A bilateral maxillofacial trunk in man: an extraordinary anomaly of the carotid system of arteries.

In a Caucasian male, the maxillary artery (M) bilaterally arose with the facial artery anteromedially from the external carotid artery. On the right side, the M entered the infratemporal fossa between the neck of the mandible and the medial pterygoid muscle, whereas the left M pierced the medial pterygoid muscle, first being covered by the muscle and the angle of the mandible. On both sides, the M ran deep to the inferior head of the lateral pterygoid muscle and the buccal nerve. The right M lay deep to the inferior alveolar, but superficial to the lingual nerve, whereas the left inferior alveolar and lingual nerves had formed two roots, thus encircling the left M. The ascending palatine artery was replaced on both sides by palatine branches of the ascending pharyngeal artery. Since a bilaterial maxillofacial trunk with topographical relations as described herein has not been previously reported in man, the embryology and comparative anatomy of this variation are discussed.     

Homologies of the stapedial artery in humans, with a reconstruction of the primitive stapedial artery configuration of Euprimates

Data drawn from the perspectives of paleontology, comparative anatomy, embryology, teratology, and normal adult variation were analyzed with nine homology criteria in order to determine the homologues of the stapedial artery in adult humans. It was determined that 1) the stem of the stapedial artery does not persist within the cranial cavity; 2) the stem of the ramus inferior is retained in its entirety and forms the upper portion of the stem of the middle meningeal artery; 3) the proximal part of the ramus infraorbitalis is normally absent and is replaced by a collateral shunt arising from the ramus mandibularis; 4) the ramus mandibularis is retained and forms the lower portion of the middle meningeal stem and the inferior alveolar artery; 5) the most proximal portion of the maxillary artery is formed by an anastomotic shunt connecting the external carotid artery to the ramus mandibularis; 6) the anterior division of the ramus superior is normally present and well developed; 7) the posterior division of the ramus superior is present in many individuals; and 8) the junction of the two divisions of the ramus superior with the ramus inferior usually migrates to the floor of the middle cranial fossa. The range of human arterial patterns, and those of all other euprimates, can be derived from a hypothetical primitive pattern that is very similar to that of primitive rodents. In this pattern, the stapedial artery stem enters the middle cranial fossa and trifurcates into the anterior and posterior divisions of the ramus superior and the ramus inferior. In their evolution, strepsirhines initially lose the ramus inferior and haplorhines initially reduce the stapedial artery stem.     

Longitudinal study of craniofacial growth in Macaca fascicularis

This paper is an analysis of normal craniofacial growth in adolescent crab-eating macaques (Macaca fascicularis). Eight female adolescent monkeys were used in this study. Their individual craniofacial growth was studied for a 24-month period utilizing tantalum implants and roentgenographic cephalograms. Throughout the observation period, each monkey consistently showed a class I molar relationship with a good overjet and overbite. The amount of anterior displacement of the maxilla and the mandible was significantly dominant compared to the vertical displacements at every observation period. The midface exhibited a maxillary differential growth pattern in which the premaxilla displaced superiorly and the posterior maxilla moved inferiorly, resulting in a counterclockwise rotation of the entire maxilla. Growth of the lower anterior teeth and alveolar bone compensated for the incremental vertical spaces which were induced by superior displacement of the premaxilla and inferior repositioning of the chin. In addition, the amount of anterior displacement of the upper and lower anterior teeth were significantly larger than that of the premaxilla and the chin. The dentocraniofacial growth pattern in Macaca fascicularis was quite similar to that seen in Macaca mulatta.     

An angiographic study of the carotid arterial and jugular venous systems in the cat.

Standard techniques for performing carotid angiography in dogs and in man were adapted to the cat in order to study the vascularization of both intracranial and extracranial structures. Venous drainage was examined by venography of selected vessels. The carotid-cerebral and the vertebral-basilar arterial systems of the cat were studied, although no attempt was made to define the territory supplied by each system. In serial angiograms, vascularization of the rete mirabile conjugatum was visualized and distinct arterial and venous retia were delineated. Large facial veins were seen approximately one second after the intra-arterial injection of radio-contrast material. The early filling of the large facial veins appeared to be the result of an artery-to-venous shunt. Contrast material flowed posteriorly in these veins and drained into the venous rete. When contrast material was injected either into the sagittal sinus or retrograde in the external jugular vein, the internal jugular vein was visible in four of ten cats. This vessel drained blood directly from intracranial contents before anastomosis with the vertebral and external jugular veins.     

Arterial anatomy of the lower lip: a cadaveric study

The aim of the study was to investigate the arterial anatomy of the lower lip. The location, course, length, and diameter of the inferior labial artery and the sublabial artery were revealed by bilateral meticulous anatomic dissections in 14 adult male preserved cadaver heads. Another cadaver head was used for silicone rubber injection to fill the regional arterial tree. The inferior labial artery was the main artery of the lower lip and in all cases branched off the facial artery. The mean length of the inferior labial artery was found to be 52.3 mm (range, 16 to 98 mm). The mean distance of the origin of the inferior labial artery from the labial commissura was 23.9 mm. The mean external diameter of the inferior labial artery at the origin was 1.2 mm. The sublabial artery was present in 10 (71 percent) of the cadavers. Mean measurements of this artery were 1 mm for diameter, 23.4 mm for length, and 27.6 mm for distance from the labial commissura. The sublabial artery may originate from the facial artery or the inferior labial artery. This study found that this region does not have a constant arterial distribution, the inferior labial artery and the sublabial artery (if it exists) can be in different locations unilaterally or bilaterally, and the diameter and the length may vary.     

Cadaveric study of the arterial anatomy of the upper lip

Arterial distribution of the upper lip was investigated in this study. The location, course, length, and diameter of the superior labial artery and its alar and septal branches were determined on 14 preserved cadaver heads. Another cadaver head was used to show the arterial tree by the colored silicone injection technique. The superior labial artery was the main artery of the upper lip and always originated from the facial artery. The superior labial artery was 45.4 mm in length, with a range from 29 to 85 mm. The mean distance of the origin of the superior labial artery from the labial commissura was 12.1 mm. The superior labial artery was 1.3 mm in external diameter at its origin. The mean distance of origin of the superior labial artery from the lower border of the mandible was 46.4 mm. The alar division of the superior labial artery was mostly found as a single branch (82 percent). Its mean length was 14.8 mm and the mean diameter at the origin was 0.5 mm. The distance between the origins of the superior labial artery and the septal branch was 33.3 mm. The septal branch was single in most of the cases (90 percent). The mean length of the septal branch was 18.0 mm and the diameter at its origin was 0.9 mm. After all dissections, it was concluded that the arterial distribution of the upper lip was not constant. The superior labial artery can occur in different locations unilaterally and bilaterally, with the branches showing variability.     

Anatomy of the arteries of the head in the domestic fowl

The anatomy of the cephalic arterial system in the fowl was studied in 24 specimens by means of latex-injected preparations and by dissection. Branches of the external carotid artery supply the extracranial regions. The vertebral arteries unite with the occipitals and have no major communications with the encephalic system. Blood can reach the brain directly from the internal carotid artery and indirectly by way of the extensive cerebral-extracranial anastomoses; especially prominent are those to the palatine and sphenomaxillary arteries from the maxillary and facial branches of the external carotid artery. A large external ophthalmic artery supplies the temporal rete and eye musculature, and an internal ophthalmic artery links the rete and the cerebral vessels. The circle of Willis is incomplete both anteriorly and posteriorly; the anterior cerebral arteries do not unite and the basilar artery is generally asymmetrical in origin. The basilar artery tapers caudally and is continued as the ventral spinal artery.     

Color Doppler flow imaging of the facial artery and vein

The purpose of this study was to provide some guidelines with respect to the location of the facial vessels, display the potential inverted blood flow of the facial artery, and reemphasize the value of color Doppler ultrasound studies in flap planning. An anatomic study of the facial artery and vein was done using color Doppler ultrasonography in 12 adults. The artery and the vein were located together at the lower border of the mandible. Around the oral commissure and under the nasal ala, they were located apart from each other with variable distances. This divergence of the facial vein from the artery is important information in the planning of axial pattern flaps. Furthermore, the reverse flow was observed in 12 patients after the blood flow of the facial artery was stopped by applying pressure manually at the lower border of the mandible. Observation of the reversed flow confirms the possibility of safe elevation of a retrograde flow-arterialized flap based on the distal portion of the facial artery.     

The blood vascular system in the head of the herring gull (Larus argentatus)

The structure and development of the blood vascular system in the head of the herring gull (Larus argentatus) have been studied using injection techniques and histological sections. Three different but interconnected divisions of the arterial system are recognized in the adult: the cerebral carotid artery system, the external ophthalmic artery system, and the external carotid artery system. Embryologically, the arterial system is characterized by changes in the relative development of these three divisions; the cerebral carotid system being the most prominent in the first half of the embryonic period. The venous system is divided into two parts, the rostral cephalic system and the caudal cephalic system, which drain separate regions of the head. The Rete ophthalmicum, which is an arteriovenous network associated with the external ophthalmic artery system, can be identified from the fifth day of incubation, and its development appears to be coupled with changes in the arterial supply to the eye. The possibility of a homology between the Rete ophthalmicum of birds and the Rete caroticum of mammals is briefly discussed.     

Meningeal arterial patterns in great apes: Implications for hominid vascular evolution

Arterial meningeal patterns were observed for 100 hemispheres from great ape endocasts (Pan paniscus, Pan troglodytes, Gorilla gorilla, and Pongo pygmaeus). Eight patterns emerged based on the relative contributions to the walls and dura mater of the middle part of the braincase of meningeal arteries that stem from two sources. These arteries enter the braincase through either the orbit (delivering blood from the internal carotid artery) or through the base of the middle cranial fossa (via the middle meningeal artery whose blood comes from the external carotid artery). The three genera of apes manifest different frequencies of the eight, patterns, with orangutans highly dependent on orbital meningeal arteries at one extreme, and chimpanzees showing the greatest reliance on the middle meningeal artery at the other. As was the case in an earlier study of rhesus monkeys, there is a trend across the two genera of African apes for increased mean cranial capacity to be associated with increased reliance on the internal carotid artery for supplying the middle portion of the braincase. However, unlike the case for macaques, this trend does not reach statistical significance in African apes. Because it is rare for humans to manifest significant arterial contributions from the orbit to the middle cranial fossa, the comparative data on monkeys, apes, and humans suggest that, during the course of vascular evolution in Homo, the middle meningeal artery eventually took over supply of the entire middle cranial fossa. This hypothesis should be tested in the hominid fossil record. Earlier work on meningeal arterial patterns in apes has traditionally relied on Adachi's system that was determined from humans and focuses on the origin of the middle branch of the middle meningeal artery. As a result, the extensive orbital contributions to the middle portion of the braincase that characterize apes were not recognized and the eight patterns described in this paper were often erroneously assigned to the three patterns that adequately describe only humans. Adachi's system should therefore be abandoned for nonhuman primates and early hominids. A correct understanding of meningeal arterial evolution cannot be achieved until the orbital contributions to the meningeal arteries are recognized and incorporated into an evolutionary study that spans from apes to fossil hominids to living people. © 1993 Wiley-Liss, Inc.     

Arterial segmentation and subsegmentation in the human spleen

The segmental nature of the arterial tree of the human spleen was analyzed in 181 subjects of both sexes, who had died of various accidental causes. Based on the observation of the pattern of the terminal and polar splenic branches, selective arteriographs and corrosion casts, and taking account of the ideas reported in the literature, we proposed that the spleen is divided in arterial segments and subsegments. Segments are the territories corresponding to both the primary branches of the splenic artery (primary segments) and the polar arteries (polar segments). In 92.82% of the cases there are two primary segments and in 7.18% three primary segments. Associated to these, in 29.28% there is a superior polar segment, in 44.75% an inferior polar segment, and in 10.49% both superior and inferior polar segments are present. Thus, the number of segments varies from two to five. Occasionally, two or three inferior polar segments can be present. Subsegments are the territories corresponding to the extrasplenic subdivisions of the primary branches and the polar arteries. According to the number of arterial subdivisions, the subsegments can be of second, third, fourth, fifth or sixth order. The last branches of the splenic artery (penetrating arteries) are all subsegmentary in nature and supply hilar or polar subsegments. Anastomoses between extrasplenic branches of the splenic artery were observed in 19.89% of the cases. Sometimes, thin anastomotic bridges could be observed between arterial splenic compartments.     

The relationship between facial proportions and root length in the dentition of dogs

The present analysis represents a follow-up to a previous experimental study in which facial shortening obtained in rats by septum removal produced also shortening of the molar roots. In the present study relative root length was compared in short-faced as against long-faced dogs and significant correlations between relative facial length and dental root length were found. Root shortening in the maxilla of short-faced dogs clusters around the areas of the premaxillary-maxillary suture and the maxillary-palatine suture. For the mandible it shifts one tooth more distally and is of lower statistical significance. This distribution seems to tie in with the greater growth arrest in the above sutural areas in the maxilla of short-faced dogs and the lesser growth arrest of their mandible.     

Main patterns and individual differences in baboon skull split-lines and theories of causes of split-line orientation in bone

Split-line patterns are reported in skulls of five adult male baboons. While variations in pattern occur in all parts of the skull, these variations are relatively minor in the following regions: supraorbital, lateral orbital, medial orbital, nasal bones, zygomatico-alveolar crest, nasal opening, alveolar process of maxilla and mandible. Wide differences in pattern occur in these regions: infraorbital, zygomatic bone, body of maxilla, and frontal bone posterior to the supraorbital area. The major variability in split-line orientation indicates that oversimplified interpretations of the patterns in terms of (1) conformity to gross structure, or (2) direction of bone growth, are untenable. The variations do not contradict a functional interpretation in which mechanical forces and skull form interact to different degrees in different individuals, however. Skulls of a variety of primates are useful for functional analysis, because they have similar structural plans, but the differences are well outside the normal range of variation for a single species.     

Homeobox gene hoxa3 is essential for the formation of the carotid body in the mouse embryos

Homeobox gene Hoxa3 is strongly expressed in the third pharyngeal arch and pouch. We found that Hoxa3 homozygous null mutant mice had the lack of the carotid body. In all late-term mutant embryos examined (n = 10), no carotid body was present. The carotid body rudiment is formed in the wall of the third branchial artery, which develops into the common carotid artery and the first part of the internal carotid artery. The symmetrical patterns of the third, fourth, and sixth arch arteries were observed in wild-type littermates at embryonic day (E) 10.5-12.5. In Hoxa3 homozygous mutant embryos, however, the third arch artery began to degenerate at E10.5 and almost disappeared at E11.5. Furthermore, the bifurcation of the common carotid artery at the normal position, i.e., at the upper end of the larynx, was never detected in the mutant embryos at E16.5-E18.5. The common carotid artery of the homozygous mutants was separated into the internal and external carotid arteries immediately after its origin. Thus, the present study evidenced that the absence of the carotid body in Hoxa3 homozygous mutants is due to the defect of development of the third arch artery, resulting in malformation of the carotid artery system. During fetal development, the carotid body of mice is in close association with the superior cervical ganglion of the sympathetic trunk. The superior cervical ganglion rather showed hypertrophic features in Hoxa3 homozygous mutants lacking the carotid body.     

Thermography in Occlusive Cerebrovascular Diseases

Cooling of the skin over the medial supraorbital region in 80% of patients who have an occlusion or severe stenosis of a carotid artery can be demonstrated by facial thermography. Minor stenotic lesions in the carotid arteries do not produce characteristic thermographic changes, while thermography is of no help in the diagnosis of vertebrobasilar arterial disease.Thermographic changes suggestive of carotid arterial lesions are found occasionally in patients whose angiograms are normal, owing to variations in the size of the frontal sinuses, or factors such as fever or inflammatory lesions.It is suggested that facial thermography is of value in the preliminary investigation of patients with occlusive cerebrovascular disease.     

New buccinator myomucosal island flap: anatomic study and clinical application

The authors studied the vascular anatomy of the buccinator muscle by dissecting fresh cadavers. The anatomy of the buccal branches of the facial artery consistently confirmed the existence of a posterior buccal branch, a few inferior buccal branches, and anterior buccal branches to the posterior, inferior, and anterior portions of the buccinator. The buccal artery and posterior buccal branch anastomose to each other and ramify over the muscle. Several veins originate from the lateral aspect of the muscle, converge into the buccal venous plexus, and drain into the facial vein (from two to four tributaries) or into the pterygoid plexus and the internal maxillary vein (from the buccal vein). These vessels and nerves enter the posterior half of the buccinator posterolaterally. The facial artery and vein are located at variable distances from each other around the oral commissure and the nasal base. Two patterns of buccinator musculomucosal island flaps supplied by these buccal arterial branches are proposed in this article. The buccal musculomucosal neurovascular island flap (posteriorly based), supplied by the buccal artery, its posterior buccal branch, and the long buccal nerve, can be passed through a tunnel under the pterygomandibular ligament for closure of mucosal defects in the palate, pharyngeal sites, the alveolus, and the floor of the mouth. The buccal musculomucosal reversed-flow arterial island flap (superiorly based), supplied by the distal portion of the facial artery through the anterior buccal branches, can be used to close mucosal defects in the anterior hard palate, alveolus, maxillary antrum, nasal floor and septum, lip, and orbit. The authors have used the flaps in 12 patients. There has been no flap necrosis, and results have been satisfactory, both aesthetically and functionally.     

Neurovascular territories of the external and internal oblique muscles

The purpose of this study was to document the extent of the arteries supplying the external and internal oblique muscles and the connections among the vascular territories. Ten adult human cadavers underwent whole-body arterial perfusion (200 ml/kg) with a mixture of lead oxide, gelatin, and water, through the carotid artery. The external and internal oblique muscles were dissected and subjected to radiography. The vasculature of each muscle was analyzed by using the paper template technique. The areas of the vascular territories of the individual intercostal arteries within the external oblique muscle varied from 9 to 22 percent. The area of the vascular territory of the muscular branch of the deep circumflex iliac artery was 5 to 18 percent. The ascending branch of the deep circumflex iliac artery supplied a mean of 35.7 percent of the vascular territory of the internal oblique muscle. The lower six posterior intercostal arteries supplied a mean of 48.5 percent. The lateral branches of the deep inferior epigastric artery supplied a mean of 15.8 percent. This information provides the basis for the design of external and internal oblique muscle flaps for functional muscle transfer.     

Cephalic arterial pattern in New World edentates and Old World pangolins with special reference to their phylogenetic relationships and taxonomy

The cephalic arterial pattern in edentates and pangolins is described on the basis of 9 corrosion specimens, representing all the classical superfamilies, with special reference to their phylogenetic relationship and taxonomy. In this respect, the importance of the manner in which the external carotid artery system annexes the stepedial area of supply and of the course of the internal carotid artery in relation to the tympanic cavity is emphasized. The investigation does not indicate any special relationship between the New World edentates and the Old World pangolins, whereas the marked difference in the course of the internal carotid artery in recent edentates stresses the independent development of the South American anteaters compared with that of the two other edentate groups (armadillos and tree sloths). Most probably the edentates were divided very early into two main lines which have evolved independently since the early Tertiary, i.e. one for the anteaters and one for the tree sloths and armadillos, indicating a probable subdivision of the true edentates into two suborders. This subdivision is markedly different from the classical two-fold division of the edentates.     

Embolization of the branches of the external carotid artery]

Authors present their own experience with the embolization of the external carotid artery branches. The main indications to embolization included well vascularized and hemorrhagic brain tumors in facial part of the skull, mainly meningiomas, juvenile angiofibromas, and angioneuromyomas. Embolization of external carotid artery was performed in 15 patients. Complete impatience of blood vessel supplying the tumor was achieved in 12 cases, but it was incomplete in 3 cases. Single serious complication in the form of hemiplegia was noted. There were also mild complications in 5 patients, which did not require any intervention.     

Craniofacial growth in subjects with unilateral complete cleft lip and palate, and unilateral incomplete cleft lip, from 2 to 22 months of age

This paper reports a longitudinal quantitative cephalometric analysis of the craniofacial growth in subjects with unilateral complete cleft lip and palate (UCCLP), and unilateral incomplete cleft lip (UICL), from 2 to 22 months of age. The purpose of the study was to determine the amount and direction of growth in UCCLP compared to UICL (control group) from 2 months of age (just prior to lip repair) to 22 months of age, 20 months later. The sample comprised of 49 subjects with UCCLP (37 males and 11 females) and 45 with UICL (29 males and 16 females). The cephalometric analysis of the craniofacial morphology included lateral, frontal, and axial projections. The data were presented as mean plots of the craniofacial region including the calvaria, cranial base, orbits, nasal bone, maxilla, mandible, cervical column, pharynx, and soft-tissue profile. A valid common coordinate system (registration according to the n-s line in the lateral projection, latero-orbitale line in the frontal projection, and meatus acusticus externus line in the axial projection for the landmark positions at examination 1 and 2) was ascertained. The growth at a specific anatomical location in a patient was defined as the displacement vector from the coordinate of the corresponding landmark in the X-ray at examination 1 to its coordinate at examination 2, corrected for X-ray magnification. The growth of an anatomical region in a patient was assessed by investigating the growth pattern formed by a collection of individual growth vectors in that region. The amount of growth in the UCCLP and UICL group was very similar. The general craniofacial growth pattern, in terms of the direction of growth, was also fairly similar in the UCCLP group and the control group. However, the maxilla and mandible showed a more vertical growth pattern than that observed in the control group. This study confirms that UCCLP is a localized deviation, and not a craniofacial anomaly, due to the fact that a normal growth potential has been observed in all craniofacial regions, except where the growth had been directly influenced by surgical intervention. Furthermore, the vertical growth pattern of the maxilla and mandible supports the hypothesis of a special facial type in cleft lip and palate individuals, and the facial type as a liability factor increasing the probability of cleft lip and palate.