© 1991 K.irger A O . B asel CMK11-5180/91/1424-0374 S 2.75/0
Acta Anat 1991;142:374-378
Arterial Supply of the Oral Mucosa E. Piehslinger'', A. Chouekib, K. Choueki-Guttenbrunnerb, H. Lembacher“ 'Department of Fixed and Removable Prosthodontics and hDepartmcnt of Anatomy. University' of Vienna School of Medicine. Vienna. Austria
Key Words. Arterial supply • Mucosa, oral • Segmentation • Pedicles, nutritive
Introduction The exact knowledge of the arterial supply of the mucous membrane is most important for oral surgery. This refers to both the pedicled graft and the therapy of angiomas, which is based on an attempt to bloc the arte rial support of the tumor. Primarily, some general facts about the blood supply of any mucous membrane have to be surveyed, and their application to the different parts of the oral mucous membrane has to be considered. The immediate supply of a mucous membrane comes from vessels situated in the submucous layer, if a submucous layer does exist. Most distinctly, this situation concerns the sublingual mucous membrane. In the rich body of are olar tissue below it. we also find the sublingual gland. Through the frenulum linguae, the areolar tissue reaches some parts of the inferior surface of the apex linguae. Also, the gingiva libera of both the upper and the lower jaw has a submucous layer. Contrarily, the gingiva fixa is intimately connected with the alveolar process. Hence, • •
I
1
. J
------------1 . •
/ > «••»
U n f
tK o
W ACCa Ic
of bone and mucous membrane must form a morpholog ical and functional unit. A similar but not identical relation exists between the hard palate and its mucous membrane. The difference depends on multiple glandulae palatinae. The mucous membrane of the soft palate has a similar relation to the palatine aponeurosis. A strong relation ship between the mucous membrane and an aponeurotic layer can be found on the dorsum linguae. In cheeks and lips, the mucous membrane and its glands have a direct mechanical connection with muscles. In all regions without a submucous layer, the mucous membrane and the underlying structure represent neces sarily a nutritive unit. Those statements refer to the immediate vascular supply. We analyzed the arteries from which those direct-supplying vessels receive their blood, with emphasis on important variations and view, and tried to find out whether there are any more or less distinctly limited segments of mucous membrane which are supplied by certain arterial branches that would represent the nutritive pedicles of the respective segm e rits
Downloaded by: King's College London 137.73.144.138 - 1/23/2018 3:39:41 AM
Abstract. In 15 human heads, bilateral injection through the common carotid artery was carried out in order to find out whether there are any more or less distinctly limited segments of the oral mucosa supplied by certain arterial branches that would represent the nutritive pedicles of the respective segments. It seems that the gingiva libera of the buccal side in the region of the upper molars and premolars represents such a segment. In spite of small anastomoses between the right and left sublingual arteries, one half of the sublingual mucosa may also be considered as a segment. The same refers to the mucosa of one half of the hard palate. Even smaller units of varying extent of the palatine mucosa may be differentiated as distinct vascular areas. For the majority of the oral mucosa, however, no limitations of vascular segments with distinct arterial pedicles could be discovered.
Fig. 1. In this region of rich anastomoses it is impossible to distin guish between different regions. The borders are drawn schematically. 1 and 2= Buccal artery, infraorbital artery, facial artery; 3 = superior alveolar artery. 4 = ascending palatinal artery, ascending pharyngeal artery, lesser palatinal arteries; 5 = greater palatinal arteries; 6= lingual artery.
Material and Methods The arterial system of 15 human heads was bilaterally filled through the common carotid arteries with different substances for three differ ent purposes. (1) After injecting colored latex suspension, we prepared the vessels of 6 heads to their smallest ramifications using a Zeiss micro scope (fivefold magnification). Part of those specimens had been fixed by phenol and formaldehyde before injection: the others were fresh. (2) In 6 specimens, the arteries were injected withTechnovit. i.e. a methyl ester of methacrylic acid which polymerizes and hardens within 30-40 min. By subsequent maceration, we gained corrosion specimens of the skeleton with the arteries, to demonstrate the topographical relations. (3) Three specimens were injected with china ink and were cleared by the method of Spalteholz (1|.
Results The sublingual mucous membrane, including the fren ulum linguae, receives its blood through small branches of the sublingual artery. From the trunk of this vessel, it is always separated by the sublingual gland. We always found multiple small anastomoses between the right and left arteries. In three specimens of our material, the typ ical origin of the sublingual artery from the lingual artery was missing bilaterally and was substituted by an origin from the submental artery. If one considers the typical origin essential for the definition of the term arteria sub lingualis. the following explanation for this variety may be
375
Fig. 2. In this region of rich anastomoses it is impossible to distin guish between different regions. The borders are drawn schematically. 1 and 2= Buccal artery, inferior labial artery, mental artery; 3 = ascending pharyngeal artery, ascending palatinal artery; 4 = infe rior alveolar artery; 5 = lingual artery.
given: the submental artery substitutes a missing sub lingual artery. In all other cases, the submental and sub lingual arteries were anastomosing across the mylohy oideus. The peripheral part of the body of areolar tissue in which the sublingual artery ramifies ascends between the lingual surface of the mandible and the corresponding gingiva libera up to the linea girlandiformis. Hence, this line represents the limit of the area of mucous membrane supplied by the sublingual artery. In the tongue, the blood supply of the mucous mem brane and musculature are inseparably connected. In the apex and body only the lingual artery has to be con sidered. in the radix also the ascending pharyngeal and ascending palatinal arteries. Since the different arteries of the radix linguae have rich anastomoses with each other, it is impossible to describe limits between separate areas of blood supply in the mucous membrane of this region. The septum linguae represents a distinct barrier between the vascular systems of the right and left sides. This, how ever, does not exclude indirect extralingual connections between the two lingual arteries: the above-mentioned anastomoses between the two sublingual arteries and the connections of the ascending pharyngeal and palatinal arteries. The ascending pharyngeal and ascending palatinal arteries are the dominant vessels of the entire isthmus faucium. For the palatinal tonsils, both the posterior branch
Downloaded by: King's College London 137.73.144.138 - 1/23/2018 3:39:41 AM
Arterial Supply of the Oral Mucosa
376
Piehslinger/Chou
Acta Anat 1991;142:374-378
Arterial Supply of the Oral Mucosa E. Piehslinger'', A. Chouekib, K. Choueki-Guttenbrunnerb, H. Lembacher“ 'Department of Fixed and Removable Prosthodontics and hDepartmcnt of Anatomy. University' of Vienna School of Medicine. Vienna. Austria
Key Words. Arterial supply • Mucosa, oral • Segmentation • Pedicles, nutritive
Introduction The exact knowledge of the arterial supply of the mucous membrane is most important for oral surgery. This refers to both the pedicled graft and the therapy of angiomas, which is based on an attempt to bloc the arte rial support of the tumor. Primarily, some general facts about the blood supply of any mucous membrane have to be surveyed, and their application to the different parts of the oral mucous membrane has to be considered. The immediate supply of a mucous membrane comes from vessels situated in the submucous layer, if a submucous layer does exist. Most distinctly, this situation concerns the sublingual mucous membrane. In the rich body of are olar tissue below it. we also find the sublingual gland. Through the frenulum linguae, the areolar tissue reaches some parts of the inferior surface of the apex linguae. Also, the gingiva libera of both the upper and the lower jaw has a submucous layer. Contrarily, the gingiva fixa is intimately connected with the alveolar process. Hence, • •
I
1
. J
------------1 . •
/ > «••»
U n f
tK o
W ACCa Ic
of bone and mucous membrane must form a morpholog ical and functional unit. A similar but not identical relation exists between the hard palate and its mucous membrane. The difference depends on multiple glandulae palatinae. The mucous membrane of the soft palate has a similar relation to the palatine aponeurosis. A strong relation ship between the mucous membrane and an aponeurotic layer can be found on the dorsum linguae. In cheeks and lips, the mucous membrane and its glands have a direct mechanical connection with muscles. In all regions without a submucous layer, the mucous membrane and the underlying structure represent neces sarily a nutritive unit. Those statements refer to the immediate vascular supply. We analyzed the arteries from which those direct-supplying vessels receive their blood, with emphasis on important variations and view, and tried to find out whether there are any more or less distinctly limited segments of mucous membrane which are supplied by certain arterial branches that would represent the nutritive pedicles of the respective segm e rits
Downloaded by: King's College London 137.73.144.138 - 1/23/2018 3:39:41 AM
Abstract. In 15 human heads, bilateral injection through the common carotid artery was carried out in order to find out whether there are any more or less distinctly limited segments of the oral mucosa supplied by certain arterial branches that would represent the nutritive pedicles of the respective segments. It seems that the gingiva libera of the buccal side in the region of the upper molars and premolars represents such a segment. In spite of small anastomoses between the right and left sublingual arteries, one half of the sublingual mucosa may also be considered as a segment. The same refers to the mucosa of one half of the hard palate. Even smaller units of varying extent of the palatine mucosa may be differentiated as distinct vascular areas. For the majority of the oral mucosa, however, no limitations of vascular segments with distinct arterial pedicles could be discovered.
Fig. 1. In this region of rich anastomoses it is impossible to distin guish between different regions. The borders are drawn schematically. 1 and 2= Buccal artery, infraorbital artery, facial artery; 3 = superior alveolar artery. 4 = ascending palatinal artery, ascending pharyngeal artery, lesser palatinal arteries; 5 = greater palatinal arteries; 6= lingual artery.
Material and Methods The arterial system of 15 human heads was bilaterally filled through the common carotid arteries with different substances for three differ ent purposes. (1) After injecting colored latex suspension, we prepared the vessels of 6 heads to their smallest ramifications using a Zeiss micro scope (fivefold magnification). Part of those specimens had been fixed by phenol and formaldehyde before injection: the others were fresh. (2) In 6 specimens, the arteries were injected withTechnovit. i.e. a methyl ester of methacrylic acid which polymerizes and hardens within 30-40 min. By subsequent maceration, we gained corrosion specimens of the skeleton with the arteries, to demonstrate the topographical relations. (3) Three specimens were injected with china ink and were cleared by the method of Spalteholz (1|.
Results The sublingual mucous membrane, including the fren ulum linguae, receives its blood through small branches of the sublingual artery. From the trunk of this vessel, it is always separated by the sublingual gland. We always found multiple small anastomoses between the right and left arteries. In three specimens of our material, the typ ical origin of the sublingual artery from the lingual artery was missing bilaterally and was substituted by an origin from the submental artery. If one considers the typical origin essential for the definition of the term arteria sub lingualis. the following explanation for this variety may be
375
Fig. 2. In this region of rich anastomoses it is impossible to distin guish between different regions. The borders are drawn schematically. 1 and 2= Buccal artery, inferior labial artery, mental artery; 3 = ascending pharyngeal artery, ascending palatinal artery; 4 = infe rior alveolar artery; 5 = lingual artery.
given: the submental artery substitutes a missing sub lingual artery. In all other cases, the submental and sub lingual arteries were anastomosing across the mylohy oideus. The peripheral part of the body of areolar tissue in which the sublingual artery ramifies ascends between the lingual surface of the mandible and the corresponding gingiva libera up to the linea girlandiformis. Hence, this line represents the limit of the area of mucous membrane supplied by the sublingual artery. In the tongue, the blood supply of the mucous mem brane and musculature are inseparably connected. In the apex and body only the lingual artery has to be con sidered. in the radix also the ascending pharyngeal and ascending palatinal arteries. Since the different arteries of the radix linguae have rich anastomoses with each other, it is impossible to describe limits between separate areas of blood supply in the mucous membrane of this region. The septum linguae represents a distinct barrier between the vascular systems of the right and left sides. This, how ever, does not exclude indirect extralingual connections between the two lingual arteries: the above-mentioned anastomoses between the two sublingual arteries and the connections of the ascending pharyngeal and palatinal arteries. The ascending pharyngeal and ascending palatinal arteries are the dominant vessels of the entire isthmus faucium. For the palatinal tonsils, both the posterior branch
Downloaded by: King's College London 137.73.144.138 - 1/23/2018 3:39:41 AM
Arterial Supply of the Oral Mucosa
376
Piehslinger/Chou
