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.

Avaliação do diâmetro do ramo intraósseo da artéria alveolar superior posterior e sua relação com a cirurgia de levantamento do seio maxilar ­ estudo transversal / Evaluation of intra-osseous branch of posterior superior alveolar artery diameter and its relation with the maxillary sinus

Objetivo: descrever a anatomia do ramo intraósseo da artéria alveolar superior posterior (riAASP) na parede lateral do seio maxilar. Material e métodos: 31 pacientes se encaixaram nos critérios de inclusão para a pesquisa. Avaliou-se a presença ou não do riAASP, sua distância até o assoalho do seio maxilar e até a crista alveolar, e seu diâmetro nas regiões dentais posteriores bilateralmente em maxila, comparando regiões dentadas com edentadas através de TCFCs. Resultados: o riAASP foi identificado em 21 pacientes (67,7%), sendo mais visualizado na região de primeiro molar. Foram avaliadas 248 regiões dentais de 31 pacientes, onde o riAASP foi visualizado e mensurado em 153 regiões (61,7%). Quanto mais posterior era a região, maior era o diâmetro do vaso, tanto para regiões dentadas quanto para as edentadas, e o diâmetro médio encontrado foi de 1,2 mm. A distância do riAASP até o assoalho do seio maxilar nas regiões dentadas não apresentou diferença estatisticamente significante nas diferentes regiões dentais. Já nas regiões edentadas, quanto mais posterior foi a região, menor foi esta distância. Em relação à distância da artéria até a crista alveolar, quanto mais anterior era a região dental, mais distante da crista o riAASP se posicionou. Conclusão: o conhecimento anatômico, a solicitação de exames de tomografi a computadorizada, a interpretação no planejamento pré-operatório e a habilidade do cirurgião poderão eliminar ou diminuir os acidentes relacionados à hemorragia do riAASP durante a cirurgia de levantamento do seio maxilar.

Objective: to define the anatomy of the intraosseous branch of the posterior superior alveolar artery (ioPSAA) in the lateral wall of the maxillary sinus. Material and methods: 31 patients meet the inclusion criteria for the study. The presence or absence of ioAASP, its distance to the floor of the maxillary sinus, to the alveolar crest and its diameter, were evaluated in the posterior dental regions bilaterally in the maxilla, comparing edentulos and dentate regions through CBCTs. Results: the ioPSAA was identifi ed in 21 patients (67.7%), being more visualized in the 1st molar region. A total of 248 dental regions of 31 patients were evaluated, where ioAASP was visualized and measured in 153 regions (61.7%). The diameter of the artery increases as it runs posteriorly in the maxilla, for both toothed and edentate regions. The mean diameter found was 1.2 mm. The distance from the ioPSAA to the maxillary sinus fl oor in the dentate regions did not present a statistically significant difference in the different dental regions. In the edentate regions, the more posterior the region, the smaller the distance to the sinus floor. Regarding the distance from the artery to the alveolar crest, the more anteror the dental anterior, the greater the distance of ioPSAA from the alveolar crest. Conclusion: anatomical knowledge, the need for CT scans, its interpretation in the preoperative planning, and the surgeon's ability, may eliminate or reduce the accidents related to riAASP hemorrhage during maxillary sinus surgery.

Hemorragia durante cirurgia de levantamento do seio maxilar / Bleeding complication on sinus lifting surgery: case report

Relata-se um caso clínico de hemorragia durante cirurgia de levantamento do seio maxilar provocada por uma lesão de ramos intraósseos da artéria alveolar superior posterior. O controle de recursos técnicos e cirúrgicos e o conhecimento anatômico local são imprescindíveis na conduta de casos de hemorragia em seio maxilar.

A description of a case report showing bleeding complication on sinus lifting surgery due to rupture of the intraosseous branches of the superior posterior alveolar artery is reported. The vascular anatomy of the lateral wall of maxillary sinus and the relationship of anatomic structures to this kind of accident is described. The surgeon must be aware of this condition to avoid surgical complications.