Exploring the potential of MRI studies in assessing risks during arthroscopy - insights on maxillary artery encounter.

Surgical Anatomy of the Donor Arteries for Extracranial-Intracranial Bypass Surgery: An Anatomic and Radiologic Study

Background and purposeThis retrospective study evaluates the safety and effectiveness of preoperative endovascular embolization in patients who underwent temporomandibular joint (TMJ) replacement surgery.Material and methodsWe included all patients treated with...

Internal Maxillary Artery to Anterior Circulation Bypass with Local Interposition Grafts Using a Minimally Invasive Approach: Surgical Anatomy and Technical Feasibility

ObjectiveTo examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery.Materials and methodsThe method was applied to five adult cadaver sides bilaterally. The MA was easily found 1–2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2–3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA.ResultsThe average diameter of the MA proximal to the infraorbital artery branch was 2.6±0.3 mm. The average diameter of the P2 was 2.2±0.2 mm. The average length of the graft was 47±5.2 mm.ConclusionAs MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to “ECA to PCA” bypass.

This article reports the successful surgical-orthodontic treatment of an elderly patient with dentofacial deformity and signs and symptoms of temporomandibular disorder (TMD). The patient was a 63-year-old woman with a concave profile due to mandibular protrusion. To correct skeletal deformities, the mandible was posteriorly repositioned by employing intraoral vertical ramus osteotomy (IVRO) following presurgical orthodontic treatment. After active treatment for 31 months, the facial profile was significantly improved and satisfactory occlusion was achieved. In addition, TMD symptoms of clicking sounds on the left side and difficulty in mouth opening were resolved. Regarding the findings of magnetic resonance imaging, anterior disc displacement in the opening phase was improved in the temporomandibular joint on the left side. Furthermore, stomatognathic functions were also improved without any aggravation of age-related problems. In conclusion, surgical repositioning of the mandible using IVRO leads to both morphological and functional improvements even in elderly patients.

Observation of the posterior superior alveolar artery in the maxillary tuberosity region by computed tomography angiography: Pilot study using Japanese cadaveric specimens

Condylar and temporomandibular joint disc positions after mandibular osteotomy for prognathism

Navigation-Assisted Intraoral Vertical Ramus Osteotomy

4:18 PM Abstract No. 174 - Angiographic features and endovascular management of carotid blowout syndrome in patients with nasopharyngeal carcinoma treated with radiotherapy - a review of 12-years experience

INTRODUCTION: A large animal model for composite face transplantation is necessary to better understand the immunologic processes and nerve regeneration. Current porcine models of facial transplantation fail to include all major branches of the facial nerve, and have not demonstrated long-term survival.1,2 A better understanding and detailed evaluation of vascular anatomy and microvascular territories in facial subunits and bone can help effectively develop a reliable porcine composite tissue flap model for experimental reconstructive or transplantation studies. METHODS: Eleven 10kg domestic pigs were used for in-vivo studies. Vascular anatomy was assessed by Intra-operative anatomical dissections of 11 hemi-facial composite tissue flaps including the auricle. In addition Computed Tomographic Angiography (CTA) and Laser-assisted Indocyanine Green Fluorescence Angiography (LA-ICGFA) were used to assess vascular architecture preoperatively and flap perfusion. In addition, 8 cadaveric pigs were used for selective angiography of branches of the external carotid artery using a barium sulfate and latex mixture to provide detailed qualitative and quantitative analysis of the vascular territories using ultra-high resolution 3D CTA followed by a detailed anatomical dissection. Perforator distributions in facial subunits and the relationship of vascular territories to the facial nerve branches were documented. RESULTS: A composite tissue flap of the hemi-face including the auricle was elevated and auto-transplanted in eleven 2 months old domestic pigs. Three pigs underwent preoperative CTA. We demonstrated two principal vessels supplying the hemifacial tissues: Internal maxillary artery (IMA) and superficial temporal artery (STA), with less significant contribution from the facial artery. Use of 3D volume rendering of the CTAs and the anatomical dissections demonstrated the vasculature and potential angiosomes of dominant and minor branches from the external carotid artery. We have been able to categorize facial subunit vascularity to delineate safe vascular territories for flap design in facial transplantation or reconstructive surgery. CONCLUSION: We describe a new swine facial transplantation model with successful outcomes and reliable vascularity confirmed with anatomic, in-vivo CTA studies. Novel detailed vascular injection studies provide understanding of 3D vascular territories paramount to flap design, therefore enabling successful long-term modeling of hemi-facial composite tissue transplantation. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Kuo, Y. R., Shih, H. S., Lin, C. C., et al. (2009). Swine hemi-facial composite tissue allotransplantation: a model to study immune rejection. Journal of Surgical Research, 153(2), 268–273. 2. Gordon, C. R., Murphy, R. J., Coon, D., et al. (2014). Preliminary development of a workstation for craniomaxillofacial surgical procedures: introducing a computer-assisted planning and execution system. The Journal of craniofacial surgery, 25(1), 273.

Distraction osteogenesis has recently become a mainstay for treatment of craniofacial syndromes with mandibular hypoplasia. This article presents the difficult case of a patient with a previous costochondral rib graft who underwent mandibular distraction and developed a fibrous pseudoarthrosis at the distraction site. This was attributed in part to an associated temporomandibular joint ankylosis. Resorption of the pseudoarthrosis occurred once the distractor was removed. It appears that distraction osteogenesis of a mandible with an ankylosed temporomandibular joint can result in healing with a fibrous union, presumably because of movement at the distraction site when masticating. This can result in a pseudo "temporomandibular joint" at the distraction site. A temporomandibular joint arthroplasty was performed, followed by repeat distraction. We conclude that if there is an ankylosed temporomandibular joint or a stiff temporomandibular joint that may ankylose during the course of the distraction process, then a temporomandibular joint arthroplasty should be performed before or at the time the distractor is placed.

Primary aneurysmal bone cyst of the temporomandibular joint: Multidisciplinary management with a CAD/CAM total joint replacement in a unique patient population

Temporomandibular joint disease (TMJ) is one of the most pressing problems of modern dentistry, on the one hand, the frequency of pathology of the temporomandibular joint, and on the other hand - the complexity of diagnosis.
 In the medical specialty "dentistry" there is no section where there would be as many debatable and unresolved issues as in the diagnosis and treatment of diseases of the temporomandibular joints.
 Aim of the research. Based on the analysis of sources of scientific and medical information to determine the role and place of "Costen's syndrome" in the pathology of the temporomandibular joints.
 Results and discussion
 The term TMJ dysfunction has up to 20 synonyms: dysfunction, muscle imbalance, myofascial pain syndrome, musculoskeletal dysfunction, occlusal-articulation syndrome, cranio-mandibular TMJ dysfunction, neuromuscular and articular dysfunction.
 Finally, in the International Classification of Diseases (ICD-10), pain dysfunction of the temporomandibular joint has taken its place under the code K0760 with the additional name "Costen's syndrome", which is given in parentheses under the same code.
 Thus, such a diagnosis as "Costen's syndrome" is not excluded in the International Classification of Diseases.
 The first clinical symptoms and signs of TMJ were systematized in 1934 by the American otorhinolaryngologist J. Costen and included in the special literature called "Costen's syndrome".
 This syndrome includes: pain in the joint, which often radiates to the neck, ear, temple, nape; clicking, crunching, squeaking sound during movements of the lower jaw; trismus; hearing loss; dull pain inside and outside the ears, noise, congestion in the ears; pain and burning of the tongue; dizziness, headache on the side of the affected joint, facial pain on the type of trigeminal neuralgia. The author emphasized the great importance of pain and even singled out "mandibular neuralgia."
 The criteria proposed by McNeill (McNeill C.) in 1997 are somewhat different from those described in ICD-10: pain in the masticatory muscles, TMJ, or in the ear area, which is aggravated by chewing; asymmetric movements of the lower jaw; pain that does not subside for at least 3 months.
 The definition of the International Headache Society is similar in content.
 Anatomical and topographic study of the corpse material suggested the presence of a structural connection between the TMJ and the middle ear. According to some data, in 68% of cases the wedge-shaped mandibular ligament reaches the scaly-tympanic fissure and the middle ear, and in 8% of cases it is attached to the hammer. In addition, several ways of spreading inflammatory mediators from the affected TMJ to the middle and inner ear, which causes otological symptoms, have been described.
 It should be noted that there are certain prerequisites for the mutual influence of the structures of the cervical apparatus, middle and inner ear and upper cervical region at different levels: embryological, anatomical and physiological.
 At the embryological level. It is confirmed that from the first gill arch develops the upper jaw, hammer and anvil, Meckel's cartilage of the lower jaw, masticatory muscles, the muscle that tenses the eardrum, the muscle that tenses the soft palate, the anterior abdomen of the digastric muscle, glands, as well as the maxillary artery and trigeminal nerve, the branches of which innervate most of these structures.
 At the anatomical level. Nerve, muscle, joint and soft tissue structures of this region are located close enough and have a direct impact on each other. The location of the stony-tympanic cleft in the medial parts of the temporomandibular fossa is important for the development of pain dysfunction.
 At the physiological level. A child who begins to hold the head, the functional activity of the extensors and flexors of the neck gradually increases synchronously with the muscles of the floor of the mouth and masticatory muscles, combining their activity around the virtual axis of the paired temporomandibular joint.
 In addition, the location of the caudal spinal nucleus of the trigeminal nerve, which is involved in the innervation of the structures of the ear, temporomandibular joint and masticatory muscles at the level of the cervical segments C1-C3 creates the possibility of switching afferent impulses from the trigeminal nerve to the upper cervical system. Innervate the outer ear, neck muscles and skin of the neck and head. Also important are the internuclear connections in the brainstem, which switch signals between the vestibular and trigeminal nuclei.
 That is why the approach to the treatment of this pathology should be only comprehensive, including clinical assessment of the disease not only by a dentist or maxillofacial surgeon, but also a neurologist, otorhinolaryngologist, chiropractor, psychotherapist with appropriate diagnostic methods and joint management of the patient.

Class III malocclusion with severe facial asymmetry, unilateral posterior crossbite, and temporomandibular disorders

Endoscopically Assisted Intraoral Vertical Ramus Osteotomy and Piezoelectric Surgery in Mandibular Prognathism