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Mapping the Maxillary Artery and Lateral Pterygoid Muscle Relationship: Insights from Radiological and Meta-Analytic
Maria Piagkou1,2, George Triantafyllou1,2, Panagiotis Papadopoulos-Manolarakis1,3
1Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
The maxillary artery (MA) most often runs lateral to the lateral pterygoid muscle (LPM), but variations like medial or intramuscular courses exist. Understanding these anatomical differences is crucial for safe surgical and anesthetic procedures in the infratemporal fossa (ITF).
Area of Science:
- Anatomy
- Radiology
- Surgical Anatomy
Background:
- Variations in the maxillary artery (MA) course relative to the lateral pterygoid muscle (LPM) present significant challenges in infratemporal fossa (ITF) interventions.
- These anatomical variations can lead to increased risks of hemorrhage, nerve injury, and anesthesia complications.
Purpose of the Study:
- To investigate the topographic relationship between the maxillary artery (MA) and the lateral pterygoid muscle (LPM).
- To combine high-resolution radiological imaging with anatomical literature analysis to detail MA-LPM variations.
Main Methods:
- Retrospective analysis of 250 brain CTAs (500 sides) to classify MA course (lateral, medial, intramuscular).
- Systematic review and meta-analysis of 32 studies (5938 arteries) following PRISMA 2020 and EBA guidelines.
- Quality assessment using the Anatomical Quality Assurance (AQUA) tool.
Main Results:
- Imaging cohort: MA coursed lateral to LPM (64.2%), medial (29.6%), intramuscular (6.2%), and temporalis-traversing (3.0%).
- Meta-analysis: Pooled prevalence of lateral MA course was 79.6%, medial 19.9%, and intramuscular 0.01%.
- Higher incidence of lateral variants in cadaveric studies and Asian populations; imaging studies detected more medial/transmuscular paths.
Conclusions:
- The maxillary artery (MA) typically courses lateral to the lateral pterygoid muscle (LPM), but significant variations occur.
- Medial, intramuscular, and temporalis-traversing MA routes complicate maxillofacial surgery, TMJ procedures, and regional anesthesia.
- Preoperative vascular mapping is essential for improving procedural safety and outcomes in the infratemporal fossa (ITF).
