The internal maxillary artery lies posterior to the maxillae and the palatine bones and anterior to the pterygoid plates of sphenoid. The blood supply to the maxilla and the palatine bones is through the periosteum, the incisive artery and the greater and lesser palatine arteries. The frontal process projects upwards to articulate with the maxillary process of the frontal bone as well as the nasal bone anteriorly and the lacrimal bone posteriorly. The zygomatic process is an extension of the anterolateral surface of the body which contributes to the zygomaticomaxillary suture. The palatine process is a horizontal process from the body to the alveolar process and medially articulates with the palatine process of the opposite maxilla, while posteriorly it articulates with the horizontal plate of the palatine bone. The alveolar process houses the dental arch with the sockets varying in size according to the teeth. The base is rimmed inferiorly by the alveolar process. It has an orbital or superior surface which forms the floor and rim of the orbit, a malar or anterolateral surface which forms part of the cheek and a posterolateral or infratemporal surface which contributes to the infratemporal fossa. It is pyramidal shaped with the base being the medial surface facing the nasal cavity and the apex being elongated into the zygomatic process. The body is hollowed out and contains the maxillary sinus. The maxilla consists of a central body and four processes, namely, the frontal, zygomatic, alveolar and palatine process. The zygomatic buttresses which continue superiorly with the lateral orbital rims form the lateral pillars, and the most caudal pillars are the pterygoid plates. The vertical pillars are the medial pillar formed by the piriform rims which continues superiorly as the frontal process of the maxilla. The horizontal pillars are formed by the frontal bar (composed of the supraorbital rims and nasal process of the frontal bone), the zygomatic arch, the infraorbital rims and the nasal bridge and finally the alveolar process of the maxilla. It is this strength that has often been described as the facial buttresses which Manson alluded to when describing the vertical and horizontal struts that support the facial skeleton. The facial bones in isolation are comparatively fragile but gain strength and support as they articulate with each other. The midface is composed of the nasal, zygoma, maxilla, ethmoid and its conchae, palatine, inferior concha and vomer which are collectively referred to as the middle third of the facial skeleton. It was also in the same century that Garretson and Blair advocated mandibular-maxillary fixation with the aid of splints to primarily treat maxillary fractures.įull size image 1.3 Applied Anatomy of the Midfacial Bones In the nineteenth century, Charles Fredrick Reiche provided the first detailed treatise on maxillary fractures. Over the subsequent centuries, there appeared many techniques which in essence were variations of what Hippocrates had described. Hippocrates who is often portrayed as the “Father of Medicine” described a myriad of facial injuries around 400 BC and his insight provided the basis for bandages and single jaw interdental wiring as methods of fixation and stabilization of facial fractures. The earliest known writings of maxillofacial fractures were recorded in the Edwin Smith papyrus in 1650 BC. In an area so anatomically complicated as the midface, the lines of fracture produced in the middle third are classified based upon the experimental studies of René Le Fort in 1901. Robert Marciani in his fifty year review article dated 1993, vividly described the challenges faced by early surgeons regarding the clinical and radiological diagnosis of mid face fractures and the compromised surgical results that may ensue. Complex midface trauma has challenged the diagnostic and operative skills of surgeons through the decades.
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