Vascularization of the palate in maxillary osteotomies: anatomical study

Le Fort 1 maxillary osteotomy carries a risk of injury to the descending palatine arteries which vascularize the bulk of the mucosa of the bony palate. Some authors believe that injury to these arteries in the greater palatine canal is intrinsic to the procedure without any consequence for the trophicity of the mucosa or bony palate. In order to assess the risk of injury to the descending palatine arteries during such surgery, and to demonstrate the supplementary vascularization which would avoid ischemia of the palate, we carried out a study of the vascularization of the palate on 11 fresh cadavers. We used intra-arterial injection of colored latex and dissection of the vessels running to the palate. The study was done without osteotomy in the first subject, after a Le Fort 1 osteotomy in the five following subjects and after a Le Fort 1 osteotomy and ligation of the two descending palatine arteries in the last five subjects. Our results show that injury of the descending palatine arteries is not intrinsic to the procedure in spite of mobilization of the palatine plateau. When the descending palatine arteries are ligated there is diminution in coloration of the mucosa of the bony palate but there is substitution by the arteries vascularizing the soft palate, essentially the ascending palatine artery and the pharyngeal branch arising from the ascending pharyngeal artery. However, this substitute vascularization has individual variations.