Evaluation of the Posterior Superior Alveolar Artery Using Cone Beam Computed Tomography.

BACKGROUND: Maxillary posterior tooth region is an important area with respect to periapical surgery, implant placement, and sinus lifts. Posterior superior alveolar artery (PSAA) is located on the lateral wall of maxillary sinus and may become injured during such surgical procedures. Therefore, knowledge of the subject is essential to a clinician. The goal was to determine the anatomical relationship of posterior superior alveolar artery to the floor of maxillary sinus and alveolar crest. In our study we attempted to present the locations and course of posterior superior alveolar artery (PSAA) using cone beam computed tomography (CBCT) imaging. MATERIAL/METHODS: CBCT scans of 50 patients (30 males, 20 females) who had undergone computed tomography imaging were analyzed. We assessed the visibility and location of vascular canal/notch of posterior superior alveolar artery on cross sectional images and measured the distances from lower margin to the floor of maxillary sinus and alveolar crest in the 1st molar and 2nd molar regions. Unpaired t-test was carried out in the analysis to determine the level of significance. RESULTS: Maxillary PSAA was visualized in 36 patients (70%). Mean diameter of the vessel was 0.63 mm. Mean distance between PSAA and alveolar crest was the shortest in the 2nd molar region. The mean distance between PSAA and floor of maxillary sinus was 9.96 mm. CONCLUSIONS: Periapical surgeries, implants and maxillary sinus lift are performed on routine basis. PSAA is an important structure in the posterior maxillary region; the clinician should be aware of its location and course. CBCT is an excellent tool to localize the PSAA because of it provides finer details at low exposure and less radiation. It should be recommended in clinical practices.

Odontogenic Keratocyst: A Rare Presentation in Anterior Maxilla.

The odontogenic keratocyst is an enigmatic developmental cyst that deserves special attention. It has characteristic histopathological and clinical features; but, what makes this cyst special is its aggressive behavior and high recurrence rate. Odontogenic keratocyst is a benign odontogenic cyst, commonly affecting the mandible. These lesions have posed a great difficulty for the surgeons and pathologists.  Few cases affecting the maxilla are also reported.  Literature search suggests that odontogenic keratocysts may affect maxillary posterior and canine region. The present case reports a lesion of odontogenic keratocyst occuring in the maxillary incisor region, crossing midline which was initially misdiagnosed as infected residual cyst. After careful evaluation, it was reported as an odontogenic keratocyst. Key Words: Odontogenic keratocyst, Maxilla, Incisor teeth.