Frequency, location, and diameter of the anastomosis between the posterior superior alveolar artery and the infraorbital artery in imaging studies: systematic review and meta-analysis.

The anastomosis between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) courses along half of the lateral wall of the maxillary sinus. Risk of injury to the anastomosis between PSAA and IOA during surgical procedures has been reported. The aim of the present study was to carry out a systematic review and meta-analysis to determine the frequency, location, and diameter of the anastomosis between PSAA and IOA in imaging studies (cone-beam computed tomography, spiral cone-beam computed tomography, and computed tomography). A search was carried out in the PubMed, EMBASE, and LILACS. Original works were included reporting imaging studies to analyze the frequency, location, and diameter of the anastomosis in humans. The risks of bias were analyzed using the AQUA tool. Generalized linear mixed models were used to estimate the frequency and the 95% CI in the meta-analysis. The variance in prevalence estimates was stabilized by logit transformation. The qualitative analysis included 49 studies with 10,837 patients. The frequency of the anastomosis between PSAA and IOA was 74% (prediction interval 0.20-0.97%). The anastomosis was most frequently located in the intraosseous region (60.0%), followed by the submembranous region (33.0%), and least frequently in an extraosseous location (5.0%). Arteries with diameter of 1.0-1.9 mm were most frequent (32.0%), followed by arteries with diameter less than 1 mm (23.0%); a small number with diameter greater than 2 mm was recorded (4.0%). These data can be used as a reference to help surgeons when planning interventions in the lateral wall of the maxillary sinus. Registration number: INPLASY, number 202120071.

Anastomosis between the posterior superior alveolar artery and the infra-orbital artery: a review of current terminology / Anastomosis entre la arteria alveolar superior posterior y la arteria infra-orbital: una revisión de la terminología actual

SUMMARY: The posterior superior alveolar artery (PSAA) and the infra-orbital artery (IOA) present intraosseous and extraosseous rami which form an anastomosis in the lateral wall of the maxillary sinus. This anastomosis is always present, however it has not yet been included in anatomical terminology (AT), and different terms are used in scientific communication to refer to it. The aim of this study was to carry out a review of the different terms used to name this vascular structure. A literature review was carried out on the terms used to name the anastomosis between the PSAA and IOA in imaging studies and human cadavers that assessed the presence/frequency of this anatomical structure. The search was carried out in the Medline, EMBASE and LILACS databases, in Portuguese, Spanish and English, with no date restrictions. Qualitative analysis was applied to the studies selected, analysing the terminology used to refer to the anastomosis between the PSAA and IOA. Of the 2108 original articles found, 60 were selected as potentially relevant and 54 studies were finally included for qualitative analysis. Sixteen terms were found to refer to the anastomosis between the PSAA and IOA, the most frequent being Posterior Superior Alveolar Artery (PSAA), followed by Alveolar Antral Artery (AAA). Many terms are used in the medical literature to designate the anastomosis between the PSAA and IOA, the most frequent being PSAA and AAA. There is a need to unify the terms used to designate this vascular structure, and to incorporate the selected term into anatomical terminology, in order to avoid confusion in scientific communication.

RESUMEN: La arteria alveolar superior posterior (AASP) y la arteria infra-orbital (AIO) tienen ramas intra y extra óseas que forman una anastomosis en la pared lateral del seno maxilar. Esta anastomosis está siempre presente, sin embargo, aún no ha sido incluida en la terminología anatómica (TA), por lo que en la comunicación científica se utilizan diferentes términos para referirse a ella. El objetivo de este estudio fue realizar una revisión sobre los diferentes términos utilizados para nombrar esta estructura vascular. Se realizó una revisión de la literatura sobre los términos utilizados para nombrar la anastomosis entre AASP y AIO en estudios imagenológicos y en cadáveres humanos que evaluaron la presencia/frecuencia de esta estructura anatómica. La búsqueda fue realizada en las bases de datosMedline, EMBASE y LILACS, en los idiomas portugués, español e inglés, sin restricción de fecha. Los estudios seleccionados fueron evaluados de forma cualitativa, analizando la terminología empleada para referirse a la anastomosis entre AASP y AIO. Fueron encontrados 2108 artículos originales, siendo seleccionados 60 artículos potencialmente relevantes y finalmente fueron incluidos 54 estudios para análisis cualitativo. Fueron encontrados 16 términos para referirse a la anastomosis entre AASP y AIO, siendo AASP el más frecuente seguido de arteria alveolo-antral (AAA). Son muchos los términos utilizados en la literatura médica para designar la anastomosis entre AASP y AIO, siendo AASP y AAA los más usados. La unificación de los términos utilizados para designar esta estructura vascular y su incorporación en la Terminología Anatómica contribuiría a evitar equívocos en la comunicación científica.

Analysis of the presence, location and morphometry of the «alveolar antral artery¼ by cone-beam computed tomography in Chilean adults / Análisis de la presencia, ubicación y morfometría de la arteria alvéolo-antral por tomografía computarizada de haz cónico en adultos chilenos

SUMMARY: The posterior superior alveolar artery is responsible for the vascularisation of the mucous which covers the posterior wall of the maxillary sinus, pulp and the periodontal tissues of upper molars. The collateral rami of the infraorbital artery irrigate the mucous of the anterior and lateral walls of the maxillary sinus, as well as the pulp and periodontal tissue of the upper anterior teeth and upper premolars. Both these arteries present intraosseous and extraosseous rami which form an anastomosis in the anterior and lateral walls of the maxillary sinus, called the alveolar antral artery (AAA). The aim of this study was to analyse the presence, location and morphometry of the AAA in a Chilean population, considering sex, side and age, using Cone-Beam computed tomography (CBCT). Forty-two CBCT examinations of Chilean adults were evaluated to analyse the presence, location (extraosseous, intraosseous or subperiosteal) and diameter (<1mm, 1-2 mm, 2-3 mm, >3 mm) of the AAA and the distance from the AAA to the amelocemental limit of the upper second premolar (2PM), permanent upper first molar (1M) and permanent upper second molar (2M) by sex and age range. Pearson's chi-squared test, Student's t-test, ANOVA and Pearson's correlation coefficient were applied, using a significance threshold of 5 %. AAA was found in 75 sides (89.3 %), 38 on the right side (90.5 %) and 37 on the left (88.09 %); extraosseous location was most common. More than 80 % of the arteries presented a diameter between 1 and 2 mm, with no important differences between sexes or age ranges. In younger individuals, the artery was located closer to the vestibular amelocemental limit than in older individuals. Carrying out a proper treatment plan which includes imagenological analysis before surgical procedures is essential to avoid possible haemorrhagic events in the region.

RESUMEN: Arteria alveolar superior posterior es responsable de la vascularización de la mucosa que recubre la pared posterior del seno maxilar, la pulpa y el tejido peridontal en el que se insertan los molares superiores. Las ramas colaterales de la arteria infraorbitaria irrigan la mucosa de las paredes anterior y lateral del seno maxilar, así como la pulpa y el periodonto de los dientes anteriores superiores y los premolares superiores. Ambas arterias presentan ramas intraóseas y extraóseas que forman una anastomosis en las paredes anterior y lateral del seno maxilar, denominada arteria alvéolo antral (AAA). El objetivo de este estudio fue analizar la presencia, localización y morfometría del AAA en una población chilena, considerando sexo, lado y edad, mediante tomografía computarizada Cone-Beam (CBCT). Se evaluaron 42 exámenes CBCT de adultos chilenos para analizar la presencia, ubicación (extraósea, intraósea o subperióstica) y diámetro (<1 mm, 1-2 mm, 2-3 mm,> 3 mm) del AAA. y la distancia del AAA al límite amelocemental del segundo premolar superior (2PM), primer molar superior permanente (1M) y segundo molar superior permanente (2M) por sexo y rango de edad. Se aplicaron la prueba de chi-cuadrado de Pearson, la prueba t de Student, ANOVA y el coeficiente de correlación de Pearson, utilizando un umbral de significancia del 5 %. Se encontró AAA en 75 lados (89,3 %), 38 del lado derecho (90,5 %) y 37 del lado izquierdo (88,09 %); la localización extraósea fue la más común. Más del 80 % de las arterias presentaban un diámetro entre 1 y 2 mm, sin diferencias importantes entre sexos ni rangos de edad. En individuos más jóvenes, la arteria se ubicó más cerca del límite amelocemental vestibular que en individuos mayores. La realización de un adecuado plan de tratamiento que incluya análisis imagenológico antes de los procedimientos quirúrgicos es fundamental para evitar posibles eventos hemorrágicos en la región.

Important anatomical variations of the superior posterior alveolar artery: Studied by cone beam computed tomography.

The knowledge of anatomical variations of the posterior superior alveolar artery (PSAA) is very important in surgeries for maxillary sinus (MS) elevation and subsequent insertion of dental implants, avoiding common and serious surgical complications. The main objective of this study was to analyse important anatomical variations of the PSAA by means of cone beam computed tomography (CBCT) examinations. 180 tomographic CBCT were analysed, and MS was divided into three equal regions: (I) anterior, (II) intermediate and (III) posterior. Variables evaluated were the visualisation of the artery, distance from the artery to the ridge crest, distance from the artery to the sinus floor, alveolar ridge height and arterial diameter. The PSAA visualisation was more prevalent in males and region III (76.7%). The distance from the artery to the sinus floor presented no significant difference between regions II and III, with both regions showing significantly lower values than region I. A significant difference was observed in the diameter of the arteries with higher prevalence of diameters >1.0 mm in males and <1.0 mm in females. The PSAA can be well visualised frequently with a CBCT, and differences in artery diameter were observed in relation to gender (males > females). Additional care is recommended when it is necessary to extend surgeries to the posterior MS region, avoiding haemorrhages that are associated with failures in these procedures.

Evaluación de la arteria alveolo-antral mediante tomografía volumétrica en población mexicana y su relación con levantamiento del piso del seno maxilar / CBCT evaluation of the alveolar antral artery in a mexican cohort and its relationship to maxillary sinus floor lifting

Introducción: El conocimiento de la anatomía de la región maxilar debe ser esencial para el cirujano antes de realizar levantamiento del seno maxilar para evitar complicaciones. La arteria alveolo antral forma una anastomosis intraósea con la arteria infraorbitaria a nivel de la pared antero lateral del seno maxilar, aproximadamente a una distancia de entre 18.9 y 19.6 mm desde el reborde alveolar maxilar. La arteria alveolo antral es la encargada de dar vascularidad a la membrana mucosa del seno maxilar, pared antero lateral del seno y tejido perióstico subyacente.Objetivo: Describir y establecer la frecuencia, diámetro y localización dela anastomosis entre la arteria infraorbitaria y la arteria alveolar posterior superior, llamada arteria alveolo antral y su relación con la cresta ósea alveolar en una población mexicana. Material y métodos: Se realizaun protocolo de estudio observacional, descriptivo y transversal en una población de 1,116 pacientes derecho habientes del Instituto de Seguridad Social y Servicios para los Trabajadores del Estado (ISSSTE), en el oriente de la Ciudad de México, mediante la revisión de estudios de tomografía volumétrica computarizada. Resultados: Se encuentra la anastomosis arterial en el 90 por ciento de los estudios revisados, correspondiente a 1,005 estudios de tomografía.

Introduction: In order to avoid complications, it is essential for surgeonsto have a detailed knowledge of the anatomy of the superior maxillarybone prior to performing any sinus lift procedure. The alveolarantral artery forms an intraosseous anastomosis with the infraorbitalartery at the level of the anterolateral wall of the maxillary antrum at anapproximate distance of between 18.9 and 19.6 mm from the maxillaryalveolar ridge. The alveolar antral artery is responsible for providingvascularity to the mucous membrane of the maxillary sinus, the anteriorlateral wall of the sinus, and the underlying periosteal tissue. Objective:To analyze and establish the frequency, diameter, and locationof the anastomosis between the infraorbital artery and the posteriorsuperior alveolar artery known as the alveolar antral artery, and itsrelationship to the alveolar bone crest in a Mexican cohort. Materialand methods. We conducted a cross-sectional observational descriptivestudy involving a cohort comprised of 1,116 patients of the Institute forSocial Security and Services for State Workers (ISSSTE) on the eastside of Mexico City. The study consisted of a review of CBCT studies.Results: The arterial anastomosis was found in 90% of the 1,005 CBCTstudies reviewed, based on which the following values were determinedfor the distance between the alveolar ridge and the canal of the alveolarantral artery: for the fi rst premolar, 18.24 mm; second premolar,17.35 mm; fi rst molar, 16.96 mm, and for the second molar, 18.75 mm.Conclusions: We established the average measurements for the locationof the vascular bundle in question and the measurements neededto safeguard it along its course, which is important for the preservationand osseointegration of bone grafts placed during maxillary sinus liftprocedures, thus providing a margin of safety not previously reportedin the literature for a Mexican cohort.