and 1 other(s)
Introduction: Oral surgeries will generally require preoperative radiological planning to visualize relevant neighboring structures and avoid damaging them during surgery. In operations on the maxillary sinus, particularly elevation of the lateral sinus floor, there is the danger of injuries with severe bleeding from the anastomosis of the superior posterior alveolar artery and the infraorbital artery. Aim of this prospective study was the clinical and radiological evaluation of patients receiving sinus lift surgery at the Dental school of Medical University of Graz Material and methods: This prospective study included patients undergoing sinus floor augmentation between January 2017 and September 2017 at the Department of Dentistry and Maxillofacial Surgery, Medical University of Graz. Digital volume tomography (DVT) was used for the preoperative radiological evaluation of the topological position of the anastomosis of the superior posterior alveolar artery and the infraorbital artery. Intraoperative verification of the topographical position of the anastomosis and any bleeding were documented on a standardized evaluation form by the surgeon during the procedure. Data were analyzed with descriptive and exploratory statistical methods. Results: The patient collective included 15 women and 5 men (n=15/5) with an average age of 59 years (SD 15.4). There were 80 total evaluations of the topographical position of the anastomosis, including preoperative tomography and intraoperative inspection. There were 5 evaluations of region 17/27 (14%), 20 of region 16/26 (25%), 11 of region 15/25 (6%) and 4 of region 14/24 (5%). The dental gaps were classified as edentulous spaces (40%), free ends (50%) and edentulous (10%). The smallest vessel diameter of the anastomosis was found in region 16/26 with 0.72 mm, and the maximal vessel diameter in region 14/24 with 2.06 mm. Smallest craniocaudal distance of 1.26 mm and the maximal craniocaudal distance of 13.6 mm from the sinus floor to the lower edge of the vessel were found in region 15/25. There was no case of intraoperative bleeding among the 20 patients. The results indicate that there is great anatomical variation in the prevalence, size, position and morphology of the anastomosis of the superior posterior alveolar artery and the infraorbital artery, independent of the degree of atrophy and the dental status. Conclusion: To prevent bleeding during a sinus floor augmentation, preoperative three-dimensional imaging is recommended when planning the procedure.
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