Ophthalmic Artery Originating from Internal Maxillary Artery: A Potential Cause of Blindness from Facial Trauma

眼動脈起源於上頜動脈分支可能在顏面骨外傷後造成失明

羅世倫(Shih-Lun Lo) ； 蘇亦昌(I-Chang Su) ； 陳明庭(Ming-Ting Chen) ； 李建智(Jian-Jr Lee)

《臺灣整形外科醫學會雜誌》 26卷2期 (2017/06) Pp. 149-155

摘要

Background: The ophthalmic artery (OA) is the first intracranial branch of the internal carotid artery (ICA). The most critical branch of the OA is the central retinal artery, which supplies the retina and is essential for vision. Injury to the OA may lead to blindness. Aim and Objectives: We present a rare variant pattern of the OA, originating from the branch of the internal maxillary artery (IMAX) without blood supply from the ICA. Plastic surgeons need to be made aware of this variation of the OA, which has significant clinical implications for potential blindness. Materials and Methods: We retrospectively reviewed the angiographic data of our patients with head and neck lesions who underwent diagnostic angiography or trans-arterial embolization in the hybrid operating room at Cathay General Hospital from March 2015 to May 2016. Results: We evaluated a total of 103 patients (86 right OAs, 91 left OAs), with special attention to the OA origin and its course into the orbit. One fast-flow vascular malformation case had a right-sided OA arising from the middle meningeal artery (MMA; main branch of IMAX) without any blood supply from the ICA. Another case was total occlusion of the ICA, where the left OA was supplied by the branch of the IMAX and reconstituted the ICA. Conclusion: The OA variant arising from the branch of the IMAX can lead to visual loss in case of accidental or surgical trauma. Considering that the MMA is anatomically located medial to the mandibular condyle, blindness may potentially occur with damage to the MMA due to facial trauma.

關鍵字

ophthalmic artery ； internal maxillary artery ； facial trauma ； blindness

並列摘要

背景：眾所皆知的眼動脈是內頸動脈的第一個顱內分支。眼動脈最重要的一條分支是中央視網膜動脈，供應視網膜的血流與視力息息相關。一旦傷害到眼動脈會造成失明。目的及目標：我們提出一個罕見的變異，眼動脈是起源於上頜動脈分支且無內頸動脈的血液供應。所有整形外科醫師必須知道這種變異的可能及造成臨床上的影響。材料及方法：我們回顧性去看所有國泰綜合醫院從2015年3月至2016年5月期間，利用複合式手術房，針對顱內或頭頸部病變的病人，有施行血管攝影或使用經動脈血管栓塞治療的個案，分析血管攝影的影像資訊。結果：我們評估了103個病人（86條右眼動脈，91條左眼動脈）的眼動脈走向分支和變異性。其中發現一位高血流量性血管畸形的病人，其右側的眼動脈是起源於中腦膜動脈分支且無任何從內頸動脈來的血液供應。另外一位內頸動脈阻塞的病人，其左側眼動脈是從上頜動脈動脈分支而來且重新建立內頸動脈的血液供應。結論：若在意外或手術上的破壞到上頜動脈分支，眼動脈若存在變異可能會造成失明。考量到中腦膜動脈的解剖位置靠近下頜骨髁突的內側，如果臉部創傷造成潛在的意外、傷害到中腦膜動脈就有可能造成失明。