Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
In 99% of cases however, it enters the foramen spinosum. When this foramen is absent, the artery enters the foramen ovale , which is typically the foramen for the mandibular division of the trigeminal nerve.
The middle meningeal gives rise, in about 50% of cases, to an accessory meningeal artery, which also enters the skull via the foramen ovale, or the emissary sphenoidal foramen (20% of cases). It may also supply a palatine branch.
The artery may or may not supply the trigeminal (semilunar) ganglion , which usually gets its blood supply from the internal carotid or, less often, the accessory meningeal artery.
The anterior division of the middle meningeal artery occasionally gives rise to a medial branch (0.8% of cases). This branch enters the skull through the superior orbital fissure or a small foramen in the greater wing of the sphenoid to anastomose with the ophthalmic artery.
The entire ophthalmic system of arteries occasionally arises from the middle meningeal artery. On the other hand, the middle meningeal, if absent, may be replaced by branches from the lacrimal or ophthalmic arteries.
The middle meningeal may give rise to the lachrimal artery.
The communicating branch of the middle meningeal artery may join the lacrimal artery and replace the entire ophthalmic artery in about 2% of individuals according to Singh and Dass (1960) (cited by Lang, 1983). In about 1 % of cases (Jazuta, 1905 cited by Lang, 1983) the entire lacrimal artery arises from the frontal branch of the middle meningeal artery, Not infrequently, a branch from the anastomotic region of the ophthalmic artery runs backward through the superior orbital fissure and takes part in the blood supply of nerves, bone, and dura in the cavernous sinus (Lang, 1983).
Ginsberg, et al also discussed the foramen spinosum and pointed out the Lindblom reported that in rare cases, early division of the middle meningeal artery into an anterior and posterior division may result in duplication of the foramen spinosum. Sondheimer also reported this variant. Ginsberg and colleagues provide additional information as follows: The foramen spinosum may be hypoplastic or absent in a case of an aberrant middle meningeal artery. Curnow reported hypoplasia hi a case of the ophthalmic artery being the origin of the middle meningeal artery. Both Fisher and Greig described the development of the middle meningeal artery. The stapedial artery originates as a dorsal branch of the second aortic arch and is a part of the carotid artery system. The superior, supraorbital branch becomes the middle mengeal artery. In the l5mm embryo, the infraorbital and mandibular branch of the stapedial artery fuse use with the external carotid artery, and is destined to become the internal maxillary artery. The main trunk of the stapedial artery atrophies and its origin from the internal carotid disappears. The usual distribution of the stapedial artery is then replaced by branches from the external carotid artery. If the connection with the external carotid artery fails to occur, the middle meningeal artery arises from the ophthalmic artery. In this case, the middle meningeal enters the skull through the superior orbital fissure. Lindblom reported this variation in 0.4% of his cases. The stapedial artery may also persist. This vessel has also been associated with an aberrant internal carotid artery. The persistent stapedial artery courses through the tympanic cavity, between the crura of the stapes and enters the facial canal distal to the geniculate ganglion. It enters the middle cranial fossa by the facial hiatus. which is the opening for the greater superficial petrosal nerve, and becomes the middle mengeal artery. In both of these cases, the variants of origin of the middle meningeal artery, the foramen spinosum will be tiny, or absent. Ginsberg, et al found the foramen spinosum absent in four (3.2%) patients. Asymmetry of size was observed in 20 (16%) of their patients. A smaller foramen spinosum did not correlate with the size of the ipsilateral foramen ovale.
Image 298, Image 386
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