| Presenter: Bahar Bassiri Gharb, MD, Cleveland Clinic
Authors: Bahar Bassiri Gharb (1), Gaby Doumit (1), Antonio Rampazzo (1), Frank Papay (1)
(1) Cleveland Clinic, Cleveland, OH
Bahar Bassiri Gharb, MD
Maxillary artery has been traditionally considered the main blood supply of the facial skeleton. However, the deep and concealed location of the artery in the infratemporal and pterygopalatine fossae enclosed by the cranial base, mandible and maxilla makes the harvest of facial allografts based on this artery challenging. The purpose of this study was to modify the Le Fort III procedure in order to allow safe inclusion of the maxillary artery in the allograft.
Sixteen fresh cadaver heads were used in this study. Ten full facial allografts containing mandible, maxilla, zygomatic and nasal bones were harvested through a traditional Le Fort III approach. In 6 cadaver heads, maxillary artery and internal jugular veins where injected with red and blue latex respectively. A modified Le Fort III approach was designed: the orbital floor osteotomy was performed at the posterior-most aspect of the orbit. The zygomatic arch was removed and the pterygomaxillary disjunction was performed under direct vision after excising the temporalis and lateral pterygoid muscles. Six full facial allografts were harvested through the modified approach. In all 16 allografts the maxillary artery and its branches were dissected to assess for damage during the procurement.
When the traditional Le Fort III approach was used to harvest the facial allograft, the terminal branches of the maxillary artery (the infraorbital and the terminal part of the sphenopalatine arteries) were injured constantly. The modified approach preserved these branches and allowed the dissection of the maxillary artery under direct vision. The pterygoid plexus veins were damaged in both cases.
Maxillary artery should be considered as the main blood supply of the facial allograft when a major portion of the facial bones is to be harvested along with limited amount of facial soft tissues. The described modified Le Fort III approach allowed the safe dissection of the maxillary artery, preserving the main blood supply to the facial skeleton.