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Anatomy and Embryology of the Mouth and Dentition
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Teeth in the lower jaw are supplied by the inferior alveolar (dental) artery, a branch of the maxillary artery (see Figure 41.5). It lies in the infratemporal fossa where it gives off a mylohyoid branch before entering the mandibular foramen. The inferior alveolar artery then traverses the mandibular canal (accompanied by the inferior alveolar nerve) to supply the mandibular molars and premolars and divides into the incisive and mental branches below the premolar teeth. The incisive branch continues below the incisor teeth (which it supplies) to the midline. The mental artery leaves the mental foramen to supply the chin.
Anatomy of the Skull Base and Infratemporal Fossa
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The first part of the maxillary artery gives off the: inferior alveolar arterymiddle meningeal arteryaccessory meningeal arterydeep auricular arteryanterior tympanic artery. The inferior alveolar artery passes down to join the inferior alveolar nerve and enter the mandibular foramen. The MMA passes straight up through the foramen spinosum, while the accessory meningeal artery passes through the foramen ovale. The deep auricular artery passes up to supply the external auditory canal and the anterior tympanic artery enters the petrotympanic fissure on its way to the middle ear.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The maxillary artery (Plate 3.29) is superficial to the lateral pterygoid muscle in about two-thirds of human adults and deep to this muscle in about one-third of human adults. One of its major branches is the middle meningeal artery, which arises medial to the neck of the mandible, then runs superiorly to pass between fibers of the auriculotemporal nerve before entering the foramen spinosum to supply the dura mater (Plate 3.22). Anteriorly to the middle meningeal artery, and also running superiorly, are the anterior and posterior deep temporal arteries that enter the deep surface of the temporalis muscle, and the masseteric artery that enters the deep surface of the masseter muscle. In contrast, the inferior alveolar artery runs inferiorly to enter the mandibular foramen with the inferior alveolar nerve. The buccal artery runs anteriorly and inferiorly to supply the cheek. After giving rise to these branches, the maxillary artery runs anteriorly toward the pterygopalatine fossa and divides into four terminal branches: the posterior superior alveolar artery, the infraorbital artery, descending palatine artery, and sphenopalatine artery. The sphenopalatine artery runs with the nasopalatine nerve from the sphenopalatine foramen to the incisive canal and supplies the nasal septum and part of the mucosa that covers the anterior hard palate. The sphenopalatine artery branches into the posterior lateral nasal artery that goes to the lateral nasal wall and the posterior septal branch that goes to the nasal septum. The descending palatine artery lies in the greater palatine canal that runs vertically, lateral to the palatine bone, from the region of the sphenopalatine foramen to the greater palatine foramen. Distally, the descending palatine artery divides into the greater palatine artery and the lesser palatine artery to supply the hard and soft palates respectively. The other terminal branch of the maxillary artery that lies in this region, the infraorbital artery, passes across the inferior orbital fissure, enters the infraorbital canal, and then emerges on the face through the infraorbital foramen.
Acute Vision Loss as an Ophthalmic Complication of Dental Procedures
Published in Seminars in Ophthalmology, 2021
Cody Lo, Ashley H.S. Kim, Ahmed Hieawy, Nawaaz A. Nathoo
The extent to which the oral cavity and orbit share vasculature allows for ischemic causes of vision loss following dental procedures through embolic occlusion, vasospasm, and dissection.12–16 The oral cavity and orbit share a common vascular origin from the common carotid artery prior to the bifurcation of the internal carotid to the orbit and the external carotid to the oral cavity.14 However, additional connections with inter-individual variability may exist between the oral cavity and the orbit but carry a relatively smaller volume of blood. This includes the inferior alveolar artery connecting to the internal maxillary artery leading to the middle meningeal , lacrimal, and ophthalmic arteries.2 This path allows for local anesthetic used in dental procedures to travel a short retrograde course through the inferior alveolar artery if injected intra-arterially under sufficient pressure. This is followed by an anterograde course through the arteries supplying the orbit resulting in transient impairment of vision.2,27 While it is easier to rationalize the vascular relationship between the maxillary (upper) teeth and the orbit, cases of amaurosis shortly following infiltration of the mandibular (lower) teeth have also been reported.28 It is estimated that ophthalmic complications, which include vision loss, occur in 0.1% of dental anaesthesia injections, although these events may be under reported.27 Ophthalmic complications of local anesthetic typically have an immediate onset and affect the ipsilateral eye resulting in vision changes that may be transient or permanent.29 A systematic review of ocular adverse effects following dental local anesthesia found that the most common ocular complications seen (in order of decreasing frequency) include ophthalmoplegia, diplopia, amaurosis, and Horner’s syndrome; while these complications were typically transient, 8% of ocular complications resulted in permanent visual impairment.30,31 Our review identified cases of central retinal artery occlusions (CRAOs), branch retinal artery occlusions (BRAOs), and non-arteritic anterior ischemic optic neuropathies (NAION) following dental procedures, which we will elaborate on further below.