title: Relevant Surgical Anatomy of Pterygomaxillary Dysjunction in Le Fort III Osteotomy.
abstract: BACKGROUND
  Le Fort III osteotomy represents the foundation of surgical correction for midface hypoplasia. One serious complication of Le Fort III osteotomy is severing the internal maxillary artery or its branches during osteotome advancement for pterygomaxillary dysjunction. This study sought to characterize the relevant surgical anatomy of the infratemporal fossa and of the internal maxillary artery as it enters the pterygomaxillary fissure.
  
  
  METHODS
  Bilateral midface dissections were performed on 15 fresh, normocephalic adult cadavers (30 hemifaces). Four superficial anatomical measurements were performed on the surface of the face, followed by 10 deep measurements of the internal maxillary artery and its branches relative to the infratemporal fossa and its surrounding bony landmarks.
  
  
  RESULTS
  The distance from the anterosuperior aspect of the zygomatic arch to the sphenopalatine artery entering the pterygomaxillary fissure was 38.9 ± 3.2 mm. The distance from the alveolar process of the maxillary bone to the sphenopalatine artery entry into the pterygomaxillary fissure was 30.3 ± 6.4 mm. The zygomaticofrontal suture was 43.4 ± 8.5 mm from the sphenopalatine artery entry into the pterygomaxillary fissure, 58.8 ± 8.0 mm from the pterygomaxillary junction, and 74.9 ± 6.5 mm from the maxillary alveolar process. The distance from the sphenopalatine artery to the posterior superior alveolar artery was 14.4 ± 4.1 mm. Elevation of the internal maxillary artery from the lateral pterygoid plate was 5.8 ± 2.5 mm.
  
  
  CONCLUSIONS
  This study characterizes the surgical anatomy of the infratemporal fossa in the context of Le Fort III osteotomies and their associated pterygomaxillary dysjunctions.
authors.affiliation: Cleveland, Ohio; and Montreal, Quebec, Canada.|From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.
authors.forename: Susan
authors.initials: S
authors.lastname: Orra
authors.affiliation: Cleveland, Ohio; and Montreal, Quebec, Canada.|From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.
authors.forename: William S
authors.initials: WS
authors.lastname: Tierney
authors.affiliation: Cleveland, Ohio; and Montreal, Quebec, Canada.|From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.
authors.forename: Avery C
authors.initials: AC
authors.lastname: Capone
authors.affiliation: Cleveland, Ohio; and Montreal, Quebec, Canada.|From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.
authors.forename: Bahar Bassiri
authors.initials: BB
authors.lastname: Gharb
authors.affiliation: Cleveland, Ohio; and Montreal, Quebec, Canada.|From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Papay
authors.affiliation: Cleveland, Ohio; and Montreal, Quebec, Canada.|From the Education Institute, Cleveland Clinic Lerner College of Medicine, the Department of General Surgery, Digestive Disease Institute, and the Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation; and the Division of Plastic and Reconstructive Surgery, CHU Sainte Justine, University of Montreal.
authors.forename: Gaby
authors.initials: G
authors.lastname: Doumit
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000033:anatomy & histology* / Q000601:surgery*; D008875:Middle Aged; D019340:Osteotomy, Le Fort / Q000379:methods