Internal maxillary artery

The original ventral pharyngeal artery turns into the facio-lingual system, while the hyoid artery and the stapedial artery will evolve to become the internal maxillary artery and the middle meningeal artery (Figs. 18.3, 18.4)... 

Fig. 18.4. Angiographic view of the external carotid artery. 1, faciolingual trunk 2, occipital artery 3, internal maxillary artery 4, superficial temporal artery 5, middle meningeal artery...

The sphenopalatine artery, the terminal branch of the internal maxillary artery enters the nasal cavity where it is divided into a septal, medial branch and a lateral branch that supplies the conchae. These two arteries have a distinctive appearance on the angiographic views. These branches usually anastomose with the anterior and posterior ethmoidal arteries, which arise from the ophthalmic artery system, at the anterior and posterior ethmoidal cells, and eventually connects the external and internal carotid... 

Autoregulation mechanisms have been described to be more effective in the internal maxillary artery and the pharyngo-occipital system, whereas the facial artery has not shown to respond as effectively. Vasoconstriction as a response for hypertension or mechanical trauma is observed in large or medium sized arteries whereas small distal arteries seem to react with true regulatory mechanisms. 

Internal carotid artery (IGA) may supply the JAF without having intracranial portion of the tumor. However, if angiographic tumor blush is located above the skull base on AP and/or lateral views and has vascular supply from the IGA branches and/or from ascending pharyngeal and/or proximal internal maxillary arteries, it might represent intracranial extension of the tumor. However, the subarachnoid space extension of tumor is exclusively... 

The endovascular management may require the usage of other techniques such as injection of fluid materials such as NBCA or alcohol with flow control thru the internal maxillary artery or ascending pharyngeal branches. Sacrifice of the ICA can be considered on an individual basis in patients with intracavernous extension. 

The distal internal maxillary artery is the main arterial trunk supplying lesions in the nasomaxillary area (9,10,23]. Vascular supply is via the sphenopalatine artery of the internal maxillary artery, the alar and septal branches of the facial artery. 

Fig. 20.2a,b. Young woman with a tumor of the cheekbone. Angiography was performed in order to disclose any hypervascularity before surgery. The lesion was avascular hut opacification of the internal maxillary artery in the AP a and lateral views b showed intense nasal fossa mucosal blush (asterisk) corresponding to a normal appearance in a woman in the premenstrual period, with no EPX... 

The initial study in idiopathic EPX should involve the internal carotid artery ipsilateral to the bleed, using both lateral and AP views in order to detect any lesion of the petrous or cavernous segment of this vessel. This also allows the evaluation of nasal fossa vascularity that originates from the ethmoidal arteries. Angiography of internal maxillary artery is then performed in lateral views to depict any culprit anastomoses with the internal carotid system, as the external carotid origin of the ophthalmic artery. These... 

Fig.20.4a,b. Patient with HHT disease suffering from recurrent EPX. Nasal fossa telangiectasias are vascularized by both septal and turbinate branches of the internal maxillary artery (lateral view a, small arrows) and by ethmoidal branches of the ophthalmic artery (lateral view b, small arrows)... 

Fig. 20.7. Massive EPX with hemodynamic instability following maxillofacial trauma. A large false aneurysm due to a vascular laceration of the distal internal maxillary artery (asterisk) is detected. After microcatheterization of the pathological arterial segment, it is embolized with proximal glue deposition, with rapid hemodynamic stabilization and control of the EPX...

Ligature of the internal maxillary artery should be avoided. The unilateral and proximal aspect of the procedure will allow the development of ipsi-and contra-lateral anastomoses that will distally reconstruct the vessel, and will continue to favor rebleeding but without allowing subsequent selective catheterizations. 

Breda SC, Choi IS, Persky NS, Weiss M (1989) Embolization in the treatment of epistaxis after failure of internal maxillary artery ligation. Laryngoscope 99 809-815... 

Chandler JR, Serrins AJ (1965) Transantral ligation of the internal maxillary artery for epistaxis. Laryngoscope 75 1151-1160... 

DA (1996) Sentinel transoral hemorrhage from a pseudoaneurysm of an internal maxillary artery branch a complication of CT guided biopsy of the masticator space. AJNR Am J Neuroradiol 17 377-381... 

The arteries supplying juvenile angiofibromas arise from branches of the external carotid artery (EGA). The tumor blush is intense and persistent. There is no arteriovenous shunting within the lesion. The contralateral EGA should be explored in all cases that reach the midline. The distal internal maxillary artery is the first vessel to investigate. Large tumors are also supplied by other branches... 

Fig.23.10a,b. Juvenile nasopharyngeal angiofibroma in an 11-year-old boy. Preoperative embolization with particles of the arterial branches of the internal maxillary artery, a Selective external carotid angiogram shows a vascular tumor fed by multiple branches of the internal maxillary artery.b After multiple selective catheterization with a coaxial system (Tracker 38 and Tracker 18), embolization was performed with particles. Postembolization angiogram shows significant devascularization... 

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