The identification and protection of the descending palatine artery in Le Fort I osteotomy: A forgotten technique?

Regan, Barry O.; Bharadwaj, Girish

doi:10.1016/j.bjoms.2005.12.016

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…5–10 Lanigan et al 6 also advised against routine ligation and recommended that the DPA should be preserved whenever possible to minimize the risk of postoperative hemorrhage and aseptic necrosis. 5…”

Section: Discussionmentioning

confidence: 99%

“…1–4 During this maneuver, bleeding from descending palatine artery (DPA) and pterygoid venous plexus are stressful, being the DPA the major postoperative arterial hemorrhage source. 5,6…”

mentioning

confidence: 99%

“…Changes in surgical technique, as proposed by Precious et al (1991) who advocated pterygomaxillary disarticulation without the use of osteotomes, the use of spreaders, and digital manipulation to achieve pterygomaxillary separation, downfracture, and further mobilization, aimed reducing the risk of damage to the descending palatine vessels. 5,7 The use of minimally invasive ultrasonic bone surgery is widely applied and it presents significant benefits, such as the possibility of developing an accurate osteotomy, reduced risk of injuries to soft tissues. However, surgical time might become longer compared to execution with reciprocating saws or drills.…”

mentioning

confidence: 99%

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A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy

Rodrigues

Mendes

Borba

et al. 2022

Journal of Craniofacial Surgery

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: For accurate repositioning of the maxilla in Le Fort I osteotomy, bone removal around the descending palatine neurovascular bundle and maxillary tuberosity is frequently required. Such task can be challenging due to the high vascularity of the region, which is the most common site of hemorrhage during removal of bony interferences. Although a rare occurrence, ligation of the descending palatine artery in cases of intraoperative vascular damage can be related to the development of aseptic necrosis. This article reports a simple technique for retraction and protection of the descending palatine neurovascular bundle during bony removal related to a posterior maxillary impaction, which can be easily reproduced in orthognathic selected cases.

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Section: Discussionmentioning

confidence: 99%

“…1–4 During this maneuver, bleeding from descending palatine artery (DPA) and pterygoid venous plexus are stressful, being the DPA the major postoperative arterial hemorrhage source. 5,6…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy

Rodrigues

Mendes

Borba

et al. 2022

Journal of Craniofacial Surgery

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“…5 Hemorrhage with Le Fort type I osteotomies most often occurs in the posterior region of the maxilla. 13 Only a small number of studies to date have examined variations in the descending palatine artery due to difficulty accessing and dissecting the pterygopalatine fossa. Choi and Park have described five morphological types of distribution of the maxilla artery in the pterygopalatine fossa.…”

Section: Discussionmentioning

confidence: 99%

Distribution of the maxillary artery in the deep regions of the face and the maxilla: Clinical applications

Touré

2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…The greater palatine artery and nerve emerge in the oral cavity via the greater palatine foramen, just anterior to the posterior border of the hard palate, adjacent to the second or third molar. 7 The greater palatine artery then travels anteriorly, lateral to the greater palatine nerve, along the hard palate to enter the incisive foramen; thus, supplying the posterior twothirds of the hard palate. 2,8 Despite the widespread use of intraoperative image guidance, surgical landmarks remain as the preferred method to identify anatomical structures within a surgical field.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Landmarks to the Greater Palatine Canal: A Radiographic Study

et al. 2017

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The palatine neurovascular bundle is at risk during endoscopic surgery. Injury may result in significant blood loss and anesthesia of the ipsilateral hard palate. Nonetheless, its endoscopic anatomy has not been described previously. This article strives to establish landmarks to identify the greater palatine canal; thus, avoiding injury to its contents. This study comprised 50 deidentified computed tomographic angiograms using landmarks that are immediately visible during endoscopic medial maxillectomy to calculate: the angle of the greater palatine canal to the vertical, the distance from the anteroinferior aspect of the greater palatine canal to the orifice of the nasolacrimal duct, the distance from the anteroinferior aspect of the greater palatine canal to the posterolateral free edge of the hard palate, and the distance from the anterior aspect of the greater palatine canal as it enters the hard palate to the posterior wall of the maxillary sinus. The mean angle of the greater palatine canal to the vertical was 23.01 degrees. The mean distance from the anteroinferior aspect of the greater palatine canal to the nasolacrimal duct was 31.52 mm. The mean distance from the anterior aspect of the greater palatine canal to the posterolateral free edge of the hard palate was 7.71 mm and the mean distance from the anterior aspect of the greater palatine canal to the posterior wall of the maxillary sinus was 7.07 mm. Accessible anatomical landmarks help ascertain the location of the greater palatine canal intraoperatively; thus, avoiding injury to its contents.

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The identification and protection of the descending palatine artery in Le Fort I osteotomy: A forgotten technique?

Cited by 14 publications

References 8 publications

A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy

A Simple Method to Retract the Descending Palatine Neurovascular Bundle During Osseous Removal of Posterior Interferences in Le Fort I Osteotomy

Distribution of the maxillary artery in the deep regions of the face and the maxilla: Clinical applications

Endoscopic Endonasal Landmarks to the Greater Palatine Canal: A Radiographic Study

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