Vascularization of the mandibular condylar head with respect to intracapsular fractures of mandible

Abstract

Background: Causes of mandibular condylar (condylar) head necrosis as a consequence of intracapsular mandibular fractures are still a subject of controversy. Objectives: To investigate why in some cases of intracapsular fractures condylar head necrosis occurs. Material: 58 human heads from the collection of Head and Neck Clinical Anatomy Laboratory, from the Institute of Physiology and Pathology of Hearing, Warsaw, Poland, constituted the material. Study: Head arterial tree injections, anatomical preparation with the use of standard set of microsurgical equipment and an operating microscope. Results: The main source of condylar head vascularization is the inferior alveolar artery, supplying bone marrow of the whole mandible as well as its cortical layer. Additional arterial blood supplying comes from a various number (2-7) of branches supplying the temporomandibular joint capsule. They originate directly from the maxillary artery or from its primary branches: masseteric artery, external pterygoid artery or superficial temporal artery. Two rare variants of accessory mandibular head vascularization were encountered. The first (2 cases) was an arterial branch from the maxillary artery and the second (1 case) was a branch from the external pterygoid artery. In these cases the arterial supply of lateral part of temporomandibular joint capsule from other sources was reduced. Conclusion: Fractures resulting in the lateral part of the condylar head in isolation could be potentially threatened by necrosis because of poor vascularization. © 2011 European Association for Cranio-Maxillo-Facial Surgery.