Topographic examination of maxillary artery and its segments with three-dimensional CT angiography

The maxillary artery originates as a terminal branch of the external carotid artery, located deep to the parotid gland at the level of the neck of the mandible. From its origin, it courses toward the pterygopalatine fossa, giving off multiple branches along its path. The anatomical course, segmentation, and relationships of this artery with surrounding structures are critically important in clinical and surgical practice especially in procedures involving the face, jaw, and skull base. In this study, the segments, topographical relationships, variations, distances to specific anatomical landmarks, and diameter and depth measurements of the a. maxillaris were evaluated using three-dimensional computed tomography angiography (3D-CTA). These findings aim to support safe surgical planning and reduce vascular complications, particularly in maxillofacial and skull base surgeries. A total of 120 individuals (60 males and 60 females) aged between 18 and 65 years were included in the study. Bilateral maxillary arteries were examined. CT angiographic data were obtained through Fuji PACS and analyzed using the Syngo.via VB30A_HF06 software (Siemens, Germany). Measurements were taken from the origin of the maxillary artery to the head of the mandible, mandibular angle, mandibular notch, coronoid process, posterior border of the ramus of mandible, mastoid process, zygomatic arch, transverse process of the C2 vertebra, and the external acoustic meatus. Statistically significant differences were found between the right and left sides, as well as between sexes (p < 0.001). In terms of diameter and depth measurements of the maxillary artery, statistically significant differences were also observed between the right and left sides (p < 0.001). Among the 240 arteries analyzed, 122 originated at the level of the C1 vertebra, 107 above the level of C1, and 11 between the levels of C1 and C2. Regarding their relationship to the lateral pterygoid muscle, 98 arteries passed medially, 138 laterally, and 4 arteries were found to pass through the muscle. It is thought that knowing the anatomy of the maxillary artery in the application areas will contribute to the prevention of vascular complications that occur and may occur in oral and maxillofacial surgeries, temporomandibular joint surgeries, and repairs of mandibular fractures.