Yusof Mohd Yusmiaidil Putera Mohd, Mah Michelle Clare, Reduwan Nor Hidayah, Kretapirom Kornkamol, Affendi Nur Hafizah Kamar
Centre for Oral & Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Universiti Teknologi MARA Selangor, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia.
Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA Selangor, Sungai Buloh Campus, 47000 Sungai Buloh, Selangor, Malaysia.
Saudi Dent J. 2020 Dec;32(8):396-402. doi: 10.1016/j.sdentj.2019.10.010. Epub 2019 Nov 13.
Knowledge and evaluation of the blood supply within the maxillary sinus before sinus augmentation are vital to avoid surgical complications. The lateral maxilla is supplied by branches of the posterior superior alveolar artery and infraorbital artery forming intraosseous anastomoses (IA) within the bony lateral antral wall. This study was undertaken to (i) measure mean diameter of IA and its distance from the alveolar ridge within dentate and posteriorly edentulous subjects and, (ii) qualitatively display the relationship of IA throughout its course within the lateral maxillary sinus in cone beam computed tomography (CBCT).
Maxillary CBCT images of two-hundred-and-fifty-seven consecutive patients (163 men, 94 women, mean age 42 years) were analyzed. Samples were later divided into dentate (n = 142) and posteriorly edentulous (n = 115) jaws. Using both alveolar ridge and tooth location as reference points, the distance and diameter of IA were assessed.
The IA was seen in 63.7% of all sinuses with 68.2% in dentate and 62.4% in edentulous. Mean distance and diameter of IA across the posterior tooth locations were 17.9 ± 3.0 mm and 1.4 ± 0.5 mm (dentate) and 15.1 ± 3.0 mm and 1.0 ± 0.5 mm (posteriorly edentulous), respectively. In each sample, there were no significant differences in distance-alveolar ridge and no significant correlations in diameter-tooth location. A statistically significant Pearson coefficient correlation between diameter and distance in dentate state was observed ( -0.6).
This study reveals that dentate maxillary jaws present larger diameters as compared to posteriorly edentulous jaws, although the IA course remains the same. As these canal structures contain neurovascular bundles with diameters that may be large enough to cause clinically substantial complications, a thorough pre-surgical planning is therefore highly advisable.
在上颌窦增高术前了解和评估上颌窦内的血供情况对于避免手术并发症至关重要。上颌骨外侧由后上牙槽动脉和眶下动脉的分支供血，这些分支在骨性外侧窦壁内形成骨内吻合（IA）。本研究旨在：（i）测量有牙和后牙缺失患者中IA的平均直径及其与牙槽嵴的距离，以及（ii）在锥形束计算机断层扫描（CBCT）中定性显示IA在上颌窦外侧全程的关系。
分析了257例连续患者（163例男性，94例女性，平均年龄42岁）的上颌CBCT图像。样本随后分为有牙颌（n = 142）和后牙缺失颌（n = 115）。以牙槽嵴和牙齿位置作为参考点，评估IA的距离和直径。
在所有鼻窦中，63.7%可见IA，其中有牙颌中为68.2%，无牙颌中为62.4%。后牙位置处IA的平均距离和直径在有牙颌中分别为17.9±3.0 mm和1.4±0.5 mm，在后牙缺失颌中分别为15.1±3.0 mm和1.0±0.5 mm。在每个样本中，距离-牙槽嵴无显著差异，直径-牙齿位置无显著相关性。在有牙状态下，观察到直径与距离之间存在统计学显著（-0.6）的皮尔逊系数相关性。
本研究表明，尽管IA的走行不变，但有牙的上颌颌骨与后牙缺失的颌骨相比，IA直径更大。由于这些管道结构包含直径可能大到足以引起临床上严重并发症的神经血管束，因此非常建议进行全面的术前规划。
