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Reply: Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle

Toure, Gaoussou M.D., Ph.D.

Author Information
Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 436e-437e
doi: 10.1097/PRS.0000000000005230
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Sir:

I thank Dr. Kun Hwang for his interest in the article “Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle.”1 He summarized my work well, but it is important to add the key role of the lateral pterygoid muscle in the displacement of the condyle in fractures of the condylar region and also in the vascularization of the condyle. The reported clinical experience and my work are concordant: they highlight the important role of the lateral pterygoid in the vascularization of the condyle. An endosteal vascularization exists that in cases of fracture and displacement of fracture fragments may be compromised, if not interrupted. However, the vascularization remains ensured by the lateral pterygoid muscle.

The images that I presented in my article1 corresponded to the reality, and the vascularization of the condyle was considered together with the muscles and the periosteum. It seems difficult to be more explicit than the images presented1: Figure 2 clearly shows the arteries that go to the condyle, as do Figures 5 and 6. The vascularization occurs through the muscles inserted on the condyle and periosteum (Fig. 1).

Fig. 1.
Fig. 1.:
Lateral view of the left temporomandibular joint. 1, External carotid artery; 2, transverse facial artery and arterial branches to the condyle; 3, maxillary artery between the sphenomandibular ligament and the ramus; 4, arterial branch from superficial temporal artery to the joint capsule; 5, superficial temporal artery; 6, joint capsule; 7, masseter; 8, mandibular condyle; LP, lateral pterygoid muscle; MF, mandibular fossa.

Dr. Kwang provides a beautiful image that is not at odds with my work. It is difficult to find arteries that enter a dry bone. I thank Dr. Kwang for referring to the article by Dr. Saka et al.2; regardless of the interpretation that can be made, a careful and objective analysis of the images in this article are consistent with the arterial systematization made in my article. After careful rereading of my article and the information provided to me by the correspondent, I feel strengthened in my confidence in my published results and conclusions.

DISCLOSURE

The author has no conflicts of interest to declare.

Gaoussou Toure, M.D., Ph.D.
URDIA
Laboratoire d’Anatomie
University Paris 12
45 rue des Saints-Pères
Paris 75006, France
[email protected]

REFERENCES

1. Toure G. Arterial vascularization of the mandibular condyle and fractures of the condyle. Plast Reconstr Surg. 2018;141:718e–725e.
2. Saka B, Wree A, Anders L, Gundlach KK. Experimental and comparative study of the blood supply to the mandibular cortex in Göttingen minipigs and in man. J Craniomaxillofac Surg. 2002;30:219–225.

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