Position of posterior superior alveolar artery in relation to the maxillary sinus using cone beam computed tomography in Indian sub-population

Purpose: To assess the location of posterior superior alveolar artery (PSAA) using CBCT in relevance to sinus lift procedure for implant placement. Patients and Methods: A retrospective study was conducted using the CBCT data of 500 patients (n = 500). Linear measurements were carried out to localize the medio-lateral and vertical position of posterior superior alveolar artery in postero-lateral wall of maxillary sinus and its proximity to the floor of maxillary sinus using CS 3D imaging 3.7.0 software program. The relative position of PSAA was determined as; (a) intra-osseous, (b) below the membrane and (c) outer-cortex of lateral sinus wall. The location of PSAA was assessed in molar region bilaterally by using following radiographic measurement; (1) distance between the lower border of posterior superior alveolar artery and alveolar crest, (2) height from the floor of maxillary sinus to alveolar crest and (3) distance from the posterior superior alveolar artery to medial wall of maxillary sinus. Results: The prevalence of the artery was observed in 99.4% of the sinuses and was mostly intraosseous (84.2%).The mean distance between the lower border of the artery and alveolar crest is significantly higher in males compared to females (P < 0.01). The distribution of artery location did not differ significantly across various age groups (P > 0.05). Discussion/Conclusion: The most common variant of PSAA was identified in the intra-osseous region and the mean distance of the vessel to crest of the residual ridge differs significantly with gender and not with age.

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Evaluation of the Anastomosis Canal in Lateral Maxillary Sinus Wall With Cone Beam Computerized Tomography: A Clinical Study

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-17-00129 ◽

2018 ◽

Vol 44 (1) ◽

pp. 5-13

Author(s):

Wentao Sun ◽

Anhao Liu ◽

Yin Gong ◽

Rong Shu ◽

Yufeng Xie

Keyword(s):

Clinical Study ◽

Computerized Tomography ◽

Lateral Wall ◽

Cone Beam ◽

Lateral Sinus ◽

Lower Border ◽

Alveolar Crest ◽

Sinus Wall ◽

Sinus Floor ◽

Cone Beam Computerized Tomography

This clinical study used cone beam computerized tomography (CBCT) to locate the position of the anastomosis canal in lateral wall of maxillary sinuses, and to evaluate the thickness of lateral sinus wall and the distance from the lower border of the canal to the sinus floor, which could provide surgeon with information about this anastomosis. Two hundred and forty-two (242) volumes of CBCT scans were included in this study. The distances from the lower border of the anastomosis canal to the sinus floor and from the maxillary alveolar crest to the sinus floor were evaluated in transversal plane, and the thickness of the lateral sinus wall was measured at the distance of 3, 6, 9 mm from the sinus floor and at the level of the lower border of the canal at the same plane. The canal was identified in 87.6% (424/484) of the sinus. Most canals were intraosseous, or beneath the sinus membrane. The mean distance was 9.2 ± 3.5 mm from the lower border of the canal to the sinus floor, and 10.8 ± 4.0 mm from the alveolar crest to the sinus floor. The thickness of the lateral sinus wall was 2.4 ± 0.9 mm, 1.8 ± 0.8 mm, 1.7 ± 0.7 mm, 1.8 ± 0.8 mm at the distance of 3, 6, 9 mm from the sinus floor and at the level of the lower border of the canal. The location of the anastomosis canals varied from each patient, but the distance from the sinus floor was similar in different teeth sites. The sinus floor could be an anatomic landmark of sinus floor augmentation. In order not to interrupt this canal, great care must be taken by the implant surgeon to identify this canal.

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Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-18-00229 ◽

2020 ◽

Vol 46 (4) ◽

pp. 415-422

Author(s):

Junho Jung ◽

Jung Soo Park ◽

Seoung-Jin Hong ◽

Gyu-Tae Kim ◽

Yong-Dae Kwon

Keyword(s):

Maxillary Sinus ◽

Surgical Techniques ◽

Lateral Sinus ◽

Sinus Floor Elevation ◽

Second Molar ◽

Sinus Wall ◽

Posterior Maxilla ◽

Significant Difference ◽

Sinus Floor ◽

Molar Region

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

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Imaging study of the anatomical variations and the maxillary sinus pathology in patients with missing lateral teeth for the application of dental implants

ORL ro ◽

10.26416/orl.30.1.2016.517 ◽

2016 ◽

Vol 1 (1) ◽

pp. 6-12

Author(s):

Iulian Damian ◽

Gheorghe-Ionel Comșa

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Dental Implants ◽

Preoperative Evaluation ◽

Anatomical Variations ◽

Accurate Information ◽

Maxillary Artery ◽

Lateral Sinus ◽

Sinus Wall ◽

Increased Risk

Preoperative evaluation of maxillary sinus anatomy is very important to avoid surgical complications due to close anatomical relations between the sinus and the posterior maxillary teeth and/or edentulous alveolar ridge. Posterior superior alveolar artery is a branch of the maxillary artery and provides the vascularization of the lateral sinus wall and underlying mucosa. Maxillary artery branches should be taken into consideration during sinus lifting procedures and bone augmentation due to increased risk of bleeding by damaging the artery during the osteotomy. Computed tomography (CT) explores three-dimensional anatomic structures and provides complex and accurate information about them. Cone Beam Computed Tomography (CBCT) offers an accurate view of the teeth and surrounding structures at high resolution, despite low-dose radiation used. In this study, the incidence of anatomical variations and sinus pathology were assessed using CBCT. The aim is to evaluate the presence of sinus pathology (sinus mucosal thickening, oro-antral communications, sinus tumors, cysts, polyps), presence and position of the posterior superior alveolar artery. These issues are important because they are about the limits of the dental implants in the posterior maxillary area. The presence of sinus pathology and anatomical variations may predispose to complications and even failures of implantation therapy.

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Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1724092 ◽

2021 ◽

Author(s):

Navarat Vatcharayothin ◽

Pornthep Kasemsiri ◽

Sanguansak Thanaviratananich ◽

Cattleya Thongrong

Keyword(s):

Confidence Interval ◽

Maxillary Sinus ◽

Inferior Turbinate ◽

Radial Access ◽

Sinus Wall ◽

Nasal Floor ◽

Significant Difference ◽

Anterolateral Wall ◽

The Mean ◽

Maxillary Sinuses

Abstract Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9–45.3), 56.0 ± 6.1 (95%CI: 53.7–58.3), and 60.1 ± 6.2 (95%CI: 57.8–62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3–48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1–61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6–65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches (p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

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3D Volumetric Analysis and Anatomical Considerations for Sinus Bone Graft

Applied Sciences ◽

10.3390/app11030951 ◽

2021 ◽

Vol 11 (3) ◽

pp. 951

Author(s):

Ji Hyoung Kim ◽

Hyo Joon Kim ◽

Ye Joon Jo ◽

Jun Seok Choi ◽

Seong Yong Moon

Keyword(s):

Bone Graft ◽

Maxillary Sinus ◽

Alveolar Bone ◽

Lateral Wall ◽

Volumetric Analysis ◽

Ct Scans ◽

Sinus Floor Elevation ◽

Sinus Wall ◽

Sinus Floor ◽

The Mean

The aim of this study is to evaluate anatomical considerations and assess the volume of the maxillary sinus bone graft. There were sixty-three patients (eighty-three sinuses) who had taken CT scans for implant surgery. Patients included those whose height of the residual alveolar bone was less than 5 mm. The position of posterior superior alveolar artery, the thickness of the maxillary sinus wall, and the volume of the maxillary sinus according to the amount of sinus floor elevation were measured. The mean vertical distance of posterior superior alveolar artery was 11.91 ± 4.79 mm from 3.03 mm to 24.05 mm. The mean thickness of the lateral wall was 1.71 ± 0.55 mm in the range of 0.74 mm to 3.93 mm. The volume of 3 mm, 5 mm, 7 mm, and 10 mm from the sinus floor was 0.173 ± 0.11 cm3, 0.526 ± 0.25 cm3, 1.068 ± 0.43 cm3, and 2.184 ± 0.74 cm3 on average, respectively. The knowledge of the posterior superior alveolar artery position, the lateral wall thickness, and the volume of the maxillary sinus can help the clinician for sinus bone graft.

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Ameloblastoma of the maxillary sinus: conservative surgical management considering high recurrence risk potential

BMJ Case Reports ◽

10.1136/bcr-2020-241487 ◽

2021 ◽

Vol 14 (5) ◽

pp. e241487

Author(s):

Lukas S Fiedler ◽

Annette Wunsch

Keyword(s):

Maxillary Sinus ◽

Radical Resection ◽

Recurrence Risk ◽

Flexible Endoscopy ◽

Cystic Mass ◽

High Rate ◽

Sinus Surgery ◽

Nasal Passage ◽

Lateral Sinus ◽

Sinus Wall

Ameloblastoma (AM) in the maxillary sinus is rare. This benign entity shows locally invasive, destructive and aggressive behaviour and a high rate of recurrence. Therefore, the course of treatment is radical resection. We report the case of a 38-year-old man presenting with signs of recurrent sinusitis in the Ear, Nose and Throat Department. Transnasal flexible endoscopy revealed a cystic mass in the right inferior and middle nasal passage. CT scan showed an obliterated right maxillary sinus with a ballooning effect and pressure atrophy of the lateral sinus wall, without possible differentiation of the middle and low nasal turbinate. The patient was treated with transnasal functional sinus surgery; pathology stated AM. AM in the maxillary sinus is rare, locally destructive and therefore as a gold standard is resected radically to prevent recurrence. We demonstrate a conservative approach; explicitly, we combined a transvestibular and functional endoscopic sinus surgery resection of the AM to maintain function and reduce the possibility of postoperative impairments. Whether the strategy of treatment for AM is conservative, it nonetheless can result in a recurrence-free status. Nevertheless, inclusion into an oncological follow-up-programme with regularly performed MRI and CT is recommended.

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Custom Focal Trough in Cone-Beam Computed Tomography Reformatted Panoramic Versus Digital Panoramic for Mental Foramen Position to Aid Implant Planning

Journal of Clinical Imaging Science ◽

10.25259/jcis_150_2019 ◽

2020 ◽

Vol 10 ◽

pp. 34

Author(s):

Khaled Beshtawi ◽

Emad Qirresh ◽

Mohamed Parker ◽

Shoayeb Shaik

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Mental Foramen ◽

Reference Points ◽

Cone Beam ◽

Vertical Position ◽

Linear Measurements ◽

Mean Values ◽

The Mean ◽

High Level

Objectives: To compare the linear measurements from digital panoramic (DP) radiographs and cone-beam computed tomography (CBCT) volumes for the localization of the mental foramen (MF). Material and Methods: Thirty-one patients with panoramic and CBCT radiographs depicted on the same machine were analyzed. The vertical and horizontal positions of the MF were compared by the differences in distances measured from reference points to the boundaries (tangents) of the MF in digital panoramic (DP) and CBCT reformatted panoramic (CRP) views. The vertical position of MF was also analyzed on CBCT oblique coronal views (CORO) and compared with its corresponding distances on DP and CRP views. Results: Statistically significant differences (P < 0.05) were found in all compared measurements between CRP and DP views. In addition, the vertical distance (Y1) compared between DP, CRP, and CORO views also showed a statistically significant measurement discrepancy in the mean distance (P < 0.000) with the highest mean difference of 1.59 mm (P < 0.05) was attained from Y1 (DP-CORO). Inter- and intra-examiner analysis indicated a high level of agreement for all measurements. Conclusion: The mean values of discrepancies in measurements between DP and CRP views for horizontal and vertical linear measurements were clinically tolerable. Nevertheless, significant differences in the vertical MF position were detected between the panoramic views (DP, CRP) and the coronal views (CORO). This implies that the use of coronal view measurements during implant planning might reduce the risk of neurovascular injuries.

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The Radiological Evaluation of Posterior Superior Alveolar Artery by Using CBCT.

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666200628134308 ◽

2020 ◽

Vol 16 ◽

Author(s):

Hazal Karslioglu ◽

Mesude Çitir ◽

Kaan Gunduz ◽

Pelin Kasap

Keyword(s):

Maxillary Sinus ◽

Nasal Septum ◽

Sinus Lift ◽

Alveolar Crest ◽

Sinus Wall ◽

Perioperative Bleeding ◽

Anatomical Relationship ◽

Exact Position ◽

Inferior Border ◽

Maxillary Region

Background: Evaluation of the maxillary sinus anatomy prior to sinus lift procedures is important to avoid surgical complications due to the close anatomical relationship between the posterior maxillary region and the maxillary sinüs. Introduction: In order to avoid traumatizing the posterior superior alveolar artery and to prevent perioperative bleeding, locating exact position of the artery is imperative before the surgical procedures. Methods: 150 CBCT scans were evaluated. The distance from the inferior border of the PSAA to the alveolar crest (the vertical line from the artery to the crest) and floor of maxillary sinus, the distance from PSAA to medial sinus wall, nasal septum, zygomatic arch, position, distance from floor of maksiller sinüs to the alveolar crest and diameter of the PSAA were assessed. Locations of the artery were classified. Results: The artery diameters were mostly ≥ 1 mm. Artery was mostly intraosseous (59.7%), 21.7 % was superficial and only 18.7% was intra-sinuscular. Conclusion: The location of PSAA is intraosseous in most patients. The artery diameters were mostly ≥ 1 mm and we can say that increasing the size also increases the risk of complications.

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Cone Beam CT Evaluation of Maxillary Sinus Floor and Alveolar Crest Anatomy for the Safe Placement of Implants

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405615666191212105745 ◽

2020 ◽

Vol 16 (7) ◽

pp. 913-920

Author(s):

Başak Kuşakçi Şeker ◽

Kaan Orhan ◽

Emre Şeker ◽

Gülbahar Ustaoğlu ◽

Oğuz Ozan ◽

...

Keyword(s):

Maxillary Sinus ◽

Alveolar Bone ◽

Cone Beam ◽

Alveolar Crest ◽

Posterior Maxilla ◽

Maxillary Sinus Floor ◽

Sinus Floor ◽

The Mean ◽

Bone Height ◽

Anterior Median

Background: Alveolar bone height in the posterior maxillary region is very important and critical for dental implant planning and placement. Objective: This study aimed to evaluate the anatomy of the maxillary sinus floor in relation to the alveolar crest and to determine variations in the vertical measurements between the maxillary sinus floor and the alveolar bone crest tip in the posterior edentulous maxilla with the use of cone beam computerized tomography. Methods: This analysis enrolled 234 retrospectively selected patients (123 males with mean age 52.95±11.74 (range 32-76 years) and 111 females with mean age 58.14±11.92 (range 32-75 years)) with edentulous posterior maxillary regions. The maxillary sinus floor was divided into three anatomical segments (anterior, median and posterior) in relation to the transverse palatine suture. The measurements were performed on 3D surface rendered volumetric images by using rotation and translation of the views. Landmarks for measurement were specified by using a cursor driven pointer. Vertical lines were marked on the cross-sectional images between the alveolar ridge and the deepest point of the maxillary sinus floor for each of the three regions. P < 0.05 was regarded as statistically significant. Results: The mean distance values between the sinus floor and the alveolar crest in the anterior, median and posterior regions were 8.74±3.97 mm, 5.37±3.23 mm and 7.06±3.28 mm, respectively. Measurements in the anterior region were found to be high in both total and gender groups compared to other regions. Also, subsinus alveolar bone heights decreased with increasing age in both genders in all three regions. Conclusion: This study emphasizes that the mean subsinus alveolar bone height is highest in the anterior segment of the edentulous posterior maxilla. These results may guide clinicians to make the decision of implant placement area and lead to less invasive alternative surgery methods for edentulous posterior segments.

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