Topography of the third portion of the maxillary artery via the transantral approach in Asians

A radioanatomical study of 3rd segment terminal branches of the maxillary artery in the pterygopalatine fossa

This study describes the clinical anatomical topography and relationship of the terminal branches of the maxillary artery to the bony wall of the maxillary sinus in the pterygopalatine fossa (PPF) to estimate the bleeding risk during surgical interventions. Using contrasted computer tomography records, (i) the route of the maxillary artery in the infratemporal fossa, (ii) the number of the arteries in the critical PPF surgery plane, (iii) the diameter of the largest artery in the area and (iv) its relation to the posterior wall of the maxillary sinus were examined. Furthermore, measurements were extended with (v) the minerality of the bony posterior wall of the maxillary sinus on bone-window images. For statistical analyses Student's t- and Fisher-test were applied. 50 patients (n = 50, 100 cases including both sides) were examined in this study. The maxillary artery reached the pterygomaxillary fissure on the lateral side of the lateral pterygoid muscle in 56% of the cases (n = 32), in 37% (n = 23) on its medial side and in 7% (n = 4) on both sides. The number of arteries at the level of the Vidian canal in the PPF varied between 1 and 4 with a median of 2. The diameter of the biggest branch was 1.2-4.7 mm, the median diameter was 1.90 mm. In 41% (n = 30) of the cases the biggest artery directly contacted the posterior wall of the maxillary sinus, and the mineral density of the posterior wall was decreased in 14.3% (n = 12) of all investigated cases. The present description and statistical analysis of the vasculature of the PPF optimizes operative planning-like clip size or the type and direction of the surgical approach-in this hidden and deep head/neck region.

The maxillary artery as a recipient vessel option for complex midface and anterior skull base microsurgical repair: A cadaveric study

INTRODUCTION

Variations in the operative situation for complex head and neck defect reconstructions resulting from mechanisms such as trauma, oncologic resection, and prior radiation exposure can result in situations of a vessel-depleted neck. This requires an awareness of alternate, innovative options for use in reconstructive repairs. The purpose of this study was to provide characterization of the third segment of the maxillary artery necessary to consider its use as a recipient vessel in free flap repair of complex midface defects.

MATERIALS AND METHODS

Seventeen cadaver hemifaces were used for anatomic demonstration of the maxillary artery third segment by a transmaxillary approach to obtain descriptive measures for statistical analysis.

RESULTS

The average artery intraluminal cross-section diameter was obtained for the sphenopalatine (1.39 ± 0.12 mm) descending palatine (0.94 ± 0.10 mm), and terminal maxillary (1.68 ± 0.17 mm) arterial vessels. The mean transmaxillary depth with was (43 ± 1.2 mm). Mean mobilizable lengths for sphenopalatine, descending palatine, and terminal maxillary arteries were (30 ± 2 mm), (29 ± 2 mm), and (20 ± 2 mm), accordingly. Vessel patterns were characterized using Morton and Kahn classification for sphenopalatine-descending palatine bifurcation as well as the Kwak classification for maxillary artery third segment morphology.

CONCLUSIONS

In situations where primary recipient vessel sites are unavailable, the maxillary artery represents an innovative option to be considered with suitable recipient artery characteristics.

Evaluating the anatomical location of the posterior superior alveolar artery in cone beam computed tomography images

The purpose of this study was to examine the diameter, location, and frequency of the appearance of the posterior superior alveolar artery (PSAA) in preoperative cone beam computed tomography (CBCT) scans. Two hundred and eleven pre-implant CBCT scans were reviewed. The following criteria were considered in all subjects: (1) the location of the artery: intra-sinus or below the membrane (type I), intraosseous (type II), or superficial (type III); (2) the distance between the lower border of the artery and the alveolar crest; (3) the bone height measured from the floor of the sinus to the crest of the ridge; (4) the distance from the lateral wall of the artery to the medial wall of the maxillary sinus; and (5) the diameter of the artery (in millimetres). The distance between the artery and the medial sinus wall, as well as the diameter of the artery, were greater in patients with an alveolar bone height ≤10mm than in those with a bone height >10mm. The distance from the artery to the medial sinus wall and the diameter of the artery were positively correlated with the number of missing teeth. It was also found that the diameter of the PSAA increased with increasing age.

Detection of the posterior superior alveolar artery in the lateral sinus wall using computed tomography/cone beam computed tomography: a prevalence meta-analysis study and systematic review

A systematic search of MEDLINE, Embase, and Proceedings Web of Science was undertaken to assess the prevalence of the posterior superior alveolar artery (PSAA) in the lateral sinus wall in sinus lift patients, as identified using computed tomography (CT)/cone beam computed tomography (CBCT). For inclusion, the article had to report PSAA detection in the bony wall using CT and/or CBCT in patients with subsinus edentulism. Studies on post-mortem findings, mixed samples (living and cadaveric), those presenting pooled results only, or studies performed for a sinus pathology were excluded. Heterogeneity was checked using an adapted version of the DerSimonian and Laird Q test, and quantified by calculating the proportion of the total variance due to between-study variance (Ri statistic). Eight hundred and eleven single papers were reviewed and filtered according to the inclusion/exclusion criteria. Ten studies were selected (1647 patients and 2740 maxillary sinuses (study unit)). The pooled prevalence of PSAA was 62.02 (95% confidence interval (CI) 46.33-77.71). CBCT studies detected PSAA more frequently (78.12, 95% CI 61.25-94.98) than CT studies (51.19, 95% CI 42.33-60.05). Conventional CT revealed thicker arteries than CBCT. It is concluded that PSAA detection is more frequent when CBCT explorations are used. Additional comparative studies controlling for potential confounding factors are needed to ascertain the actual diagnostic value of radiographic explorations for assessing the PSAA prior to sinus floor elevation procedures.

Maxillary tuberosity fracture: a life-threatening haemorrhage following simple exodontia

Maxillary tuberosity fracture is a potential complication of routine exodontia of posterior maxillary teeth. On rare occasions, such a complication can result in torrential haemorrhage due to the close proximity of significant vessels to the area. We present a case of life-threatening haemorrhage complicating a tuberosity fracture during simple extraction of a maxillary posterior tooth. The local anatomy of the region is discussed and we provide guidelines for general dental practitioners for the management of the complication of a tuberosity fracture during routine exodontia.