Proximity of the maxillary artery to the mandibular ramus: an anatomic study using three-dimensional reconstruction...

The maxillary artery (MA) is the main source of brisk bleeding during maxillectomy and procedures in the subcondylar portion of the mandible. The purpose of the study was to investigate the relationship between the MA and the mandible in the infratemporal fossa. The CT scans of 100 patients were retrospectively evaluated. The distances from the MA to bony landmarks were assessed in a three-dimensional model of the CT scan. In the cases where the MA was lateral to the LP [164 of 200 MAs (82%)], the mean shortest distances from the MA to the apex of the coronoid and condyle and the deepest portion of the mandibular notch were 13.6 ± 1.6 mm, 21.3 ± 2.0 mm, and 3.6 ± 1.0 mm, respectively. The contact point between the MA and medial surface of the mandible was measured and found to be 3.6 ± 2.2 mm posterior and 1.7 ± 1.4 mm inferior relative to the deepest portion of the mandibular notch. In the cases where the MA was medial to the LP [36 of 200 MAs (18%)], the mean shortest distances from the MA to the apex of the coronoid and condyle and the deepest portion of the mandibular notch were 19.5 ± 2.5 mm, 20.7 ± 2.4 mm, and 16.3 ± 3.7 mm, respectively. The studied measurements will help guide surgeons to determine the anatomy of the operative field in relation to the MA and minimize risks of injuring the vessel.