A 77-year-old woman presented to our hospital with a 2-week history of fever, headache, and induration along the bilateral superficial temporal arteries (STAs). The color Doppler ultrasonography of the STA showed a hypoechoic mural thickening surrounding a residual color flow. A contrast-enhanced photon-counting detector (PCD) CT demonstrated mural thickening and stenosis of the bilateral STAs. The patient underwent a biopsy of the right STA. Histopathological findings were consistent with giant cell arteritis (GCA). The patient\'s symptoms were temporarily relieved after initiation of steroid treatment, but jaw claudication occurred 2 months later. Contrast-enhanced CT showed improved vascular abnormalities of the STAs but new mural thickening and stenosis of the bilateral maxillary artery. Due to its higher resolution, image contrast, and lower noise, PCD-CT may have great potential in detecting, diagnosing, and monitoring GCA.

The infratemporal fossa and pterygopalatine fossa are critical pathways for blood vessels and nerves leading to the orbit, nasal cavity, and oral cavity. Anatomical observation of these areas is challenging for learners due to their complex connections with surrounding structures and their deep location within the body. Since it is not easy to understand this area in three dimensions with only textbook images, there is a need to produce three-dimensional (3D) content. Most existing 3D data have reconstructed the digital imaging and communication in medicine files from computed tomography images with high accuracy; however, the surrounding structures often obstruct the view. For this reason, this project utilized Cinema4D (R18; Maxon) software to refine the modeled bones and to create 3D models of muscles, blood vessels, and nerves that accurately represent their anatomical shapes and pathways. To facilitate easier access for learners via PC, the content was converted into PDF format. This enables the educational materials to be more easily viewed and the main structures more clearly observed using a computer-based viewer.

BACKGROUND Bisphosphonates and anti-receptor activator of nuclear factor kappa B antibodies are used to treat bone diseases associated with increased osteoclast activity, including myeloma. However, they can cause osteonecrosis of the jaw, known as medication-related osteonecrosis of the jaw. This report presents a case of a patient with a history of myeloma who required posterior maxilla resection for bisphosphonate-related osteonecrosis of the jaw, in which preoperative embolization prevented unexpected bleeding related to vascular injury and allowed for a safe procedure with minimal bleeding. CASE REPORT An 84-year-old man presented to our department with a 3-year history of purulent drainage and bone exposure in the right maxilla. Based on the clinical findings at the initial visit, the clinical diagnosis was bisphosphonate-related osteonecrosis of the jaw, and the patient underwent a partial right maxillary osteotomy. This surgery was associated with a risk of unexpected bleeding from a branch of the maxillary artery during the posterior maxilla resection. A catheter-based embolization of the maxillary artery was performed the day before performing a partial maxillectomy to avoid unexpected bleeding risk. Thus, no abnormal bleeding occurred during partial maxillectomy, and no postoperative complications occurred for 3 years. CONCLUSIONS In the surgical treatment of medication-related osteonecrosis of the jaw, preoperative vascular embolization of the peripheral maxillary artery beyond the middle meningeal artery bifurcation is a valuable technique for safe maxillectomy involving the posterior maxilla.

OBJECTIVE: The literature has for too long described the arterial supply of the mandible as coming from a single artery, the inferior alveolar artery, and being of the terminal type. Rather, it appears to come from an extensive and complex arterial network dependent on the lingual, facial, and maxillary arteries and their collateral branches. Our study aims to confirm and demonstrate the arterial vascular richness of the mandible and to establish arterial mapping.
METHODS: The arterial vascularization of the mandible was revealed in six anatomic specimens after performing selective injections of the lingual, facial, and maxillary arteries with different dyes. A specimen was injected intra-arterially with colored latex at the level of the maxillary artery for a morphometric study.
RESULTS: Eighteen selective arterial injections were performed on six anatomic specimens. The mucocutaneous, musculoperiosteal, and intramedullary vascularizations were analyzed. Each of the arteries has a defined and delimited cutaneo-mucous vascular territory. The facial and maxillary arteries supply the musculoperiosteal vascularization of the mandible from the condyle to the symphysis. The lingual artery supplies only the inner cortex of the parasymphyseal and symphyseal regions. The facial and maxillary arteries provide intramedullary vascularization from the angle of the mandible to the parasymphysis. The vascularization of the symphysis depends on the facial artery. No staining was found in the condyle region. Neoprene latex injection was performed on an anatomic specimen, revealing a permeable anastomosis between the inferior alveolar and facial arteries.
CONCLUSIONS: The arterial vascularization of the mandible is dependent on the maxillary, facial, and lingual arteries. This is a network vasculature. This study makes it possible to establish an arterial map of the mandible. The presence of an anastomosis between the inferior alveolar artery and the facial artery confirms the existence of dynamic and borrowed vascularization. Knowledge of this arterial system makes it possible to adapt maxillofacial surgical care and to anticipate possible intraoperative complications.

BACKGROUND: Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors.
METHODS: First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients.
RESULTS: Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA\'s run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant.
CONCLUSIONS: Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety.

OBJECTIVE: Maxillary sinus carcinomas usually present as a locally advanced disease at the time of diagnosis and it is extremely unusual to have a second primary maxillary carcinoma on the contralateral side after many years of completion of treatment of the first malignancy. We present here a case report of a sphenopalatine artery (SPA) pseudoaneurysm mimicking the second primary maxillary carcinoma.
METHODS: We reviewed the literature for SPA pseudoaneurysm.
RESULTS: This report describes the case of a 90-year-old man with a background of adenoid cystic carcinoma of the right maxillary sinus, diagnosed and treated with surgery and radiotherapy 14 years ago, who presented with a history of multiple episodes of epistaxis. The radiological evaluation showed a heterogeneously enhancing mass with a central hemorrhagic component and surrounding bony erosions in the left maxillary sinus and the patient was planned for biopsy from the suspicious mass along with SPA ligation. However, on opening the maxillary antrum there was excessive bleeding and it was determined unsafe to proceed further. The patient was subsequently taken to interventional radiology for diagnostic angiography which revealed an SPA pseudoaneurysm that was subsequently embolized successfully.
CONCLUSIONS: Sphenopalatine artery pseudoaneurysms should be considered as a differential for recurrent epistaxis in patients with a history of sinonasal malignancy. In such cases, endovascular embolization is a viable management option.

This case report describes the coexistence of a retroesophageal right subclavian artery and left maxillary artery which passed deep to the mandibular nerve. An 88-year-old woman died of acute heart failure, and the postmortem revealed that the right subclavian artery originated from the aortic arch as the last branch at the level of the fourth thoracic vertebra, then passed between the esophagus and the vertebral column. The artery then ascended right superiorly and passed behind the anterior scalene muscle. The right vertebral artery arose from the retroesophageal right subclavian artery and entered the transverse foramen of the sixth cervical vertebra. The left maxillary artery branched at the common trunk of the posterior deep temporal and the inferior alveolar arteries. The maxillary artery then turned anteromedially and branched to give the middle meningeal artery. The mandibular nerve gave off the buccal nerve, deep temporal nerve and a thick nerve just below the foramen ovale. The auriculotemporal nerve that branched from the thick nerve ran deep to the maxillary artery. The maxillary artery turned anteriorly, passing deep to the branches. The artery then split to give the buccal artery and the anterior deep temporal artery. In the pterygopalatine section, the maxillary artery branched off to form the common trunk of the infraorbital and sphenopalatine arteries and the posterior superior alveolar artery. It may be necessary to pay attention to the course of the maxillary artery and its relationship to the mandibular nerve branches, when a retroesophageal right subclavian artery is seen.

The use of the maxillary artery (MA) as a donor has increasingly become an alternative method for cerebral revascularization. Localization difficulties emerge due to rich infratemporal anatomical variations and the complicated relationships of the MA with neuromuscular structures. We propose an alternative localization method via the interforaminal route along the middle fossa floor.
Five silicone-injected adult cadaver heads (10 sides) were dissected. Safe and effective localization of the MA was evaluated.
The MA displayed anatomical variations in relation to the lateral pterygoid muscle (LPM) and the mandibular nerve branches. The proposed L-shaped perpendicular 2-step drilling technique revealed a long MA segment that allowed generous rotation to the intracranial area for an end-to-end anastomosis. The first step of drilling involved medial-to-lateral expansion of foramen ovale up to the lateral border of the superior head of the LPM. The second step of drilling extended at an angle approximately 90° to the initial path and reached anteriorly to the foramen rotundum. The MA was localized by gently retracting the upper head of the LPM medially in a posterior-to-anterior direction.
Considering all anatomical variations, the L-shaped perpendicular 2-step drilling technique through the interforaminal space is an attainable method to release an adequate length of MA. The advantages of this technique include the early identification of precise landmarks for the areas to be drilled, preserving all mandibular nerve branches, the deep temporal arteries, and maintaining the continuity of the LPM.

暂无摘要。

CONCLUSIONS: Nasoseptal flap with extended pedicle dissection is a low morbidity and high success rate flap. It is a flap that can be applied to reconstruct a wide range of ipsilateral skull base defects.