Download evaluation of the posterior superior alveolar artery and the maxillary

SYNOPSIS
EVALUATION OF THE POSTERIOR SUPERIOR ALVEOLAR
ARTERY AND THE MAXILLARY SINUS :- A CONE BEAM
COMPUTED TOMOGRAPHIC STUDY
DR.MITTA.SAI GOWTHAMI
POST GRADUATE STUDENT
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
A E C S MAARUTI COLLEGE OF DENTAL
SCIENCES AND RESEARCH CENTRE, BANGALORE.
2013 – 2016
Rajiv Gandhi University of Health Sciences, Karnataka
Bangalore
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ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Dr. MITTA.SAI GOWTHAMI
1.
I yr POST GRADUATE STUDENT
Name of the Candidates and
DEPARTMENT OF ORAL MEDICINE AND
Address
RADIOLOGY
A E C S MAARUTI COLLEGE OF DENTAL
SCIENCES AND RESEARCH CENTRE,
BANGALORE
A E C S MAARUTI COLLEGE OF DENTAL
2.
Name of the institution
SCIENCES AND RESEARCH CENTRE,
BANGALORE
MASTER OF DENTAL SURGERY
3.
Course of study and subject
ORAL MEDICINE AND RADIOLOGY
31-08-2013
4.
Date of admission to course
5.
Title of the topic : EVALUATION OF THE POSTERIOR SUPERIOR ALVEOLAR
ARTERY
AND
MAXILLARY
SINUS-:
TOMOGRAPHIC STUDY
2
A
CONE
BEAM
COMPUTED
6.
BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
The posterior superior alveolar artery and the infraorbital artery are the branches of the
maxillary artery that supply the maxillary sinus and schneiderian membrane .Therefore the
maxillary blood supply forming a complex network of the maxillary bone and the branches
of the maxillary artery should be given special consideration during surgical procedures
owing to damage of the vascular supply.
A thorough knowledge of the anatomy of the maxillary sinus is essential to avoid
unnecessary complications due to the close relationship of the posterior superior alveolar
artery with the maxillary sinus.
The purpose of the study was to evaluate the location of the posterior superior alveolar
artery and its relationship to the maxillary sinus before implant surgery and augmentation
procedures using CBCT so as to prevent the potential risk of bleeding during the procedure
which may cause damage to vascular supply of the lateral wall.
CBCT system is a useful modality as they have an ability to reconstruct full
dimensional models for accurate visualisation
three
of the branches of posterior superior -
alveolar artery and thereby reduce the risk during surgery. Thus CBCT can be used for
preoperative assessment of alveolar ridge and maxillary sinus in patients receiving implants
in the posterior maxilla.
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6.2 REVIEW OF LITERATURE:
1.The following study was conducted on a group of individuals (135 mandibular third
molars), to determine the distance between the lower border of the artery ,bone height from
the sinus floor to the crest of the ridge, diameter and location of the artery. The author found
that increased age was negatively associated with the distance between the artery and the
medial sinus wall. The PSAA was observed in 89.3% of sinuses and 71.1% of arteries were
introsseous with diameters mostly ≤ 1mm (68.9%). The prevalence of sinus membrane
thickening was 57.4%.The distance from the medial sinus wall in males was significantly
higher than in females(<0.05). CBCT seems to be helpful in assessing various positions of
the posterior superior alveolar artery and the maxillary sinus morphology, which may be
used as an adjunct to the surgical treatment plan to yield more successful dental implant
treatments.1
2.The following cadaveric study was conducted on 19 human of Japanese origin. In the
greatest number of cadavers, the posterior superior alveolar artery ran mainly to the lateral
surface of the zone between superior border of the alveolar foramen and the inferior border
of the maxillary sinus(53%).In others, the PSSA ran to the zone between the infraorbital
foramen and the superior border of alveolar foramen (17.6%);in a third group ,the PSSA ran
into the zone between inferior border of the maxillary sinus and greater palatine
foramen(23.5%).The lest of two sides are spread out in this area.(5.9%).CBCT is the most
accurate tool inorder to evaluate anatomical parameters, such as the distance of the blood
supply ,for the implant of grafts in the floor of the maxillary sinus during
surgical
procedures .2
3. In this study 50 CBCT scans undergoing sinus graft surgery were chosen randomly for
evaluation. The scans were subjected to computerized analysis for shape of intrabony
indentation formed by maxillary branch. The average distance from the alveolar crest to
lower border of the artery was 15.9mm.There was no significant difference of that average
distance according to sex and age. The intrabony indentation of the maxillary artery could
not be found in CBCT scans in 17.3% of cases. The average distance from the alveolar crest
to the lower border of the artery was 15.9mm and there was no significant difference of that
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average distance according to sex, age and side. The artery was closer to the crest on first
molar area and the average distance was 13.5mm.3
4.This study was done to examine the prevalence, diameter and location of the PSSA and its
relationship to the alveolar ridge and also to study the prevalence of sinus pathology and
septum using computerized tomography scans. The author found that the septa and sinus
pathology was found to be 16.1% and 24.8% respectively. Mean diameter was found to be
0.9 to 1.8mm.No significant correlation of diameter the artery and between the age was
observed. The author suggested that CBCT is a valuable tool in evaluating presence of
sinus pathology ,septa, and arteries before maxillary sinus surgery.4
5. Cadavers were obtained through consensual donation for the study. Maxillae were
examined in 19 human cadavers aged 59 to 94 years. Bony structures within the maxillary
vascular network of the lateral wall of the maxillary sinus and the distribution of CGRPpositive fibres using immunohistochemistry and CBCT analysis were done. The posterior
superior alveolar artery was identified parallel to the posterior superior alveolar nerve and
it branched several times around the lateral wall of the maxillary sinus. The CGRP-positive
nerves were clearly visible around posterior superior alveolar artery in the floor region of
the maxillary sinus. Based on the CBCT analysis the bony canal structure of the inner
surface of the maxilla was classified into three types :- canal like, ditch shaped tunnel and
fragmented. In the present study, numerous nerve branches with CGRP-positive fibres were
identified along the vessels in the human maxillary sinus that were examined. In conclusion,
identification of the arterial supply and of the intervention of the maxillary sinus area is
essential prior to dental surgical treatment and CBCT imaging is required to observe the
intraosseous vessels in this region.5
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6.3 OBJECTIVES OF THE STUDY:
Aim of this study is to determine the prevalence, diameter and location of the posterior
superior alveolar artery and its relationship to the crest of the alveolar ridge and also to
assess the thickness of the lining of the maxillary sinus and the presence of cysts and
polyps in the sinus.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
Patients (both in and out-patients) consulting the Department of Oral Medicine &
Radiology, AECS Maaruti College of Dental Sciences and Research Centre,
Bangalore.
TYPE OF STUDY
In vivo, observational study
7.2 METHOD OF COLLECTION OF DATA
Sampling technique used-Simple random sampling technique
Sample size-A total number of 50 patients will be included in the study
Sample selection- The study excludes subjects under the following criteria-:
a)positive history of trauma
b)presence of arteriovenous malformations in the region of the
malar bone
c)any surgical intervention in the maxillary area
d)patients with obvious facial deformities
e)presence of swellings or malignancies
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METHODOLOGY: An informed consent will be obtained from each patient prior
to imaging.Measurements are done by determination of orientation of the images for
each patient.
Evaluation based bilateral scans are to be carried out in order to see and compare
both the sides of the maxillary sinus.
a)the distance between lower border of the posterior superior alveolar artery and the
alveolar crest
b)distance from the posterior superior alveolar artery to the medial sinus wall
c)diameter and location of the artery are to be determined
d)thickening of the sinus membrane
e)presence of cysts and polyps
f)presence maxillary pathology and sinus septa
LOCATIONS OF THE ARTERY
1)position of the artery (Intraosseous) below the membrane
2)outer cortex of the lateral wall of the maxillary sinus
3) lower border to the alveolar crest : the vertical line from the artery to the crest.
Maxillary pathology and presence of sinus septa should be recorded for each sinus
and analysis of the diameter of the canal with regard to age,gender and location(left
and right).
STATISTICAL ANALYSIS OF DATA-:
Evaluation of the data using descriptive statistical methods will be done. Parameters
with normal distribution for the comparison of quantitative data are evaluated using
the following tests
1)one-way analysis of variance
2)Turkey test
3)student’s t-test
Evaluation of quantitative data is to be done using Chi-square test.
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7.3 Does the study require any investigation or interventions to be conducted on patients
or other human or animals?
Yes, CBCT will be taken.
7.4 Has the ethical clearance obtained from your institution in case of 7.3?
Yes
8. LIST OF REFERENCE ARTICLES:
1)Iiguy D,Iiguy M,Dolekoglu S,Fisekcioglu E,Evaluation of posterior superior alveolar artery and the
maxillary sinus with CBCT.Braz Oral Res.,(Sao Paulo) 2013 Sept-Oct;27(5):431-7
2)YOSHIDA S et al,Okajimas Folia Anat.Jpn,Evaluation of the blood and nerve supply patterns in
the molar region of the maxillary sinus in Japanese cadavers.2010 Nov; 87(3):129-133
3)Lee J,Kim H,Park I,Lee S,Distribution of the maxillary artery related to sinus graft surgery for
implantation,Living Well Dental Hospital,Living Well Institute Of Dental Research,(p)42-48
4) Guncu GN,Yildirim YD,Wang HL,Tozum TF. Location of posterior superior alveolar artery and
evaluation of maxillary sinus anatomy with computerized tomography:a clinical study.Clin.Oral
Impl.Res,2011 Aug ;22:1164-1167.doi:IO.IIII/j.I600-050I.2010.0207I.X.
5) SATO I et al,Observing the bony canal structure of the human maxillary sinus in Japanese
cadavers using cone beam CT,Okajimas Folia Anat.Jpn.2010 Nov; 87(3):123-138
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9.SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
Dr. BHARATHI.T.H.
M.D.S
READER
DEPARTMENT OF ORAL MEDICINE
AND RADIOLOGY,
A.E.C.S. MAARUTI COLLEGE OF
DENTAL SCIENCES & RESEARCH
CENTRE, BANGALORE
11.1 GUIDE:
11.2 SIGNATURE
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DR. SATHEESHA REDDY.B H
M.D.S
PROFESSOR AND H.O.D,
DEPARTMENT OF ORAL MEDICINE
AND RADIOLOGY,
A.E.C.S. MAARUTI COLLEGE OF
DENTAL SCIENCES & RESEARCH
CENTRE, BANGALORE
11.3 CO-GUIDE IF ANY:
11.4 SIGNATURE:
DR. SATHEESHA REDDY.B H
M.D.S
PROFESSOR AND H.O.D,
DEPARTMENT OF ORAL MEDICINE
AND RADIOLOGY,
A.E.C.S. MAARUTI COLLEGE OF
DENTAL SCIENCES & RESEARCH
CENTRE, BANGALORE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
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12. REMARKS OF THE CHAIRMAN
AND PRINCIPAL
12.1 SIGNATURE OF THE CHAIRMAN
AND PRINCIPAL
,-
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CONSENT FORM
I,
aged _______ years on my own volition hereby give my
consent to be a part of the descriptive study conducted by Dr.Mitta. Sai Gowthami, Post
Graduate student, Department of Oral Medicine and Radiology, A.E.C.S. MAARUTI
COLLEGE OF DENTAL SCIENCES & RESEARCH CENTRE, BANGALORE.
I have been explained in the language known to me about the clinical procedure and I
understand that the study includes clinical examination of the oral and maxillofacial region.
I have given my consent to use this information and assessment for the purpose (research,
publication or oral presentation) as deemed fit.
Date:
Place:
Patient’s Signature
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