The Maxillary Nerve Block in Cleft Palate Care: A Review of the Literature and Expert's Opinion on the Preferred Technique of Administration.

INTRODUCTION: Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors. METHOD AND MATERIALS: First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients. RESULTS: Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA's run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant. CONCLUSION: Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety.

Three-dimensional printed personalised digital guide plate for greater palatine block in trigeminal neuralgia.

The nerve block is a safe and effective method to theat trigeminal neuralgia (TN). In terms of the V2 trigeminal neuralgia, the most difficult procedure in nerve block is accurate and fast greater palatine foramen (GPF) insertion. In this study, we developed a new technique using a personalised digital tooth-supported guide plate to increase insertion accuracy and success rates and reduce the pain of patients during injection. A total of 18 patients with TN (11 female and 7 male) were enrolled and treated between September 2020 and June 2022. Before injection, the guide plate was designed via Mimics three-dimensional (3D) reconstruction technology and printed via 3D printer. Then, all patients underwent maxillary nerve block with a guide plate for each injection. In this study, placement of all guide plates was completed within one minute and all punctures were successful the first time. The depth of the injection needle was over 2.5 cm in all cases and the guide plate was stability-supported by the maxillary teeth. The various pain scores had an obvious improvement. No patients presented symptoms of local anaesthetic toxicity or onset of new neurological sequelae. Using this new technology, we can significantly reduce the difficulty of GPF insertion and decrease patient pain during injection. The enhanced success rate of nerve block can achieve better therapeutic effect. For surgeons, personalised digital tooth-supported guide plates make the operation easier, especially for novice surgeons.

Canalis Sinuosus Mimicking Periapical Pathology on, Radiographic Assessment.

The canalis sinuosus is an anatomical variation whereby the infraorbital canal sometimes generates a small, lateral branch (canal) close to its midpoint, to allow the passage of the anterior superior alveolar neurovascular bundle in the anterior maxilla. This article focuses on an incidental finding of this variant, in a 74-year-old Trinidadian female of Afro-Caribbean descent with an endodontic presenting complaint. The canalis sinuosus shadow on conventional radiography resulted in uncertainty as to the offending tooth until a 3-dimensional scan was undertaken in this region. This report will discuss the implications of the presence of this canal from radiologic, endodontic, and surgical perspectives.

Rhinogenic Headache: The Dehiscence of Infraorbital Nerve.

Rhinogenic headache (RH), arising from nasal and sinus pathologies, present a diagnostic challenge due to their diverse etiologies. This study investigates a unique case where RH coincides with infraorbital nerve dehiscence, delving into the intricate relationship between sinonasal anatomy and neurovascular complications. The infraorbital nerve contacted a cyst in the maxillary sinus. Centripetal endoscopic sinus surgery was performed to open the maxillary sinus and remove the cyst. After 3 months of follow-up, the patient had a notable improvement in symptoms with a reduced headache. This case highlights the significance of considering uncommon anatomic variations, such as infraorbital nerve dehiscence, within the context of RH. Diligent history-taking and appropriate use of radiologic investigations are pivotal for guiding clinicians toward an accurate diagnosis and determining the most appropriate course of treatment.

Severe orbital hematoma with third eyelid swelling and prolapse following a blind maxillary nerve block in a horse.

A 20-year-old quarter horse gelding was presented for routine dental examination. Periodontal disease and luxation of tooth 108 was diagnosed and oral extraction was planned. After an unsuccessful blind maxillary nerve block, it was elected to perform the procedure under total intravenous anesthesia. Following recovery, a focal superficial corneal ulcer, severe retrobulbar swelling, mild exophthalmos, and marked swelling and prolapse of the third eyelid (nictitating membrane) were observed. Clinical signs persisted beyond 48 h despite the use of systemic anti-inflammatories and topical ocular anti-inflammatories and antibiotics. A temporary tarsorrhaphy was subsequently done at 48 h and the horse was discharged after 5 d of hospitalization and regression of clinical signs. Although it is very useful for easing dental extractions, the blind maxillary nerve block is associated with potential complications due to inadvertent vascular puncture. This case report describes a rare complication of prolapse of the third eyelid in a horse after a maxillary nerve block and successful treatment with a temporary tarsorrhaphy. Key clinical message: This case report explains how nictitating membrane swelling and prolapse can occur following a blind maxillary nerve block in the horse and describes treatment with a temporary tarsorrhaphy.

Hématome orbitaire sévère avec gonflement de la troisième paupière et prolapsus à la suite d'un bloc du nerf maxillaire à l'aveugle chez un cheval. Un hongre quarter horse de 20 ans a été présenté pour un examen dentaire de routine. Une maladie parodontale et une luxation de la dent 108 ont été diagnostiquées et une extraction orale a été planifiée. Après l'échec d'un bloc du nerf maxillaire à l'aveugle, il a été décidé d'effectuer la procédure sous anesthésie intraveineuse. Après la guérison, un ulcère cornéen superficiel focal, un gonflement rétrobulbaire sévère, une légère exophtalmie ainsi qu'un gonflement et un prolapsus marqués de la troisième paupière (membrane nictitante) ont été observés. Les signes cliniques ont persisté au-delà de 48 heures malgré l'utilisation d'anti-inflammatoires systémiques et d'anti-inflammatoires oculaires topiques et d'antibiotiques. Une tarsorraphie temporaire a ensuite été réalisée à 48 heures et le cheval est sorti après 5 jours d'hospitalisation et de régression des signes cliniques. Bien qu'il soit très utile pour faciliter les extractions dentaires, le bloc du nerf maxillaire à l'aveugle est associé à des complications potentielles dues à une ponction vasculaire involontaire. Ce rapport de cas décrit une complication rare de prolapsus de la troisième paupière chez un cheval après un bloc nerveux maxillaire et un traitement réussi par tarsorraphie temporaire.Message clinique clé:Ce rapport de cas explique comment un gonflement et un prolapsus de la membrane nictitante peuvent survenir à la suite d'un bloc du nerf maxillaire à l'aveugle chez le cheval et décrit le traitement par tarsorraphie temporaire.(Traduit par Dr Serge Messier).

Chronic Constriction Injury of the Distal Infraorbital Nerve (DIoN-CCI) in Mice to Study Trigeminal Neuropathic Pain.

Animal models remain necessary tools to study neuropathic pain. This manuscript describes the distal infraorbital nerve chronic constriction injury (DIoN-CCI) model to study trigeminal neuropathic pain in mice. This includes the surgical procedures to perform the chronic constriction injury and the postoperative behavioral tests to evaluate the changes in spontaneous and evoked behavior that are signs of ongoing pain and mechanical allodynia. The methods and behavioral readouts are similar to the infraorbital nerve chronic constriction injury (IoN-CCI) model in rats. However, important changes are necessary for the adaptation of the IoN-CCI model to mice. First, the intra-orbital approach is replaced by a more rostral approach with an incision between the eye and the whisker pad. The IoN is thus ligated distally outside the orbital cavity. Secondly, due to the higher locomotor activity in mice, allowing rats to move freely in small cages is replaced by placing mice in custom-designed and constructed restraining devices. After DIoN ligation, mice exhibit changes in spontaneous behavior and in response to von Frey hair stimulation that are similar to those in IoN-CCI rats, i.e., increased directed face grooming and hyperresponsiveness to von Frey hair stimulation of the IoN territory.

A Feasibility Study for a Novel Trans-infraorbital Canal Approach to the Maxillary Nerve in Pigs (Sus domesticus).

Experimental maxillofacial surgery is commonly performed in pigs; however, locoregional anesthesia of this area has not been described. This study evaluated the feasibility of a novel maxillary nerve block approach. In part I, cadavers were used to determine anatomic landmarks and assess maxillary nerve dye staining by using 0.03 mL kg-1 of a 1:10 mixture of commercial food dye and 0.5% bupivacaine. In part II, 10 additional pig cadavers underwent bilateral ultrasound-guided maxillary nerve blocks by using trans-infraorbital canal needle placement. The maxillary nerve was harvested and scored based on degree of staining (0 and 1, absent or incomplete staining; 2, staining; >1 cm circumferentially). Intracranial and intraconal spread of dye was evaluated. A Kruskal-Wallis test was used to compare infraorbital canal length estimated either externally via landmarks, internally via ultrasound, or actually measured after dissection. In 18 of 20 (90%) injections, successful staining (score = 2) of maxillary nerves was obtained for a nerve length of 2.4 ± 0.3 cm. Two of 20 cases (10%) had inadequate staining (score <2). At dissection of these 2 cases, the needle tip was observed to have collided with an unerupted tooth (third molar). No intracranial or intraconal spread of dye was observed. We detected no statistical differences between the estimated external, estimated internal, or actual dissection methods for measurement of infraorbital canal length (P = 0.3). Ultrasound-guided trans-infraorbital maxillary nerve block in pigs is a feasible technique, warranting further work to evaluate its in vivo efficacy and safety.

Unreported variant foramen of the frontal bone: the latero-orbital foramen.

Variant foramina of the skull can lead to misdiagnosis on medical imaging and potentially, intraoperative complications if not appreciated. Here, we report an unusual foramen found superior to the frontozygomatic suture. The foramen was located on the left side at the superolateral rim of the orbit, 2.36 cm inferolateral to the supraorbital foramen. It was positioned 2.5 mm superior to the frontozygomatic suture. The foramen had a length of 3.1 mm and a width of 1.3 mm. The internal opening of the foramen was located 1.45 cm superolateral to the zygomaticotemporal foramen. We suggest that this foramen is a pathway for either a branch of the zygomatic nerve or lacrimal nerve and/or their vascular bundles. Although the prevalence of such a finding cannot be confirmed, such a case is of archival value as a comparison for future similar cases.

Ultrasound-Guided Suprazygomatic Maxillary Nerve Block Is Effective in Reducing Postoperative Opioid Use Following Bimaxillary Osteotomy.

BACKGROUND: Ultrasound-guided maxillary nerve block has recently been described, though its impact upon bimaxillary osteotomy has not been formally investigated. PURPOSE: The present study was carried out to determine whether the addition of ultrasound-guided maxillary nerve block in subjects undergoing bimaxillary osteotomy reduces opioid use. STUDY DESIGN, SETTING, SAMPLE: A randomized clinical trial was carried out in adults undergoing bimaxillary osteotomy between April 2019 and January 2020 at Teknon Medical Center (Barcelona, Spain). PREDICTOR VARIABLE: The predictor variable was the treatment technique used (maxillary nerve block or no block). The subjects were randomized to either receive (test group) or not receive (control group) bilateral ultrasound-guided suprazygomatic maxillary nerve block (5 ml of 0.37% ropivacaine) before surgery. MAIN OUTCOME VARIABLE(S): The primary outcome variable was the intravenous methadone requirements in the first two postoperative hours. The secondary outcome variables were postoperative pain, rescue subcutaneous methadone, intravenous remifentanil used intraoperatively, the incidence of postoperative nausea-vomiting, and complications derived from maxillary nerve block. COVARIATES: Subject age, sex, weight, height, and anesthetic risk, and the duration of surgery were recorded. ANALYSES: Descriptive and inferential analyses were performed using the χ2 test and Mann-Whitney U test. Statistical significance was considered for P < .05. RESULTS: The baseline sample consisted of 68 subjects scheduled for bimaxillary osteotomy. The follow-up sample comprised 60 subjects: 30 in the control group (10 females and 20 males, aged 34.0 ± 10.2 years) and 30 in the test group (13 females and 17 males, aged 29.8 ± 10.8 years). The subjects who received maxillary nerve block showed less intravenous methadone use in the first 2 hours postsurgery (median 2.0 mg control group vs 0 mg test group; P < .001), lower pain levels at any time during the first 18 hours postsurgery (median visual analog score 4 control group vs 2 test group; P < .001), and a lesser percentage required methadone (33.3% control group vs 0% test group; P < .01) at 4-18 hours postsurgery. CONCLUSION AND RELEVANCE: The results obtained suggest that ultrasound-guided maxillary nerve block is a promising anesthetic technique capable of reducing intraoperative and postoperative opioid use, with greater patient comfort in bimaxillary osteotomy.

Transorbital Endoscopic Approach to the Foramen Rotundum for Infraorbital Nerve Stripping.

PURPOSE: To develop and evaluate a transorbital endoscopic approach to the foramen rotundum to excise the maxillary nerve and infraorbital nerve branch. METHODS: Cadaveric dissection study of 10 cadaver heads (20 orbits). This technique is predicated upon 1) an inferior orbital fissure release to facilitate access to the orbital apex and 2) the removal of the posterior maxillary wall to enter the pterygopalatine fossa (PPF). Angulations along the infraorbital nerve were quantified as follows: the first angulation was measured between the orbitomaxillary segment within the orbital floor and the pterygopalatine segment suspended within the PPF, while the second angulation was taken between the pterygopalatine segment and maxillary nerve as it exited the foramen rotundum. With refinement of the technique, the minimum amount of posterior maxillary wall removal was quantified in the final 5 cadaver heads (10 orbits). RESULTS: The mean distance from the inferior orbital rim to the foramen rotundum was 45.55 ± 3.24 mm. The first angulation of the infraorbital nerve was 133.10 ± 16.28 degrees, and the second angulation was 124.95 ± 18.01 degrees. The minimum posterior maxillary wall removal to reach the PPF was 11.10 ± 2.56 mm (vertical) and 11.10 ± 2.08 mm (horizontal). CONCLUSIONS: The transorbital endoscopic approach to an en bloc resection of the infraorbital nerve branch up to its maxillary nerve origin provides a pathway to the PPF. This is relevant for nerve stripping in the context of perineural spread. Other applications include access to the superior portion of the PPF in selective biopsy cases or in concurrent orbital pathology.

Alterações oftalmológicas decorrentes da anestesia local: aspectos de interesse para a odontologia / Ophthalmologic changes associated from local anesthesia: aspects of interest to dentistry

As complicações oftalmológicas decorrentes do uso de anestésicos locais em odontologia apresentam um baixo índice de ocorrência. Entretanto, torna-se fundamental o reconhecimento e conduta do cirurgião-dentista frente a essas possíveis complicações. O trabalho em questão tem como objetivo a identificação das alterações oftalmológicas decorrentes da injeção de anestésicos locais. Foi realizada uma revisão de literatura descrevendo as possíveis fisiopatologias, as estruturas mais acometidas, as técnicas anestésicas mais suscetíveis, bem como, a correta conduta caso ocorra e a importância do diagnóstico diferencial, visto que as alterações oftalmológicas estão presentes em outras alterações, como lesões centrais. Dessa forma pode-se concluir que as complicações, embora temporárias e geralmente benignas, podem ser angustiantes tanto para o paciente quanto para o profissional, sendo de extrema importância o reconhecimento das estruturas alteradas, possibilitando a devida explicação ao paciente e conduta a ser executada.

Ophthalmologic complications resulting from the use of local anesthetics in dentistry have a low rate of occurrence. However, it is essential to recognize and conduct the dentist in the face of these possible complications. This study aims to identify ophthalmologic alterations resulting from the injection of local anesthetics. A literature review was conducted describing the possible pathologies, the most affected structures, the most susceptible anesthetic techniques, as well as the correct conduct if it occurs and the importance of the differential diagnosis, since ophthalmologic alterations are present in other alterations, such as central lesions. Complications, although temporary and generally benign, can be distressing for both the patient and the professional, being extremely important the recognition of altered structures, allowing proper explanation to the patient and conduct to be performed.

Morphometric study of incisive, greater and lesser palatine foramina: a novel point of maxillary nerve block in a Thai population / Estudio morfométrico del foramen palatino incisivo, mayor y menor: un punto novedoso de bloqueo del nervio maxilar en una población tailandesa

SUMMARY: To study the morphometric location of the incisive, greater, and lesser palatine foramina for maxillary nerve block. Two hundred Thai dry skulls were randomly organized from the Forensic Osteology Research Center. The distances of the parameters were measured via Vernier caliper.: Thedistances from the incisive foramen to the incisive margin of the premaxilla were 10.93?2.42 mm in males and 10.98?2.06 mm in females. From the left side, the incisive foramen to the greater palatine foramen (GPF) was39.07?2.23mm in males and 38.57?2.41 mm in females, and from the right side were 39.81?2.37 mm in males and 38.62?2.53mm in females. From the left side, the incisive foramen to the lesser palatine foramen (LPF) was 43.16?2.23 mm in males and 41.84?2.42mm in females and from the right side were 42.93?2.14 mm in males and 41.76?2.61 mm in females. The GPF found at medial to the maxillary third molar were 94-95 % in males and 84 % in females. These findings suggest that the medial position to the third molar teeth be used as a landmark for a palatine nerve block in Thais. These findings will help dentists to perform local anesthetic procedures, especially the nasopalatine and greater palatine nerve blocks, more effectively.

RESUMEN: El objetivo de este trabajo fue estudiar la localización morfométrica de los forámenes palatinos incisivos, mayores y menores para el bloqueo del nervio maxilar. Se organizaron al azar doscientos cráneos secos tailandeses del Centro de Investigación de Osteología Forense. Las distancias de los parámetros se midieron mediante un calibre Vernier. Las distancias desde el foramen incisivo hasta el margen incisivo de la premaxila fueron 10,93 ? 2,42 mm en hombres y 10,98 ? 2,06 mm en mujeres. Desde el lado izquierdo, el foramen incisivo al foramen palatino mayor (FPM) fue de 39,07 ? 2,23 mm en los hombres y 38,57 ? 2,41 mm en las mujeres, y del lado derecho fue de 39,81 ? 2,37 mm en los hombres y 38,62 ? 2,53 mm en las mujeres. Del lado izquierdo, el foramen incisivo al foramen palatino menor (LPF) fue de 43,16 ? 2,23 mm en hombres y 41,84 ? 2,42 mm en mujeres y del lado derecho 42,93 ? 2,14 mm en hombres y 41,76 ? 2,61 mm en mujeres. El FPM encontrado medial al tercer molar maxilar fue 94-95 % en hombres y 84 % en mujeres. Estos hallazgos sugieren que la posición medial de los terceros molares se utilice como punto de referencia para un bloqueo del nervio palatino en individuos tailandeses. Estos hallazgos ayudarán, de manera más eficaz, a los dentistas a realizar procedimientos anestésicos locales, especialmente los bloqueos nasopalatinos y del nervio palatino mayor.

Anatomical study of the canalis sinuosus in Chilean individuals by cone-beam computed tomography / Estudio anatómico del canal sinuoso en individuos chilenos mediante tomografía computarizada cone-beam

SUMMARY: The canalis sinuosus (CS) is a double-curved bone canal in the anterior region of the maxilla. The CS contains a vasculo-nervous bundle consisting of the anterior superior alveolar nerve and its corresponding arteries and veins. The CS and its accessory canals (AC) have been little described in the literature and are often omitted in imaging evaluations before procedures in the region. The object of the present study was to evaluate the frequency of the CS and its AC in Chilean individuals, and to carry out a morphometric analysis of these anatomical structures by cone-beam computed tomography (CBCT) by sex, side and age range. CBCT examinations of 28 patients were studied, evaluating the presence, diameter and terminal portion of the CS. We also evaluated the presence and number of AC, and their terminal portion. The diameter of the AC was classified as greater or smaller than 1.0 mm. Non-parametric tests were used for quantitative variables and chi-squared for qualitative variables. The SPSS v.27.0 software was used, with a significance threshold of 5 %. The CS was present in all the samples analysed, generally presenting a diameter greater than 1.0 mm. Alterations were found, and the diameter could be greater depending on the segment evaluated, however it was not affected by sex, side or age range. The terminal portion of the CS is usually located adjacent to the region of the nasal cavity. The frequency of AC was very high, and the most common location was in the region of the upper central incisor; in 61.3 % of cases their diameter ?1.0 mm. The high frequency of CS and AC shows the importance of carrying out a detailed imaging study before invasive procedures in the anterior region of the maxilla.

RESUMEN: El canal sinuoso (CS) es un canal óseo que presenta doble curvatura, ubicado en la región anterior de maxila. El CS contiene un paquete vásculonervioso formado por nervio alveolar superior anterior, arterias y venas correspondientes. El CS y sus canales accesorios (CA) han sido poco descritos en la literatura y muchas veces son omitidos en evaluaciones imagenológicas previas a procedimientos en la región. El objetivo del presente estudio fue evaluar la frecuencia del CS y de sus CA en individuos Chilenos, bien como realizar un análisis morfométrico de estas estructuras anatómicas mediante tomografía computarizada cone-beam (TCCB) según sexo, lado y rangos etarios. Fueron evaluados exámenes de TCCB de 28 pacientes. Se evaluó la presencia, diámetro y porción terminal del CS. Se evaluó la presencia del CA, cantidad y porción terminal. El diámetro del CA fue clasificado en mayor o menor a 1,0 mm. Se utilizaron pruebas no paramétricas para variables cuantitativas y chi-cuadrado para variables cualitativas. Se utilizó el software SPSS 27.0, considerándose umbral de significación de 5 %. El CS estuvo presente en todas las muestras analizadas, presentando en general un diámetro mayor a 1,0 mm. El diámetro del CS sufre alteraciones pudiendo ser mayor dependiendo de la región evaluada, sin embargo no se ve afectado por sexo, lado o rangos etarios. La porción terminal de CS suele ubicarse adyacente a la región de cavidad nasal. La frecuencia de CA es muy alta, en un 61,3 % presentan diámetro ?1,0 mm, siendo la región de incisivo central superior su ubicación más común. La alta frecuencia de CS y de CA demuestra la importancia de realizarse un detallado estudio imagenológico previo a procedimientos invasivos en región anterior de la maxila.

Clinical study of age-related sensory innervation of the anterior hard palate / 华西口腔医学杂志

OBJECTIVES@#The present study aimed to explore the innervation of the anterior hard palatine and its relationship with individual development stage. Specifically, the effects of anesthesia on patients of different ages were observed, and neurodevelopment in the maxillofacial region was invesitgated. References that are helpful in selecting local anesthesia were provided.@*METHODS@#A total of 182 patients with mixed dentition were randomly divided into the nasopalatine nerve block and greater palatine nerve block groups. Then, 219 patients with permanent dentition were divided into an adolescent group (13-18 years old) and adult group (over 19 years old), all of whom underwent bilateral greater palatine nerve block. Palatal mucosal pain sensation was tested pre- and post-anesthesia with Von Frey hairs.@*RESULTS@#Among the children with mixed dentition, bilateral greater palatine nerve block tended to result in better anesthetic effects than nasopalatine nerve block (@*CONCLUSIONS@#The sensation of the anterior hard palatine seems mainly dominated by the greater palatine nerve until mixed dentition and gradually shifted to the nasopalatine nerve in conjunction with maxillary development and tooth replacement. Hence, the innervation of the anterior hard palatine induce a secondary development during the development of the maxilla.

Complicaciones quirúrgicas de la elevación de seno maxilar en implantología / Surgical Complications Associated to Maxillary Sinus Floor Elevation in Implantology

RESUMEN La elevación de piso de seno maxilar ha sido sumamente documentada en implantología como una técnica segura y predecible en el procedimiento de ganancia vertical ósea, en el maxilar posterior atrófico. Sin embargo, conjuntamente se han reportado complicaciones en este procedimiento, las cuales podrían poner en peligro los resultados de la regeneración, y por consiguiente la colocación del implante. El propósito de esta revisión de literatura es exponer y analizar diferentes complicaciones que pueden presentarse en la elevación de piso de seno maxilar.

ABSTRACT Maxillary sinus floor elevation has been extensively documented as a safe and predictable procedure for gaining vertical bone height in the atrophic posterior maxilla. Even though, complications have been reported, which can potentially jeopardize the outcome of the regeneration and implant therapy. Therefore, the purpose of this literature review is to present, debate and analyze the different complications that can occur during a sinus floor elevation.

Assesment of accessory branches of canalis sinuosus on CBCT images

BACKGROUND: The aim of this study is to describe the presence, to reveal the frequency and characteristics of accessory canals (ACs) of the canalis sinuosus (CS) by cone beam computed tomography (CBCT). MATERIAL AND METHODS: A total of 326 CBCT examinations were scanned retrospectively. The anatomical views were evaluated on sagittal, axial, coronal and cross sectional imaging. The following parameters were recorded: age, sex, presence or absence of ACs, location in relation to the adjacent teeth and distance to the nasal cavity floor (NCF), alveolar ridge crest (ARC) and buccal cortical bone (BCB), and incisive canal. All the collected data were statistically analyzed. RESULTS: 113 patients (34,7%); presented ACs in total 214 foramina of the sample. There were no statistically sig-nificant changes in the presence of ACs regarding age groups excluding 80-89 years. But there is a statistically significant difference regarding the frequency of ACs and the gender. The prevalence for male patients was higher than female patients. Curved-shape configuration of CS prevalence is found as 69,15%. The prevalence of vertical tracing is 26,16% and Y-shape configuration of CS prevalence is 4,67%. Diameter of the foramens of the CS branches was 1.30 mm. The mean distance of the AC to the NCF, BCB, and ARC were found 13,83 mm, 6,60 mm and 5,32 mm, respectively. CONCLUSIONS: In the anterior palatal region, ACs are mostly related to CS's branches. So; knowing the course of CS branches in surgical planning and radiographic evaluations in this region is extremely important for preventing complications and avoiding misdiagnosis

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Frequency of canalis sinuosus and its anatomic variations in cone beam computed tomography images / Frecuencia de canalis sinuosus y sus variaciones anatómicas en imágenes de tomografía computarizada de haz cónico

The aim of this paper was to determine the frequency of Canalis Sinuosus (CS) and its anatomic variations. A total of 236 cone beam computed tomography (CBCT) images were studied. Characteristics of the canal such as its form, pathway and diameter were analyzed. The CS was clearly visualized in 100 % of the images with variations in the canal observed in up to 46 % of the cases. In 79 % of the cases the variation was found to be bilateral. The most common variation was an increase in the diameter (> 1mm) of the CS. Considering that the anterior region of the middle third of the face is a common place for clinical interventions, this study supports the need to perform a thorough evaluation of the maxillary region prior to clinical interventions in order to prevent complications such as direct or indirect injury to the anterior superior alveolar neurovascular bundle contained within the CS.

El objetivo de este trabajo fue determinar la frecuencia de Canalis Sinuosus (CS) y sus variaciones anatómicas. Se estudiaron un total de 236 imágenes de tomografía computarizada de haz cónico (CBCT). Se analizaron las características del canal, como su forma, vía y diámetro. El CS se visualizó claramente en el 100 % de las imágenes, observándose variaciones en el canal en hasta el 46 % de los casos. En el 79 % de los casos la variación fue bilateral. La variación más común fue un aumento en el diámetro (> 1 mm) de la CS. Teniendo en cuenta que la región anterior del tercio medio de la cara es un lugar común para las intervenciones clínicas, este estudio apoya la necesidad de realizar una evaluación exhaustiva de la región maxilar antes de las intervenciones clínicas para prevenir complicaciones como lesiones directas o indirectas a el haz neurovascular alveolar superior anterior contenido dentro de la CS.

Canalis Sinuosos mimetizando reabsorção radicular: relato de caso / Canalis sinuosus mimicking root resorption: case report

Relato de caso: Relatar um caso de canal acessório do Canalis Sinuosos, localizado por palatino à raiz do dente 21 que, na radiografia panorâmica, foi observada como uma área radiolúcida sobreposta aos terços médio-apical dente 21, indicando reabsorção radicular, sendo indispensável uma investigação acurada por tomografia computadorizada de feixe cônico (TCFC). Conclusão: A TCFC se mostrou eficiente na identificação do Canalis Sinuosos em relação à radiografia panorâmica, possibilitando um correto diagnóstico para o caso.

Case report: This report describes a case of Canalis sinuosus accessory canal, lingually to the root of the tooth 21, that was observed on panoramic radiograph as a radiolucent area superimposed over the middle and apical thirds, indicating root resorption. However, cone-beam computed tomography (CBCT) recommended for an accurated diagnosis of the case disclose the presence of this anatomic variation. Conclusion: CBCT was more accurate in detection of Canalis sinuosus than panoramic radiography.

Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery / Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery

Abstract Introduction: The course of the infraorbital canal may leave the infraorbital nerve susceptible to injury during reconstructive and endoscopic surgery, particularly when surgically manipulating the roof of the maxillary sinus. Objective: We investigated both the morphometry and variations of the infraorbital canal with the aim to show the relationship between them relative to endoscopic approaches. Methods: This retrospective study was performed on paranasal multidetector computed tomography images of 200 patients. Results: The infraorbital canal corpus types were categorized as Type 1: within the maxillary bony roof (55.3%), Type 2: partially protruding into maxillary sinus (26.7%), Type 3: within the maxillary sinus (9.5%), Type 4: located anatomically at the outer limit of the zygomatic recess of the maxillary bone (8.5%). The internal angulation and the length of the infraorbital canal, the infraorbital foramen entry angles and the distances related to the infraorbital foramen localization were measured and their relationships with the infraorbital canal variations were analyzed. We reported that the internal angulations in both sagittal and axial sections were mostly found in infraorbital canal Type 1 and 4 (69.2%, 64.7%) but, there were commonly no angulation in Type 3 (68.4%) (p < 0.001). The length of the infraorbital canal and the distances from the infraorbital foramen to the infraorbital rim and piriform aperture was measured as the longest in Type 3 and the smallest in Type 1 (p < 0.001). The sagittal infraorbital foramen entry angles were detected significantly smaller in Type 3 and larger in Type 1 than that in other types (p = 0.003). The maxillary sinus septa and the Haller cell were observed in 28% and 16% of the images, respectively. Conclusion: Precise knowledge of the infraorbital canal corpus types and relationship with the morphometry allow surgeons to choose an appropriate surgical approach to avoid iatrogenic infraorbital nerve injury.

Resumo: Introdução: O trajeto do canal infraorbitário pode predispor o nervo infraorbitário a lesões durante cirurgias reconstrutoras e endoscópicas com manipulação do teto do seio maxilar. Objetivo: Investigamos a morfometria e as variações do canal infraorbitário e objetivamos demonstrar a relação entre elas, visando as abordagens endoscópicas. Método: Este estudo retrospectivo foi realizado em imagens de tomografia computadorizada multidetectora de seios paranasais de 200 pacientes. Resultados: Os tipos de corpos do canal infraorbitário foram categorizados como Tipo 1; inseridos no teto ósseo maxilar (55,3%), Tipo 2; projetando-se parcialmente dentro do seio maxilar (26,7%), Tipo 3; dentro do seio maxilar (9,5%), Tipo 4; localizado anatomicamente no limite externo do recesso zigomático do osso maxilar (8,5%). A angulação interna e o comprimento do canal infraorbitário, os ângulos de entrada do forame infraorbitário e as distâncias relacionadas à localização do forame foram medidos e suas relações com as variações do canal infraorbitário foram analisadas. Observamos que as angulações internas em ambos os cortes sagital e axial foram encontradas em sua maioria em canais infraorbitários Tipo 1 e 4 (69,2%, 64,7%) e, no geral, não houve angulação no canal Tipo 3 (68,4%) (p < 0,001). O comprimento do canal infraorbitário e as distâncias desde o forame infraorbitário até o rebordo infraorbitário e a abertura piriforme foram medidos e os mais longos foram identificadas no Tipo 3 e os mais curtos no Tipo 1 (p < 0,001). Os ângulos de entrada do forame infraorbitário em projeção sagital foram significativamente menores no Tipo 3 e maiores no Tipo 1, em relação aos outros tipos (p = 0,003). Septos nos seios maxilares e as células de Haller foram observados em 28% e 16% das imagens, respectivamente. Conclusão: O conhecimento preciso dos tipos de corpo do canal infraorbitário e a relação com a morfometria permitem que o cirurgião escolha uma abordagem cirúrgica apropriada para evitar lesões iatrogênicas do nervo infraorbitário.

Morphological and morphometric characterization of the "sphenoidal tubercle" / Caracterización morfológica y morfométrica del tubérculo esfenoidal

The sphenoidal tubercle is a bone elevation located in the anterior edge of the infratemporal crest of the sphenoid greater wing, where the temporal and lateral pterygoid muscles have their origin. This bone accident presents varied morphology so its description and denomination are a topic of discussion. 60 dry skulls obtained from the morphology laboratory of the Biomedical Basic Sciences Department of the University of Talca were used for a morphological and morphometric analysis of the sphenoidal tubercle including its morphology, diameters (anteroposterior, transverse and vertical) and the distance to the grooves for the maxillary artery and maxillary nerve. Sphenoidal tubercle had a prevalence of 98.4 % of all dry skulls analyzed with a bilateral presentation in the 76.6 % of the cases. According to its different forms of presentation established by Cáceres et al., (2016) the pyramidal form was the most frequent with a 25.7 %. The average diameters were of 4.12 mm anteroposterior, 5.50 mm transverse and 3.89 mm vertical. The average distance to the grooves of the maxillary artery and maxillary nerve were 9.04 mm and 7.6 mm, respectively. Sphenoidal tubercle is a constant bone accident with a variated morphology and measures. Due to its anatomical relations with important neurovascular elements such as the maxillary artery and the maxillary nerve, it may be used as a reference point for surgical access to the infratemporal fossa. From this analysis we establish that the denomination of "infratemporal process" is more accurate, because the development of this bone accident is from muscular traction performed by the lateral pterygoid muscle and the deep portion of the temporal muscle causing great variations in its morphology, probably due to external and functional parameters or even influenced by the biotype.

El tubérculo esfenoidal es una elevación ósea ubicada en el extremo anterior de la cresta infratemporal del ala mayor del hueso esfenoides, donde presta inserción al músculo temporal y pterigoideo lateral. Presenta morfología variada, por lo que su descripción y denominación resultan motivo de discusión. 60 cráneos secos obtenidos del Laboratorio de Morfología del Departamento de Ciencias Básicas Biomédicas de la Universidad de Talca, fueron utilizados para realizar un análisis morfológico y morfométrico del tubérculo esfenoidal evaluando forma, diámetros (anteroposterior, laterolateral y vertical) y distancia con el surco de la arteria y nervio maxilar. El tubérculo esfenoidal tuvo una prevalencia del 98,4 % del total de cráneos analizados, presentándose bilateralmente en el 76,6 % de los casos. De acuerdo a las diferentes formas de presentación establecidas por Cáceres et al (2016) la forma piramidal fue la más frecuente con un 25,7 %. Los diámetros promedio fueron de 4,12 mm anteroposterior, 5,50 mm laterolateral y 3,89 mm vertical. Las distancias promedio con el surco de la arteria y nervio maxilar fueron de 9,04 mm y 7,6mm, respectivamente. El tubérculo esfenoidal es un accidente óseo constante de morfología y dimensiones variadas. Debido a sus relaciones con elementos vasculares de importancia, tales como la arteria y nervio maxilar, podría ser utilizado como elemento de referencia para el acceso quirúrgico a la fosa infratemporal. A partir de su análisis planteamos que su denominación como "proceso infratemporal" sería más apropiado, debido a que se desarrollaría a partir de la tracción muscular ejercida por el musculo pterigoideo lateral y la porción profunda del músculo temporal, ocasionando variaciones notables en su morfología, probablemente debido a factores externos y funcionales o incluso influenciada por el biotipo.