Simon Bruneder1, Jürgen Wallner2, Andreas Weiglein3, Ĺudmila Kmečová4, Jan Egger5, Ulrike Pilsl3, Wolfgang Zemann2. 1. Department of Macroscopic and Clinically Applied Anatomy (Head: Prof. F. Anderhuber), Medical University of Graz, Harrachgasse 21/1, A-8010, Graz, Austria; Department of Dental Medicine and Oral Health (Head: Prof. W. Wegscheider), Medical University of Graz, Billrothgasse 4, A-8036, Graz, Austria. Electronic address: simon.bruneder@medunigraz.at. 2. Department of Oral & Maxillofacial Surgery (Head: Prof. N. Jakse), Medical University of Graz, Auenbruggerplatz 5/1, A-8036, Graz, Austria. 3. Department of Macroscopic and Clinically Applied Anatomy (Head: Prof. F. Anderhuber), Medical University of Graz, Harrachgasse 21/1, A-8010, Graz, Austria. 4. Department of Macroscopic and Clinically Applied Anatomy (Head: Prof. F. Anderhuber), Medical University of Graz, Harrachgasse 21/1, A-8010, Graz, Austria; Department of Pediatric Medicine (Head: Prof. K. Kralinsky), F.D. Roosevelt University Hospital Banska Bystrica, L.Svobodu 1, 97401, Banska-Bystrica, Slovak Republic. 5. Institute of Computer Graphics and Vision (Head: Prof. D. Schmalstieg), University of Technology Graz, Inffeldgasse 16c/II, A-8010, Graz, Austria.
Abstract
PURPOSE: Osteotomies of the Le Fort I segment are routine operations with low complication rates. Ischemic complications are rare, but can have severe consequences that may lead to avascular bone necrosis of the Le Fort I segment. Therefore the aim of this study was to investigate the blood supply and special arterial variants of the Le Fort I segment responsible for arterial hypoperfusion or ischemic avascular necrosis after surgery. MATERIAL AND METHODS: The arterial anatomy of the Le Fort I segment's blood supply using 30 halved human cadaver head specimens was analyzed after complete dissection until the submicroscopic level. In all specimens the arterial variants of the Le Fort I segment and also the arterial diameters measured at two points were evaluated. RESULTS: The typical known vascularization pattern was apparent in 90% of all specimens, in which the ascending palatine (D1: 1,2 mm ± 0,34 mm; D2: 0,8 mm ± 0,34 mm) and ascending pharyngeal artery (D1: 1,3 mm ± 0,58 mm; D2: <0,4 mm) were both supplying the Le Fort I segment. However in 10% of all specimens, the Le Fort I segment was dependent on the ascending pharyngeal artery alone and the missing ascending palatine artery was replaced with the anterior branch of the ascending pharyngeal artery (D1: 1,9 mm ± 0,32; D2: 1,0 mm ± 0,3 mm). CONCLUSION: This study is the first description of a special type of arterial variation of the Le Fort I segment. The type of this arterial variation, its clinical relevance and potential consequences are explained. Individuals with this special arterial anatomy may clinically be at a high risk for hypoperfusion and avascular segment necrosis after surgery. An individualized operation plan may prevent ischemic complications in at-risk patients.
PURPOSE: Osteotomies of the Le Fort I segment are routine operations with low complication rates. Ischemic complications are rare, but can have severe consequences that may lead to avascular bone necrosis of the Le Fort I segment. Therefore the aim of this study was to investigate the blood supply and special arterial variants of the Le Fort I segment responsible for arterial hypoperfusion or ischemic avascular necrosis after surgery. MATERIAL AND METHODS: The arterial anatomy of the Le Fort I segment's blood supply using 30 halved human cadaver head specimens was analyzed after complete dissection until the submicroscopic level. In all specimens the arterial variants of the Le Fort I segment and also the arterial diameters measured at two points were evaluated. RESULTS: The typical known vascularization pattern was apparent in 90% of all specimens, in which the ascending palatine (D1: 1,2 mm ± 0,34 mm; D2: 0,8 mm ± 0,34 mm) and ascending pharyngeal artery (D1: 1,3 mm ± 0,58 mm; D2: <0,4 mm) were both supplying the Le Fort I segment. However in 10% of all specimens, the Le Fort I segment was dependent on the ascending pharyngeal artery alone and the missing ascending palatine artery was replaced with the anterior branch of the ascending pharyngeal artery (D1: 1,9 mm ± 0,32; D2: 1,0 mm ± 0,3 mm). CONCLUSION: This study is the first description of a special type of arterial variation of the Le Fort I segment. The type of this arterial variation, its clinical relevance and potential consequences are explained. Individuals with this special arterial anatomy may clinically be at a high risk for hypoperfusion and avascular segment necrosis after surgery. An individualized operation plan may prevent ischemic complications in at-risk patients.