The Vessel Architecture Of The Maxilla And Its Clinical Significance

BackgroudThe maxillary blood supply,which has important significance for different typesof operation design and blood flowing, the infection resisting and the healing of themoved bones after the operation, is always concerned by the oral and maxillofacialsurgery.Bell, who explored the maxilla and its osteotomy by the method of micrangiumand tissue, found liberal vascular net between the gingvia,the palatine nasolabial areaand the periodontal tissue,and the collateral circulation in the internal maxilla andtissue. You zhihao,who explored the maxillary blood supply of 14 fresh cadavers byx-ray arthrography and Chinese ink perfusion appointed that the maxilla accepts notonly the blood supply of the posterior superior alveolar artery and the anteriorsuperior alveola artery, but also the blood supply of the mucoperiosteum arterybranches from the bone preface. However, Above research gives the base of bloodsupply of maxillary surgery but is not intuitive about the vessel presentation.Toresolve the proble such as the form of maxillary blood supply,and major ateries' branches, distribution and courses,this research observed explicitly the maxillarydistribution and anastomosis to present intuitively and stereophonicly the bloodvessel architecture of maxilla and its mucoperiousteum and to give bloodsupplyingbase for clinical surgery by the method of cephalofacial latex artery perfusion andcephalofacial artery casting mould.ObjectiveInquiring into the source of maxillary blood supply,following the distribution andcourses of the anterior superior alveolar artery,the posterior superior alveolarartery, the descending palatine artery, the descending palatine artery and the greaterpalatine artery, and observing the anatomosis of maxilla and its mucoperiosteum is toprovide anatomic evidence for all kinds of maxillary osteotomy and to give valuableguidableview.Methods1. Four chosen adult cadaveric heads which are injected red emulsion in arteriesare dissected from superficial to deep, and the dissected order is:the facial artery, theangular artery, the infraorbital artery, the maxillary artery,the posterior superioralveolar artery, the anterior superior alveolar artery,the descending palatineartery,the greater palatine artery and so on.Then explicitly observe the initation placesof the maxillary bloodsupply arteries(measure their diameters),follow their branchesand distribution on the maxillary surface and find out the anastomosis of the maxillaand its mucoperiosteum.2. Two cephalocevice specimen, are pressimly perfused redhyperchlororinylaceticether into both common carotid artery till both sides of facialskin become red, 6 times of injection need to be added. When the filling materialcoagulates, the soft tissue should be taken off by natural corrosion.Then 3 times ofinjection should be added to the specimen every day,reserve the bones and the blood vessel casting mould to show the bloodvessel courses,branches and anastomosis andto observe the stereo architecture and anastomosis of maxilla.Results:1.The bloodsupply resources of maxillaThe nutrient arteries of maxilla mainly come from the posterior superior alveolarartery and the anterior superior alveolar artery,four specimen are supplied by botharteries and two specimen are supplied by the posterior superior alveolar artery,andthe posterior superior alveolar artery, whose initial largest diametre is 8mm, comesfrom the third segment of the maxillary artery with the infraorbital artery taking up3/4 of all the specimen, runs down along the superior corpus maxillae and give riseto branches whose initial largest diameter is 0.9mm to run directly into maxilla byinside of the artery at the mediat of the maxillary infratemporal.The infraorbital ininfraorbital canal gives rise to the anterior superior artery whose initial largestdiameter is 0.8mm.Whatever kind of the nutrial blood vessel in maxilla is,the greater palatine arterygives rise to many bonny perforating arteries(the diameter is always smaller than0.5mm)when runing along the internal of maxilla to nourish it.2.The bloodsupply of the maxillary mucoperiosteumThe main bloodsupply systerm of the maxillary mucoperiosteum is:the buccalbranches of the posterior superior alveolar artery,the infraorbital artery and the greaterpalatine artery.The posterior median raphe of buccal maxillary mucoperiosteum issupplied by the buccal branches of the posterior superior alveolar artery(the initialdiameter is the same as its truncus aortae), which run obliquely down along thesurface of maxillary,pass round the zygomatico alveolar ridge and give rise to severalbranches, whose terminal branches nourish the maxillary molar, the gum and thebuccal mucosa of the premolar alveolar process;The anterior buccal mucoperiosteum,the root of upper lip and the labial gingiva are supplied by bothinfraobital artery,which gives rise to 3-4branches after leaving the infraorbitalforamen,and one of the branches runs vertically down nearby the canine to formterminal branches distributing to the labial gingiva of the anterior teeth.besides,eachbranch of the infraorbital arteries also gives rise to tiny periosteal nutrial arteries;Themaxillary palatine mucoperiosteum is mainly supplied by the greater palatineartery, which is from the descending palatine artery which is at the junction of themaxillary sinus' inner wall and its posteriors wall.The main branch of the greaterpalatine artery always runs in the pterygopalatine canal to the greater palatineforamen where the branch gives rise to 2-3branches(5/6),and some times it also givesrise to branches when the descending palatine artery forms(1/6).After leaving thepterygopatine canal, the greater palatine artery goes along the greater palatine groovewhich is at the junction of the alveolar process and the palatine process of maxilla,Its' lateral branches give rise to the platine membrane, the medial branches give riseto the hard oral mucosa and the terminal branches penetrate the incisive foramen torun into the nasal cavity.3.The medial and lateral blood vessel anastomosis of maxillaThere are rich vascular nets, which come from: 1).the branches of the posteriorsuperior alveolar artery.2).the branches of the superior labial artery.3).the branches ofthe infraorbital artery.4).the branches of angular artery.5).the branches of the greaterpalatine artery.6).the branches of the sphenoplatine artery and the branches of theascending pharyngeaal artery and so on, in the medial and lateral mucoperiosteum ofthe maxilla. At the same time of forming the microvascular in themucoperiosteum, some arteries also run into the maxilla through the paraforamens onmaxillary surface to anatomose with the nutrient arteries in the maxilla to form solidartery net of the medial and lateral blood supplying intersection of the maxilla. besides,there are some differences within the maxillary medial and lateral vascularanastomosis density:the medial vascular anastomosis seems more than the lateralones,there is obvious lack of vascular anastomosis near the medial palatine medianraphe,the vascular anastomosis at the lateral labial teeth area is slightly more thanlateral buccal area.Conclusions:1.This research suggests that the resource of the maxillary blood supply is veryrich.Though the superior alveolar artery is main blood supplying artery of the maxilla,there are amount of blood-supplying artery insection, and some arteries in soft tissueeven run into bone to give rise to branches.The posterior superior alveolar artery,theinfraorbital artery,the descending palatine artery,and the spheno palatine artery whichdistributes to the labial rriucoperiosteum,the buccal mucoperiosteum,and the palatinemucoperiosteum also supply blood for the maxilla by artery intersection.2.Base the characteristic of the maxillary blood supply,the author believes that ifthere are enough labial mucoperiosteum pedicle,the osteotomy can survive.For thepalatine artery have much intersection,it's better to design the palatinemucoperiosteum pedicle.3. Following should be payed attention to in the maxillary orthognathic operation:1):The osteotomy shouldn't be too small.2):the distance of the osteotomy remotion shouldn't be too far.3):ligating the descending palatine artery in the Lefort I osteotomy can't influencethe osteotomy blood-supply and can't lead to be lack of blood of the osteotomy;at thesame time, it can reduce the uncontroled bleeding during or after the operation, cutdown the operating time and increase the moving distence of the anterior maxilla.4):When moving bones and doing internal fixation in the maxillary osteotomy, it'sbetter to strip less soft tissue around the maxilla to reduce the risk of occuring maxillary necrosis and the serious retrograde affection of pulp and to make advantagefor bone healing in the consideration of uninfluecing the operation and not hamperingthe expected effection.4. It has important significance to resist inferior after osteotomy, that the characterof maxillary blood suplly desides its inferioring and diffusing has two-way.