The blood supply of the maxillary sinus is important in terms of implant applications and sinus augmentation procedures to be applied in the region
11. In cases of long-term edentulism, both the resorption of the alveolar bone and the downward sagging of the maxillary sinus in the edentulous region will lead to the inability to find the necessary bone for implant application. In this case, maxillary sinus augmentation is applied to obtain vertical bone height
12,13. As a result of a better understanding of biological healing and the development of bone graft materials used for maxillary sinus augmentation, endosseous implant placement in the atrophic posterior maxilla has become a common procedure in modern times
3. In the present study, the presence and location of the PSAA was able to be observed with CBCT scans. The artery was observed in 63% of the sinuses and was mostly intraosseous (65%).
In a study conducted by Tassoker in 2022, the incidence of maxillary PSAA was reported as 86.5% on the right and 84.5% on the left in 200 CBCT scans 14. Aksoy et al. reported PSAA in 366 (61%) of 300 bilateral maxillary sinus CBCT images. In addition, 191 (52.2%) of them were located in the right maxillary sinus, while 175 (47.8%) were in the left maxillary sinüs 11. In a 2011 study by Güncü et al. 3, it was reported that the prevalence of arteries were 64.5% and mostly intraosseous (68.2%). Ilgüy et al. 17 reported the prevalence of PSAA in the maxillary sinus as 89.3%, Tehranchi et al. 15 as 87%, Kim et al. 18 as 52%, and Chitszai et al. 16 as 71%. In 2007 Mardinger et al. 19 found the incidence of maxillary intraosseous ducts to be 55% in 208 maxillary sinus CT images. In the present study, the PSAA prevalence was found to be 63% in 300 bilateral maxillary sinus CBCT scans. Of these, 194 (51.3%) were located in the right maxillary sinus, while 184 (48.7%) were located in the left maxillary sinus. According to the results of the studies in the literature, it can be thought that PSAA is present in all samples and the prevalence differences are possible due to the use of different techniques and devices, the small diameter of the canal and the lack of accurate observation.
Güncü et al. 3 reported the mean PSAA diameter as 1.3 mm, Kim et al. 18 as 1.52 mm, Tehranchi et al. 15 as 1.29 mm, Atul et al. 20 as 0.63 mm, Danesh-Sani et al. 21 as 1.17mm, Zhitian et al. 22 as 0.96 mm, and Chitsazi et al. 16 as 1.37 mm. Aksoy et al. 11 reported that the mean PSAA diameter was between 1-2 mm in their studies. İlgüy et al. reported that the PSAA diameter was less than 1 mm in their study, contrary to the literature. In the present study, the mean diameter of the PSAA canal was found to be 1.42 mm, and the values vary between 0.20 mm and 3.50 mm. These values for the right and left sinuses were 1.42±0.50 and 1.33±0.50 mm, respectively. The present study shows parallelism with the literature. In addition, in the present study, no significant difference was found in terms of arterial diameter and distance to alveolar crest in right-left comparisons.
Tassoker et al. 14 reported the incidence of the artery in the intraosseous position as 50% on the right and 51.5% on the left. İlgüy et al. 17 found that the artery was in the intraosseous position in 71.1%. Güncü et al. 3 also found that the PSAA was localized interosseous in 68.2% in their study, Tehranchi et al. 15 at a rate of 47%, Chitsazi et al. 16 73.2%, Danesh-Sani et al. 21 similarly, found 69.6%. In this study, the frequency of intraosseous localization of the PSAA was found to be 65%. As in the present study, the PSAA is more likely to be seen in the intraosseous location. This is important in terms of complications in surgical procedures to be performed in the region. In addition, when the position of the PSAA on the lateral wall of the maxillary sinus was examined in the study, it was found that there was no statistically significant difference in the PSAA position between women and men.
Oblique distance between the PSAA lower border and crest was found to be 16.88±3.46 mm (16.79±3.79 mm in females, 17.00±2.94 mm in males) by Ilgüy et al. 17, 18±4.90 mm by Guncu et al. 3, 16 ±3.50 mm by Elian et al. 23, 16.70±3.96 mm (15.94±4.06 mm in females and 17.50±3.69 mm in males) by Tehranchi et al. 15, 16.90 mm by Mardinger et al. 19, and 18.90 mm by Kim et al. 18. In the present study, the distance of the artery to the lower border of the alveolar crest was 18.20±4.80 mm, which was 18.10±4.80 mm for the right sinus and 18.20±4.80 mm for the left sinus. In right-left comparisons, no significant difference was found in terms of distance measurements of the artery to the alveolar crest. It can be thought that these differences in distance measurements between studies may be due to anatomical variation in the positions of the arteries.
In conclusion, CBCT scanning is a valuable imaging modality for assessing the presence of arteries in maxillary sinus-related surgeries. According to the results of this study, CBCT cross sectional analysis showed the prevalence of PSAA to be high (63%). The average PSAA diameter was found to be 1.4 mm. Due to the high prevalence, it is of great importance to evaluate intraosseous anastomoses and maxillary sinus morphology with CBCT preoperatively in order to prevent complications during surgical interventions in the maxillary sinus region. Although there are differences in each patient, the findings from this study suggest that the upper border of the lateral window should be limited to 18 mm from the apex of the alveolar crest in surgical procedures to avoid any potential vascular damage.
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