Alveolar antral artery in edentulous patients and their visualization through cone beam computed tomography

Anatomy of Maxillary Sinus: Focus on Vascularization and Underwood Septa via 3D Imaging

The study of the maxillary sinus anatomy should consider the presence of two features of clinical importance. The arterial supply course and the presence of the so-called Underwood septa are two important factors to consider when planning surgical treatment to reduce the risk of surgical complications such as excessive bleeding and Schneiderian membrane perforations. This study aimed to investigate the above-mentioned anatomical structures to improve the management of eventual vascular and surgical complications in this area. This study included a total of 200 cone-beam computed topographies (CBCTs) divided into two groups of 100 CBCTs to evaluate the arterial supply (AAa) course through the lateral sinus wall and Underwood's septa, respectively. The main parameters considered on 3D imaging were the presence of the AAa in the antral wall, the length of the arterial pathway, the height of the maxillary bone crest, the branch sizes of the artery in the first group, and the position of the septa, the length of the septa, and their gender associations in the second group. The CBCT analysis showed the presence of the arterial supply through the bone wall in 100% of the examined patients, with an average size of 1.07 mm. With regard to the septa, 19% of patients presented variations, and no gender difference was found to be statistically significant. The findings add to the current understanding of the clinical structure of the maxillary sinus, equipping medical professionals with vital details for surgical preparation and prevention of possible complications.

Morphometric Assessment of Alveolar Antral Artery Using Medical Computed Tomography

This study aimed to investigate the prevalence, diameter, and position of the alveolar antral artery (AAA) in paranasal sinus computed tomography (CT) images and to correlate the location of the AAA with tooth position, the presence of teeth, and residual alveolar bone height (ABH). A retrospective study was conducted at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, from November 2016 to October 2021. CT images of 100 maxillary sinuses from 50 patients managed for modified endoscopic sinus surgery and sinus lifting by a single surgeon were selected and obtained from the Infinitt picture archiving and communication system radiology system (Infinitt Healthcare Co., Seoul, Korea). The location of the AAA in the lateral wall of the maxillary sinus was evaluated in correlation with the area of the first and second molars (M1 and M2), the presence of teeth, and the residual ABH. In this study, we found that the intraosseous type is the most common type of AAA. Furthermore, the location and distance of the AAA are significantly affected by tooth position, an edentulous state in the case of the first molar, and residual ABH. Pre-evaluation of the diameter, position, and distance to the AAA using CT images is essential to help prevent hemorrhage. The existence and wide range of the AAA distances based on the tooth position, edentulous state, and residual ABH should be considered even if CT imaging cannot locate the AAA.

Alveolar antral artery: cone beam computed tomography study and clinical context

Purpose

Anastomosis between posterior superior alveolar artery and infraorbital artery can go through bony canal in the lateral wall of the maxilla. This artery is called alveolar antral artery. It can complicate lateral sinus lift procedure by bleeding and hemosinus formation or bone graft wash out. The artery can also go in soft tissues where is not visible on cone beam computed tomography. In previous studies, the relation of this artery to sinus floor or alveolar process was measured. These structures are highly unstable during lifetime and after tooth loss. The aim of this study is to study presence and relations of bony canal in the lateral maxillary wall, to characterize the group of patients which is more likely to have bone canal in the lateral maxilla. The aim and the novelty of this study is the describing of the relationship of the bony canal to the more stable structure of hard palate and describing the relation of presence of bony canal on width of maxillary sinus, and to facilitate the prediction of presence of the alveolar antral artery.

Materials

The cone beam computed tomography scans of the patients (251 in number) of the university hospital were examined for presence of alveolar antral artery (148 was fulfilled inclusion criteria), patient were characterized by gender, age, and sinus type (wide, average, narrow). The diameter of the bony canal and its relation to the level of sinus floor and hard palate were measured.

Results

The cone beam computed tomography scans of 148 patients, out of it 55 man (37,2%) and 93 women (62,8%). Bony canal containing alveolar anastomosis was found in 69 cases (57,0%). Presence of the bony canal in the lateral wall of maxillae showed statistical probability depending on age with p = 0, 064 according to Mann-Whitney test. The older patients have more likely the bony canal. The presence of the alveolar antral artery was found more likely in the wide sinuses. The hard palate level can serve as a prediction point of alveolar antral artery only in first molar and second premolar region. In accordance with previous studies the width of bony canal is significantly higher in group of man (p = 0, 015). There was found a correlation between smaller distance of bony canal from sinus floor in the presence of teeth (p = 0, 067). After tooth loss the distance between sinus floor and bony canal increases, but the distance of bony canal to hard palate level stays constant. This can be explained hypothetically so that periodontal ligaments and root surface acts as a barrier for sinus pneumatization.

Conclusion

Lateral sinus lifting in some cases can be unenviable, the knowledge about alveolar antral artery anatomy can reduce the risk of arterial bleeding. The cone-beam computed tomography is a routine examination prior to augmentation surgery and therefore the data obtained from it has an impact on clinical practice.

Anatomical Evaluation of the Alveolar Antral Artery in the Turkish Population: A Cone-Beam Computed Tomography Study

Background Injury to the alveolar antral artery (AAA) is one of the most common complications in oral surgical procedures. This study aimed to determine the diameter and anatomical position of the AAA, establish reference values for the Turkish population, and contribute to the literature. Methodology The diameter of the AAA at the level of the first molar tooth, its distance from the sinus floor, its vertical distance to the alveolar crest, its oblique distance to the sinus floor, the width of the maxillary sinus, the thickness of the lateral sinus wall, the residual alveolar protrusion height, the residual alveolar protrusion width at the basal level, and the distance from the sinus lateral wall to the sinus floor were all measured using cone-beam computed tomography. Age, gender, and oral health were used to evaluate the collected data. Results The average age of the participants in the study was 42.63 ± 16.07 years. The average AAA diameter was 1.1 ± 0.25 mm, the average height of the residual alveolar protrusion was 0.44 ± 0.13 cm, the average width of the residual alveolar protrusion at the basal level was 0.79 ± 0.12 cm, and the average width of the residual alveolar ridge at the crest level was 0.55 ± 0.11 cm. No significant differences were observed in these parameters based on gender and dental status (p > 0.05). The average AAA distance to the sinus floor was 1.02 ± 0.26 cm, the average vertical distance to the alveolar crest was 1.21 ± 0.25 cm, the average oblique distance to the sinus floor was 1.38 ± 0.25 cm, the average maxillary sinus width was 1.63 ± 0.28 cm, the average thickness of the lateral sinus wall was 0.12 ± 0.06 cm, and the average distance from the sinus lateral wall to the sinus floor was 1.28 ± 0.22 cm. Significant differences based on gender were observed in all these parameters (p < 0.05). A significant difference was observed in the vertical distance from AAA to the alveolar crest and the oblique distance to the sinus floor based on dental status (p < 0.05), with shorter distances in dentate individuals. Only the AAA diameter showed a weak negative correlation with age (p < 0.05, 0.2 < r < 0.04). Conclusions The results obtained were within a reliable range for oral surgery. Detailed reference findings for the proximity and location of structures can be established for the Turkish population during dental surgery. It is recommended that physicians performing surgical interventions in the maxillary region carefully consider these reference values preoperatively.