Radiographic Evaluation of Maxillary Sinus Lateral Wall and Posterior Superior Alveolar Artery Anatomy: A Cone-Beam Computed Tomographic Study.

Abstract

The purpose of the current study is to assess the thickness of the maxillary sinus lateral wall in dentate and edentulous patients using cone beam computed tomography (CBCT). This study also provides information about the diameter, prevalence, and course of the posterior superior alveolar artery (PSAA), and its relation to the maxillary sinus floor. Four hundred and thirty CBCT scans of the maxillofacial complex (860 maxillary sinuses) were reviewed. Measurements of the lateral wall of the maxillary sinus and PSAA were performed on the CBCT images. Statistical analysis showed that dental status (edentulous, non-edentulous) of the patients had no significant effect on the lateral wall thickness. The mean thickness of the lateral wall of the maxillary sinus was 1.21 ± 1.07 mm at the second molar (M2), 1.98 ± 1.87 mm at the first molar (M1), 2.02 ± 1.53 mm at the second premolar (P2) and 2.16 ± 1.25 mm at the first premolar (P1). There was statistically significant difference between the left and right sides of the maxillary sinus only at P2 (p =.043). Detection rate of the PSAA on CBCT was reported as 60.58%. The mean diameter of the artery was 1.17 mm (range 0.4-2.8 mm). There was no significant correlation between age and the size of the PSAA. The most frequent path of the PSAA was intraosseous (69.6%), followed by intrasinusal (24.3%) and superficial (6.1%). The overall mean distance of the PSAA from the floor of the maxillary sinus is 8.16 mm. The results from this study suggest that using CBCT prior to the surgery provides valuable diagnostic information. However, undetected intraosseous canal in CBCT does not exclude its existence. Alteration in the lateral window design and the use of piezoelectric instruments are recommended if intraoperative complications are expected.