Abstract
Aim: The aim of this study is to evaluate the prevalence, localization and diameters of Posterior superior alveolar artery (PSAA), one of the branches of maxillary artery, and Infraorbital foramen (IOF) through which the Infraorbital artery (IOA) passes, by using conic beam computed tomography (CBCT) in dentate patients. The study also aims to research whether there is any relationship between PSAA, which has a small diameter and which sometimes cannot be seen on CBCT, and IOF, which has relatively larger diameter, in terms of size, shape and localization and to predict their location relative to each other in surgical procedures involving the maxillary sinus in edentulous patients.
Material and Method: Bilateral maxillary sinuses were analysed retrospectively in CBCT images taken for various reasons from 170 patients with no missing teeth in the maxillary posterior region. Demographic characteristics of patients such as age and gender and their radiological findings were recorded. The largest locations of PSAA and IOF in the maxillary sinus were determined and their size, shape, localization in relation to the teeth and their distances from anatomical points such as the midline, medial wall and base of the maxillary sinus and crest were evaluated.
Results: While 49.42% of the participants were male, 50.58% were female and mean age was 28.88 ± 9.95. The incidence rate of PSAA on CBCT was found as 56.2%. While the rate of those with a vertical diameter of ≥1 mm was 92.1%, the rate of those with a horizontal diameter of ≥1 mm was 65.4%. When the relationship of PSAA with the maxillary sinus was examined, the most common location was intraosseous with 60.2%. In terms of localization, the highest rate was found in the distal of the second molar with 34.6%.
IOF was observed in all CBCT images (100%). Mean horizontal diameter of IOF was found as 3.47 mm, while its mean vertical diameter was found as 3.68 mm. In terms of shape, the most common shape was semi-circular (49.4%). In terms of localization, the most common location was at the second premolar tooth level with a rate of 39.7%. While IOF was mostly seen at the first premolar tooth level in young participants, it was mostly seen at the distal of second premolar tooth in old age.
No statistical correlation was found between the diameters, localizations and shapes of PSAA and IOF (p>0.05). However, the median values of horizontal diameter, vertical diameter, distance to the midline, distance to the medial wall and base of the maxillary sinus and distance to the crest were found to be higher in men when compared to women in both anatomical structures.
Conclusion: According to the results of this study, in order to prevent a possible bleeding that can occur since PSAA and IOF diameters are higher in men than women and since the vertical and horizontal diameters of PSAA are higher than 1 mm in a great majority of the patients, clinicians are recommended to evaluate the size and localization of these anatomical structures with CBCT before surgical procedures, especially in male patients and older patients.
In the present study, no statistical correlation was found between PSAA, one of the branches of maxillary artery, and IOF, through which IOA passes, in terms of characteristics such as localization, distance to anatomical points and shape and our hypothesis of predicting their position relative to each other in surgical procedures of the maxillary sinus in edentulous patients was not confirmed. It may be useful to conduct more detailed studies with higher resolution CBCT devices in which more patients are included.