Description of an ultrasound-guided maxillary nerve block in dogs: a cadaveric study and case series.

Preoperative vascular embolization (PVE) is commonly used in managing juvenile nasopharyngeal angiofibroma (JNA) to improve outcomes. However, few studies have evaluated how embolization patterns and vascular features affect prognosis. A 15-year retrospective review was performed on 44 patients with JNA undergoing surgery at one institution. Data included demographics, vascular supply, embolization techniques, surgical outcomes, and recurrence. Forty-three patients underwent PVE. Most tumors were embolized transarterially (93.0%) using polyvinyl alcohol-based agents (79.1%). The internal maxillary artery was most commonly embolized (93.0%). Internal carotid artery supply was present in 34.9%, and more than two vessels were embolized in 23.3%. Postembolization tumor blush occurred in 60.5%, with a median of 5% of the pre-embolization blush remaining after embolization. Neither internal carotid involvement, number of vessels embolized, nor residual blush significantly impacted operative time, surgical outcomes, or recurrence. With effective embolization, vascular complexity might not affect JNA resection outcomes. Multicenter studies are required to confirm those findings.

Extranasopharyngeal angiofibromas of the sinonasal tract (ENA-SNT) are exceptionally rare tumors that remain poorly characterized in the literature. We aim to systematically review and synthesize the clinical characteristics, management, and outcomes of ENA-SNT. This review adhered to PRISMA guidelines. A literature search was conducted across major databases, including PubMed, EMBASE, Web of Science, and Google Scholar. Articles that reported ENA-SNT cases in humans were eligible for inclusion. Data extraction and quality assessment were independently performed by two reviewers. A total of 145 studies were included, comprising 163 patients. The mean age was 28.8 years (range, 0-78), with a male-to-female ratio of 2.1:1. The nasal septum (33.3%), inferior turbinate (16.6%), and maxillary sinus (16.0%) were the most frequent tumor sites. Common symptoms included nasal obstruction (73.0%) and epistaxis (68.1%), often in combination (55.2%). Angiography demonstrated no hypervascularity in 23.1% of cases; when present, the internal maxillary artery supplied the tumor in 96.1%. Preoperative biopsy caused brisk bleeding in 44.5%. Surgery was the primary treatment in 94.4% of cases, with a recurrence rate of 5.3% and an average time to recurrence of 3.8 months. Intracranial and orbital involvement were rare: 1.84% and 2.45%, respectively. This review supports ENA-SNT as a clinical entity distinct from juvenile nasopharyngeal angiofibroma. Symptoms develop more rapidly, but the tumor is less aggressive, less vascularized, and has a better prognosis. ENA-SNT can occur across all age groups and in female individuals. Surgical resection is the treatment of choice, with low recurrence rates.

Preclinical Evaluation of the WAVE-track Aspiration Catheter: Safety and Efficacy in the Swine Thrombectomy Model.

Influence of pressure on mandibular angiosomes: What implications for decellularization?

ABSTRACT Background The lateral pterygoid muscle is important for temporomandibular joint function and is closely related to the maxillary artery, which is clinically significant during procedures like botulinum toxin injections and infratemporal fossa surgery. Methods Thirty hemifaces from human cadavers were dissected. The study documented the number of muscle heads, insertion sites, and the course of the maxillary artery in relation to the muscle (superficial, deep, or transitional). Morphometric measurements included the distance between the maxillary artery and surface landmarks. Results A two-headed lateral pterygoid muscle was observed in 93.3% of specimens. The superior head most commonly inserts into both the articular disc and joint capsule (60%). The maxillary artery most frequently follows a superficial course (53.3%). The mean vertical distance to the tragus is 13.5 mm, the transverse distance is 34.1 mm, and the mean depth from the zygomatic arch is 23.3 mm. Conclusions The observed anatomical variability and morphometric data offer clinically practical guidance to minimize the risk of vascular injury during temporomandibular joint procedures.

Bilateral hypoplastic facial arteries terminating as submental arteries were identified on computed tomography angiography, accompanied by rare compensatory vascular patterns. The right maxillary artery exhibited a triangular fenestration between the maxillary tuberosity and inferior orbital fissure, from which an aberrant buccal artery arose and descended to supply the inferior lip. The left side demonstrated a common buccoalveolar trunk bifurcating into the inferior alveolar artery and an aberrant buccal artery with a previously unreported transmandibular trajectory, entering at the lingula and exiting through a retromolar foramen before continuing tortuously to vascularize the cheek and lower lip. These anatomical variants present significant surgical hazards during regional anesthesia procedures targeting the maxillary tuberosity, pterygomandibular space, and mandibular lingula, as well as during facial reconstructive surgery. Comprehensive preoperative angiographic evaluation is essential when facial artery hypoplasia is encountered to identify compensatory networks and prevent inadvertent vascular injury.

The maxillary artery constitutes a critical vascular structure at risk of iatrogenic injury during numerous oral and maxillofacial surgical procedures. Precise knowledge of its topographical relationships to anatomical landmarks is essential for enhancing procedural safety and preventing life-threatening haemorrhage. Owing to its deep location within the infratemporal fossa, the maxillary artery is not amenable to direct ligation; consequently, in cases of uncontrolled bleeding from its branches or during surgery in its vicinity, ligation of the external carotid artery is commonly performed. Objective of the research. To investigate the topographical features of the branches arising from the pterygoid segment of the maxillary artery in human fetuses, with particular emphasis on individual anatomical variability. Methods. The study was conducted on 27 human fetuses with parieto-coccygeal length (PCL) ranging from 81.0 to 375.0 mm, utilising macro- and microdissection, vascular injection with coloured latex, and morphometric analysis. All specimens were free of externally detectable congenital anomalies or malformations of the head and neck region. This research forms a component of the planned comprehensive study of the Department of Anatomy, Clinical Anatomy and Operative Surgery, Bukovinian State Medical University: “Sex- and age-related patterns of ontogenetic transformations and morphometric parameters of organs and structures under normal and experimental conditions. Morphofunctional and anthropometric features of the musculoskeletal system in athletes” (State registration No. 0125U001531). Results. Considerable anatomical variability was observed in the branching pattern of the pterygoid segment of the maxillary artery, including the formation of anastomoses between the anterior and posterior deep temporal arteries, as well as rare atypical origins of the posterior deep temporal artery directly from the inferior alveolar artery. The masseteric artery penetrates the masseter muscle at its posterosuperior aspect and bifurcates into 2–9 terminal branches, which interconnect to form an intramuscular arterial plexus. Within the muscle, the arterial branches lie deep to the masseteric nerve and cross it at an acute angle. The anterior, middle, and posterior deep temporal arteries supply the corresponding regions of the temporalis muscle, forming arterial networks oriented parallel to the muscle fibre direction: vertical in the anterior portion, oblique in the middle, and horizontal in the posterior portion—thereby ensuring homogeneous vascularisation. In the medial and lateral pterygoid muscles, arterial branches enter predominantly from the medial surface, course perpendicular to the muscle fibres, and establish a dense, fine-meshed vascular network. In isolated cases, supplementary supply was observed from the buccal artery Conclusions In human fetuses, the maxillary artery is situated within the interpterygoid and temporopterygoid fat compartments, exhibiting two to three characteristic curves—two of which correspond to the contours of the medial and lateral pterygoid muscles. Variability in the origin of branches from the pterygoid segment was documented, including rare anastomoses and atypical branching of the posterior deep temporal artery. The masseteric and deep temporal arteries form intramuscular vascular networks aligned with muscle fibre orientation, with arteries positioned deep to the accompanying nerves, thereby ensuring uniform perfusion. These findings highlight the necessity of precise knowledge of neurovascular topography during surgical interventions involving the masticatory muscles and contribute to the understanding of anatomical variation in the maxillary artery’s branching pattern during fetal development

Objective: The pterygomaxillary junction (PMJ) is a triangular cleft between the maxilla and pterygoid process of the sphenoid bone, serving as a transition point between the infratemporal and pterygopalatine fossae. The terminal branches of the maxillary artery pass through this region to reach the pterygopalatine fossa. The aim of this study was to investigate the morphometric characteristics of the PMJ. Method: Forty human skulls of unknown sex and age from the Çukurova and Bolu Abant İzzet Baysal University Departments of Anatomy were examined. After identifying the PMJ type (fissure or synostosis), the PMJ width and height, and maxillary tuberosity height were measured using a caliper. The data were then statistically analyzed. Results: Fissure-type bilateral PMJ was observed in 92.5% of 40 cases and bilateral synostosis in 7.5%. The mean PMJ height was 16.58 mm, the mean width was 5.02 mm, height of the posterior maxilla was 21.27 mm, and the average maxillary tuberosity height was 5.19 mm. No statistically significant differences were found between the right- and left-sided measurements (p > 0.05). Conclusion: The findings of this study contribute to our understanding of the PMJ. Detailed knowledge of this region is clinically important, particularly in procedures such as Le Fort I osteotomy, due to its proximity to the maxillary artery and the risk of excessive bleeding.

Two-Stage Sphenopalatine Ganglion Neurostimulation for Refractory Craniofacial Pain: A Retrospective Study.

Unexpected treatment failures can occur during middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma cases. This study aimed to classify variations in the anatomy of the extracranial MMA (exMMA) to improve MMAE. Five heads from body donors, 300 dry skulls, and 162 head and neck CT angiography (CTA) images were used to evaluate the overall features of the exMMA. Body donors dissection were incorporated to comprehensive exMMA representation. The distal features of the exMMA were determined by evaluating the outer osseous grooves of the foramen spinosum of the skulls. Measurements of the exMMA were performed using CTA. The angles between the maxillary artery and the exMMA were 109.5° ± 32.5° (left) and 117.1° ± 34.3° (right) (p < 0.05). The angle between the exMMA and the skull base was greater on the left side (79.24° ± 4.21°, p = 0.0017). The diameters of the exMMA were 1.45 ± 0.12mm (left) and 1.44 ± 0.13mm (right) (p = 0.82). Multiple types of accessorial foramen spinosum provided the paths for the accessorial MMA. In the new classification, five types were identified. Type A was the most common (73.15%) and represented an easily accessible MMAE type. This was followed by type C (25.62%, difficult to accessible), type D (18.83%, very difficult to accessible), type B (1.23%, fairly accessible), and type E (0.17%, inaccessible). Varying levels of interventional difficulty occur within the exMMAs classification. Careful preoperative evaluations should be performed before MMAE to determine the type of exMMA and potential interventional difficulty.

Temporomandibular joint disorder: Anatomy of pain (part 1).

Introduction. Modern clinical practice demands high anatomical precision when planning surgical interventions in the midface, such as Le Fort osteotomies or reconstructive procedures for craniofacial trauma. Variability in the course of the maxillary artery and its relationship with adjacent structures directly influences the risk of intraoperative bleeding and potential injury to neural formations. Aim. To comprehensively examine the anatomical, morphological, and morphometric variability of the human maxillary artery (a. maxillaris), taking cranial shape into account, in order to identify its topographic features and substantiate a safe surgical approach to its proximal segment. Materials and Methods. The study was carried out on 28 embalmed human cadavers (both sexes, aged 64–77 years). In total, 56 hemifacial specimens were examined using anatomical dissection, plastic injection, craniometry, morphometry, and angiographic analysis. Cranial types (dolichocephalic, mesocephalic, brachycephalic) were determined. Measurements included the diameter, branching angle, and segment length of the maxillary artery (a. maxillaris) and its branches. Statistical analysis employed descriptive statistics, ANOVA, χ² test, and Fisher’s exact test, with significance set at p &lt; 0.05. Results. The topographic position of a. maxillaris relative to the m. pterygoideus lateralis influenced the order, angle, and branching pattern. In 58.9% of cases, the artery ran lateral to the muscle, in 34.8% medially, and in 6.3% between the muscle heads. With a lateral course, a. meningea media branched first in 63.6% of cases, followed by a. alveolaris inferior in 72.8%. With a medial course, a. meningea media was first in 86.7% and a. alveolaris inferior second in 86.7%. A statistically significant correlation was observed between cranial type and branch diameter or branching angle. The mean diameter of a. alveolaris inferior was 0.24 ± 0.08 cm in dolichocephalic skulls, 0.16 ± 0.04 cm in mesocephalic, and 0.15 ± 0.08 cm in brachycephalic. Branching angles ranged from 87.5° ± 8.5° (dolichocephalic) to 88.2° ± 5.3° (brachycephalic). The mean diameter of a. palatina descendens was 0.185 ± 0.085 cm, with the smallest values in dolichocephalics and the largest in brachycephalics. In a. infraorbitalis, a blunt angle (120.5° ± 10.5°) predominated in dolichocephalics (75%), while a sharp angle (71.5° ± 3.5°) occurred in 25%. In brachycephalics, the pattern was reversed. Based on these findings, a modified preauricular surgical approach to the proximal segment of a. maxillaris is proposed, tailored to cranial type to optimize visualization and procedural safety. Conclusion. The study demonstrates marked anatomical variability of the maxillary artery and its branches. The morphometric and topographic data obtained are valuable for surgical planning in maxillofacial, otolaryngological, and vascular surgery, as well as for angiography, endovascular interventions, and reconstructive procedures in the head and neck region.

Introduction/Purpose Rhabdomyosarcomas are rare, highly vascular tumors characterized by an extensive arterial supply. Preoperative embolization is commonly employed in the management of hypervascular lesions to minimize blood loss and enhance surgical safety. The conventional method involves superselective catheterization of the feeding vessels, followed by embolization. However, this intervention can be challenging in lesions with numerous small feeders that are too small to catheterize, or in those with high risk feeders such as branches from the ophthalmic artery. We present a case of alveolar rhabdomyosarcoma with incapacitating nasopharyngeal hemorrhage in which standard endovascular embolization was insufficient, and successful hemorrhage control was ultimately achieved through direct endonasal tumor puncture for embolization using n‐butyl cyanoacrylate (n‐BCA) glue (TruFill, Johnson &amp; Johnson Medtech, New Brunswick, NJ, USA). Materials/Methods Single case study Results A 21‐year‐old male with a known history of alveolar rhabdomyosarcoma was transferred from an outside hospital for evaluation and management of significant nasopharyngeal hemorrhage requiring intubation and multiple transfusions. CTA of the head and neck demonstrated a large, destructive mass centered in the left nasal cavity, consistent with his known malignancy, with invasion into the left orbit and anterior cranial fossa. Initial management by Interventional Neuroradiology included particle embolization (Embosphere 300‐500 µm, Merit Medical, South Jordan, UT, USA) and coil embolization of the left supraorbital artery, distal left internal maxillary artery, and the left zygomatico‐orbital artery. Although the patient did not require further transfusions, the patient continued to experience hemoptysis, particularly with movement. Ongoing management included repeat nasopharyngeal packing by ENT. He was taken back for embolization two days later, which included direct tumor puncture with injection of n‐BCA glue and particle embolization of the left ascending pharyngeal artery, resulting in decreased tumor vascularity. However, bleeding persisted, prompting a follow‐up angiogram and subsequent embolization of the right internal maxillary artery, along with an additional direct tumor puncture embolization, with a more extensive D5W flush leading to better tumor penetration, and complete and durable cessation of hemorrhage and eventual extubation. Conclusion N‐butyl cyanoacrylate glue is a fast‐acting liquid embolic material used in the treatment of a variety of vascular malformations and lesions of the head and neck. Investigations surrounding the use of n‐BCA injections as a new alternative embolic agent began in the 1980's. This case highlights the utility of direct tumor embolization as an effective salvage technique in the management of life‐threatening hemorrhage from hypervascular lesions. In this patient, initial endovascular embolization via the left supraorbital, distal internal maxillary, and zygomatico‐orbital arteries failed to achieve lasting hemostasis, likely due to the presence of numerous small, feeding branches and multiple collateral pathways. Subsequent direct tumor puncture with n‐BCA glue resulted in significant reduction of tumor vascularity. Direct tumor embolization is a valuable adjunctive technique in the management of hypervascular tumors when traditional endovascular approaches are limited or insufficient.

Optiblock coils are a next‐generation detachable coil platform engineered for dense, controlled mechanical occlusion of vessels. Its integrated anchor‐basket‐fill architecture, extended lengths (up to 65 cm vs. 20 cm for many conventional coils) , and excellent fluoroscopic visibility enable high packing efficiency with fewer deployments and precise, proximal control. Compared with particle or liquid embolysate, a coil‐forward approach may limit distal spread and reduce the risk of reflux into dangerous anastomoses. Additionally, deliverability through standard microcatheters and conformability in small‐caliber or tortuous vessels support use across diverse neurovascular indications, including embolization of dural arteriovenous fistulas (dAVFs), middle meningeal artery (MMA) for chronic subdural hematoma, venous diverticula and emissary veins for pulsatile tinnitus (PT), internal maxillary artery (IMA) for temporomandibular joint‐related pathology, spinal vascular malformations, parent‐vessel sacrifice, and preoperative tumor embolization.We conducted a retrospective, single‐center cohort study of adults undergoing embolization with one or more Optiblock coils. Demographics, coil utilization, adjunct agents, radiation metrics, and hospitalization course were abstracted from the electronic health record. Pre‐operative and post‐operative notes were reviewed, and modified Rankin Scale (mRS) scores were assigned to assess functional status. Longitudinal change was tested with a Friedman test (α = 0.05).Ninety‐five patients (mean age 59; 47% male) underwent embolization using Optiblock coils for the indications above. Across the cohort, an average of 7 Optiblock coils were used per procedure with a mean total Optiblock length of 117 cm. Additional non‐Optiblock coils were used in 33% of patients. The mean Optiblock length per coil was 16.7cm. Embolysate was used with coils in 20% of patients, predominantly for tumor embolization or dAVF occlusion. Patients spent an average of 8.5 days in the hospital. Average procedure length was 124.55 minutes, and mean fluoroscopy time was 55.69 minutes. Mean skin dose per procedure was 1871.74 mGy. Functional outcomes improved over time: mRS decreased from 1.07 ± 1.51 pre‐procedure to 0.75 ± 1.21 at first follow‐up and 0.63 ± 1.05 at last follow‐up (p &lt; 0.001). Five (5%) intraoperative complications occurred, all managed during the procedure with no long‐term deficits. Six deaths (6%) occurred, all attributable to cardiovascular comorbidities and not related to this neuroendovascular procedure or the patient's underlying neurological disease.In this single‐center, multi‐indication cohort, Optiblock coils enabled dense, controlled mechanical occlusion with low intraoperative complication rates and significant gains in functional status across diverse neuroendovascular indications. The platform's design facilitates efficient packing with fewer deployments and precise proximal control, supporting coil‐forward or hybrid strategies particularly when use of particle or liquid embolics is contraindicated. These data underscore Optiblock's versatility across a range of clinical applications. Prospective, indication‐specific studies, comparing coil‐only, liquid/particle‐only, and hybrid approaches, are warranted to define comparative effectiveness and optimize patient selection and workflow.

Comparison of the Orbitozygomatic and Transmandibular Approaches to the Infratemporal Fossa.

This study aims to evaluate the microsuture technique in treating giant dissecting aneurysms of the middle cerebral artery (MCA) trunk, particularly in cases involving perforators-a key surgical challenge. This reconstruction of the MCA trunk was performed in four patients with giant dissecting aneurysms using a microsuture technique. The fragile wall of the dissecting aneurysm was meticulously excised while preserving the perforating arteries originating from the aneurysm body. Subsequently, a bypass was established from the internal maxillary artery (IMA) to the distal MCA (or specify the exact branch if applicable). This surgical approach achieved temporary vascular occlusion while maintaining distal perfusion, thereby preventing ischemia in the territory distal to the aneurysm during its definitive management. Among the four patients, three had surgically clipped aneurysms of the MCA trunk, while the remaining patient presented with severe headaches and left lower limb paralysis. All patients underwent microsuture of the MCA trunk and subsequently experienced uneventful postoperative recoveries without neurological deficits. Postoperative angiography demonstrated successful MCA trunk reconstruction with complete dissecting aneurysm resolution in three cases. In the remaining patient, although MCA reconstruction was not radiographically visible, patency of the IMA-to-M2 segment bypass was confirmed. Follow-up imaging revealed: At six-year follow-up, one patient exhibited both a patent IMA-to-M2 bypass and reconstructed M1 trunk on CT angiography; Two patients showed M1 trunk restoration with aneurysm disappearance at three-month follow-up; One patient maintained a patent IMA-to-M2 bypass without visualized MCA trunk. No ischemic events occurred in any patient, presumably due to preserved perforating arteries originating from the reconstructed MCA trunks. Some large dissecting aneurysms of the MCA trunk can be effectively treated with the microsuture technique by reconstructing the trunk and preserving its perforators.

Abstract The cephalic vasculature of turtles has been explored extensively for its evolutionary history. However, the rostral portion of the cephalic vasculature has rarely been investigated compared to that of the basicranial region, despite its unique morphology among diapsids and a wide range of variation within crown turtles. Here, a broad range of diapsid taxa were examined to explore the evolution of the rostral vasculature in turtles. We show that the arrangement of the rostral vasculature specific to extant turtles, bifurcation of the maxillary artery, and the caudally shifted foramen praepalatinum transmitting the palatine artery, could at least be traced back to the mesochelydians based on osteological evidence. Although one of the oldest testudinatans Proganochelys quenstedtii had a medially shifted maxillary artery as in crown turtles, its rostral vasculature likely retained the ancestral diapsid condition, consistent with the generally plesiomorphic morphology of the cranium. The crownward evolution of the rostral vascular patterning is likely related to associated rostral morphological changes, such as the keratinous beak, nasolacrimal duct, and medial nasal gland. In addition, variations of the osteological correlates for the maxillary and palatine arteries were found in crown turtles. Trionychians have a unique large opening termed foramen intermaxillaris instead of the paired foramina praepalatina on the floor of the nasal cavity, but they were shown to be homologous based on the shared palato-nasal neurovascular pattern. Chelonioids exhibited the most deviation from the generalized turtle rostral vascular patterning. Those deviations within crown turtles are likely associated with the relevant anatomical changes of the rostrum, such as the secondary palate of cheloniids.

Longitudinal changes on cranial magnetic resonance imaging in relapsing giant cell arteritis.

Arteriovenous Malformations (AVMs) are rare, high-flow vascular anomalies characterised by abnormal shunting between arteries and veins. These lesions present unique challenges in diagnosis and management due to their complex vascular anatomy, tendencies for recurrence, and potential complications. This case report discusses a 26-year-old postpartum female presenting with an AVM in the mandible, following a dental extraction during the second trimester of pregnancy. The lesion was initially managed conservatively with embolisation during pregnancy but showed significant progression postpartum, necessitating a multidisciplinary approach. Preoperative embolisation was performed using glue and Lipiodol, targeting branches of the right internal maxillary and facial arteries. This was followed by surgical resection and reconstruction using free fibula osteocutaneous grafts to restore function and aesthetics. Pathological examination confirmed the characteristics of an AVM, including fragmented elastic lamina and endothelial hyperplasia. This case underscores the importance of combining advanced diagnostic imaging, timely embolisation, and surgical intervention with aesthetic reconstruction to achieve optimal outcomes. Despite the unclear aetiology-whether trauma-induced, hormonally influenced, or congenital-the patient experienced favourable functional and aesthetic results with no recurrence at four months of follow-up. This report highlights the complexity of AVM management and reinforces the necessity of a multidisciplinary, multimodal approach for these challenging lesions.