Clinical utility of computed tomography angiography in assessing internal maxillary artery position during temporomandibular joint ankylosis surgery
In brief
CT angiography misclassified the maxillary artery course in 44% of joints
In this 34-patient case series of temporomandibular joint ankylosis surgery, preoperative CT angiography agreed with the artery's observed course in only 56% of 48 joints. The scan categories did not distinguish blood loss, need for vascular control or transfusion, so CT angiography can inform planning but cannot reliably predict operative anatomy or bleeding risk.
- Journal
- International journal of oral and maxillofacial surgery (Q1)
- Published
- 5 November 2026
- Study design
- Case series / case report
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- H M Reda, S Abd El-Hakim Hassan, G A Khalifa
- PMID
- 42988707
- DOI
- 10.1016/j.ijom.2026.10.019
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 8 November 2026): CTA-to-operative anatomy concordance for internal maxillary artery
Abstract
Temporomandibular joint (TMJ) ankylosis surgery carries a high risk of intraoperative bleeding due to the close anatomical relationship between the ankylotic mass and the internal maxillary artery (IMA). Although computed tomography angiography (CTA) is widely used for preoperative vascular assessment, its reliability in predicting the intraoperative IMA course in TMJ ankylosis surgery remains uncertain. This exploratory prospective case series included 34 patients (22 males, 12 females; mean age 19.6 ± 2.5 years) with TMJ ankylosis involving 48 joints treated with 1 cm gap arthroplasty. CTA identified three IMA-ankylotic mass relationships: close contact (n = 20, further subdivided into medial, n = 8; posterior, n = 12), enclosed (n = 13), and no contact (n = 15). Overall concordance between preoperative CTA-based IMA classification and intraoperative findings was 56.3%, with discordance in 43.7% of joints (Cramér's V = 0.069; P = 0.97). Concordance varied across CTA categories, with the lowest concordance observed in the no contact group (53.3%). Despite differences in preoperative CTA-based IMA classification, intraoperative outcomes did not differ significantly among groups. Ankylotic mass resection time was comparable across categories (median 23-24 min; P = 0.085), and no significant differences were observed in estimated blood loss, vascular control measures, or blood transfusion requirements. In conclusion, CTA demonstrates limited concordance with the clinically observed intraoperative course of the IMA in TMJ ankylosis surgery and does not significantly stratify intraoperative outcomes. Therefore, it may be considered a complementary tool for preoperative planning rather than a definitive predictor of intraoperative vascular anatomy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.