the maxillary artery or with a common origin with the middle meningeal artery, directed toward the foramen ovale), and the inferior alveolar artery (which is directed infero-anteriorly, running on the medial wall of the mandibular ramus and entering the mandibular foramen) [ 29 , 30 ].…”

“…Afterward, the maxillary artery runs medial to the lateral pterygoid muscle in about 30–45% of cases and lateral in about 55–70% [ 31 ]. The pterygoid segment of the maxillary artery gives origin to the deep temporal, the pterygoid and the masseteric arteries (directed toward the homonymous muscles), and the buccal artery (which provides the vascular supply to the buccinator muscle and to mucous membrane and skin of the cheek) [ 29 , 30 ]. The pterygopalatine segment runs in its initial tract between the two heads of the lateral pterygoid muscle, then it enters the PPF through the pterygomaxillary fissure [ 29 , 30 ].…”