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

Abstract

Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.

Bilateral supernumerary maxillary fourth and fifth molars: A clinical case report and literature review

“…17 18 19 Considering the efforts to minimize or even eliminate radiation exposure in biomedical imaging, several promising imaging modalities such as low-dose CBCT 20 or radiation-free magnetic resonance imaging have recently been implemented in dental imaging workflows, 21 providing high-quality diagnostic information with an improved risk-benefit ratio in oral and maxillofacial surgery. 22 23 24 25 In addition, CT or CBCT data can be combined with novel volume-rendering techniques such as cinematic rendering, which provides more photorealistic visualization with a better depiction of image findings than conventional reconstructions ( Fig. 4 ).…”

Role of Magnetic Resonance Imaging in Temporomandibular Joint Ankylosis - An Evaluative Study

“…Haemorrhagic complications of TMJ surgeries may be intracranial/extracranial. [ 20 21 22 23 26 27 28 ]…”

“…Intracranial complications involve extradural haemorrhage due to rupture of the middle meningeal artery and are life-threatening. [ 20 21 22 23 26 27 28 ]…”

“…Although CT angiography is an useful adjunct for managing haemorrhage during ankylotic release, it poses a well recognised risk of an allergic reaction to the dye or acute kidney injury from the volume of contrast administered. [ 22 ] The radiation exposure of multislice CT is 860–1500 mSv. [ 17 ]…”

“…In cases where the ankylotic mass is attached to the base of the skull, there is a risk of bleeding from the carotid arteries during ankylotic release due to base of skull fracture. [ 22 26 27 ] In our study, it was found that the maximum and minimum distances [ Table 1B ] from the medial edge of the condyle to the ICA (Distance EI) was 20 mm and 17 mm respectively with a mean of (18.8 ± SD1.3 mm on the right side) and (18.2 ± SD 1.1 mm on the left side) [ Table 1A and Chart 2a ] and maximum and minimum distances [ Table 1B ] from the medial edge of the condyle to the IJV (Distance EJ) was 19 mm and 11 mm respectively with a mean of (16.4 ± SD1.1 mm on the right side) and (14.5 ± SD 2.9 mm on the left side) [ Table 1A and Chart 2b ].…”