The Vessel Architecture of the Maxilla and Its Clinical Significance
|School||First Military Medical University|
|Course||Human Anatomy , Histology and Embryology|
|Keywords||Mandible Blood supply Osteotomy Applied anatomy|
The supply of the maxillary blood on the research background, has been an important issue of Oral and Maxillofacial Surgery. It on various types of maxillary osteotomy surgery designed mobile bone blood supply, there is resistance to infection and healing judgment after surgery significance. Bell using microvascular angiography and histology study found that the maxillary and medial branch circulation of the soft tissue, gums, palate, nose, lips and periodontal tissue coincide with each other vascular maxillary osteotomy segment Cong. You Zhihao with X-ray angiography and ink perfusion method for the study, 14 fresh cadavers maxillary genetically. Pointed out that the maxillary both superior alveolar artery blood supply, but also accept the blood supply from the the bone surface mucoperiost artery branches. The above study is the mandible surgery provides the basis of the blood supply, but vascular display is not intuitive, the lack of three-dimensional. In this study, for maxillary genetically for the form of well-known arterial branches, distribution, and walk the line, to be perfused through the artery latex specimen dissection of the head and face and head and facial artery casting method, detailed observations of the maxillary vascular distribution consistent, intuitive, three-dimensional The presents maxillary mucoperiosteal angioarchitecture model for clinical surgery carried out to provide blood for the foundation. Research for the source of purpose through the maxillary genetically superior alveolar artery superior alveolar artery, descending palatine artery palate main artery blood vessels line tracking and distribution of maxillary mucoperiosteal vascular anastomosis observation, various types of osteotomy for maxillary morphological basis of clinical valuable guidance. Research methods. Four cases of adult cadavers head and face red latex from arterial infusion specimens, layered anatomy, Deep and turn anatomical facial artery, the artery of the inner canthus infraorbital artery, maxillary artery, superior alveolar artery superior alveolar artery descending palatine artery, palate main artery. Maxillary detailed observation of the feeding artery starting at the location of the main blood supply artery diameter of (and measurement), tracking their maxillary surface course, distribution, and understanding of the jaw mucoperiosteal vascular anastomosis. 2. To choose fresh head and neck specimens in 2 cases, bilateral carotid artery was cannulated, pressurized perfusion red perchlorethylene ethyl acetate filler until bilateral facial skin red, recharge a total of 6 times, until the filler fully solidified After the application of natural corrosion removal of soft tissue. Retain bone and vascular casting, blood vessels running branch anastomosis observe maxillary the 3D angioarchitecture and consistent. Results 1. Nutrient artery maxilla maxillary blood supply from the superior alveolar artery superior alveolar artery. Which together supply four cases, only two cases supplied by the superior alveolar artery. Separated from the maxillary artery in paragraph 3 superior alveolar artery, infraorbital artery total dry issue 3/4, the maximum diameter of the superior alveolar artery at 1.8mm, along the upper mandible body back downstream, maxillary temporal below in parts issued in arterial medial branch directly into the upper jaw, the maximum diameter of the branch at the beginning of 0.9mm. Superior alveolar artery by the infraorbital artery at the infraorbital canal issue, starting at the maximum diameter of 0.8mm. Nutrient vessels within the maxilla either type, palate, the main artery in the upper jaw in front line process issued multiple Guchuan sticks (smaller diameter, generally less than 0.5mm), maxillary nutrition. 2. Jaw mucoperiosteal the blood supply to the blood supply of the maxillary mucoperiosteal system: buccal branch of the superior alveolar artery, infraorbital artery, palate main artery. The the maxillary buccal side back copies mucoperiost by supply buccal branch of the superior alveolar artery (starting diameter of its trunk a few undifferentiated), the buccal branch of the artery along the mandibular posterior superior alveolar surface oblique forward Xiazou the line around over zygomatic alveolar crest, ranging along Score branch, branches of nutrition maxillary molars and premolars alveolar sudden buccal mucosa and gums; mucoperiosteal buccal front, upper lip roots, labial gingival supplied by both sides of the infraorbital artery, orbital The infraorbital foramen artery 3 to 4 branches, which is an almost vertically down to the fangs nearby, forming terminal branch of the distribution of the anterior teeth labial gums, infraorbital artery, the branch also issued a small periosteal nutrient artery; supply the maxillary palatal mucoperiosteal by palate main artery, the palate the main artery descending palatine artery from maxillary sinus wall and the rear wall of the junction issued palate main artery trunk general pterygopalatine canal road to the palate big hole in 2 to 3 range (5/6), there are also descending palatine artery just formed on the branch (1/6). Palatal pterygopalatine tube along the maxillary alveolar process and palate at the junction of the main artery of the palate before the major groove of the line, the lateral branches distributed to the palatal mucoperiosteal palatal gingival and alveolar process, medial branch distribution to the hard palate oral mucosa, palate, the main artery of the last paragraph of wear the incisors holes into the nasal cavity. 3. Upper jaw, the outer vascular anastomosis maxillary the outside mucoperiost within a rich vascular network. The network sources artery: ① superior alveolar artery branches, ② labial artery branch; ③ infraorbital artery branch; ④ canthal artery branch; ⑤ palate main artery branch; ⑥ the sphenopalatine artery branch, and the ascending pharyngeal artery branch. Constitute the mucoperiosteal the capillaries network at the same time, part of the artery through the maxillary surface of many different sizes Vice hole into the maxillary maxillary nutrient artery anastomoses with branches, which constitute the maxillary stereo arterial network of internal and external traffic. Maxillary lateral vascular anastomosis density differences: the inside than the outside of vascular anastomosis at the apparent lack of consistent palate seam on the inside near the outside of the front teeth area is slightly more than the outside of the cheek. Conclusion 1. This study showed that the blood supply to the maxilla multi-source. Superior alveolar artery is the main artery of the upper jaw, upper jaw with soft tissue between rich arterial blood vessel traffic, and even into the bone of the soft tissue of the arterial branch distribution on alveolar artery, infraorbital artery descending palatine artery, sphenopalatine artery distribution in the lips, buccal, palatal mucoperiosteal arterial system by communicating artery maxillary blood supply. 2. Maxillary blood supply characteristics, the authors believe that as long as there is a certain width labial or palatal mucoperiosteal pedicle osteotomy segment can survive. Palatal artery traffic branch, so the best design palatal mucoperiosteal pedicle. 3. Note the following: (1) osteotomy segment should not be too small maxillary osteotomy operation; (2) osteotomy segment moving distance should not be too large: (3) Le fort I osteotomy ligation of the descending palatine artery not affect the blood supply of the osteotomy segment, more does not cause osteotomy segments ischemia; while reducing uncontrollable intraoperative and postoperative bleeding, shorter operative time and increase the mandible front moving distance. (4) move maxillary osteotomy bone and the purposes of internal fixation affects the operation, without prejudice to the expected effect of the premise, to minimize the peel around the maxillary soft tissue to reduce postoperative ONJ the pulp serious degeneration risk, and create favorable conditions for bone healing. 4. Maxillary blood supply to determine the characteristics of the two-way nature of the infection and spread. This osteotomy resistance to infection also has very important significance.