Assessment of temporomandibular joint-related arteries by three-dimensional rotational angiography

This study provides insight into the in-vivo three-dimensional rotational angiographic (3D-RA) evaluation of the vascular anatomy surrounding the temporomandibular joint (TMJ), emphasizing clinically relevant variations for surgical planning. Superficial temporal artery (STA), transverse facial artery, maxillary artery (MA), and middle meningeal artery (MMA) were retrospectively analysed in 67 patients (100 hemicrania) using 3D-RA to delineate their courses, bifurcation patterns, and spatial relationships with TMJ landmarks in relation to age and sex. Findings indicated that the STA followed a laterocondylar course in 51% of cases. Bifurcation was present in 99%, and a straight arterial course occurred in 71%. The STA-condyle distance increased with age (P = 0.001), suggesting potential surgical relevance in older patients. The MA was mostly superficial to the lateral pterygoid muscle, and, when located deeply, the MA-sigmoid notch distance significantly increased (P = 0.001), potentially affecting surgical procedures which are performed near the sigmoid notch. Sex-related differences were also observed: the TFA-glenoid fossa distance was larger in males (P = 0.001) and correlated with age (P = 0.016), while the MMA-articular eminence distance was greater in males (P = 0.001). These findings refine current understanding of TMJ vascular anatomy and provide detailed, in-vivo data to enhance preoperative assessment and minimize vascular injury risk during TMJ surgeries.