The alveolar antral artery resides lateral to the maxillary sinus and can lead to complications in sinus lift surgery. Traditional approaches that decrease intraoperative bleeding into the surgical field include vessel preservation using multiple bony windows or neutralizing the vessel at the surgical site. Unfortunately, these methods are technique sensitive, time intensive, and may lead to hemosinus and graft loss. The variable distance from the crest of the alveolar ridge and vessel diameter further complicates pre-operative planning. This paper discusses the anatomical features of the alveolar antral artery, techniques for clinical assessment, and current management strategies. We then describe a novel protocol to manage the alveolar antral artery in sinus lift procedures via tamponade of the vessel at a proximal site. This method is faster than those described in the literature, does not require any additional equipment or expertise, and aims to improve long-term graft predictability by decreasing the risk of sinus membrane perforation. The alveolar antral artery is an under-reported source of surgical complications and warrants further research.
References
[1]
Tatum, H. (1986) Maxillary and Sinus Implant Reconstructions. Dental Clinics of North America, 30, 207-229.
[2]
Chipaila, N., Marini, R., Sfasciotti, G.L., Cielo, A., Bonanome, L. and Monaco, A. (2014) Graftless Sinus Augmentation Technique with Contextual Placement of Implants: A Case Report. Journal of Medical Case Reports, 8, 437. https://doi.org/10.1186/1752-1947-8-437
[3]
Bedrossian, E., Rangert, B., Stumpel, L. and Indresano, T. (2006) Immediate Function with the Zygomatic Implant: A Graftless Solution for the Patient with Mild to Advanced Atrophy of the Maxilla. The International Journal of Oral & Maxillofacial Implants, 21, 937-942.
[4]
Varela-Centelles, P., Loira, M., González-Mosquera, A., et al. (2020) Study of Factors Influencing Preoperative Detection of Alveolar Antral Artery by CBCT in Sinus Floor Elevation. Scientific Reports, 10, Article No. 10820. https://doi.org/10.1038/s41598-020-67644-9
[5]
Chiapasco, M., Casentini, P. and Zaniboni, M. (2009) Bone Augmentation Procedures in Implant Dentistry. The International Journal of Oral & Maxillofacial Implants, 24, 237-259.
[6]
Maridati, P., Stoffella, E., Speroni, S., Cicciu, M. and Maiorana, C. (2014) Alveolar Antral Artery Isolation during Sinus Lift Procedure with the Double Window Technique. The Open Dentistry Journal, 8, 95-103. https://doi.org/10.2174/1874210601408010095
[7]
Lee, C.Y.S. (2010) Brisk, Prolonged Pulsatile Hemorrhage during the Sinus Graft Procedure: A Case Report with Discussion on Intra-Operative Hemostatic Management. Implant Dentistry, 19, 189-195. https://doi.org/10.1097/ID.0b013e3181dec0c7
[8]
Elian, N., Wallace, S., Cho, S.-C., Jalbout, Z.N. and Froum, S. (2005) Distribution of the Maxillary Artery as It Relates to Sinus Floor Augmentation. The International Journal of Oral & Maxillofacial Implants, 20, 784-787.
[9]
Rahpeyma, A. and Khajehahmadi, S. (2015) Open Sinus Lift Surgery and the Importance of Preoperative Cone-Beam Computed Tomography Scan: A Review. Journal of International Oral Health, 7, 127-133.
[10]
Balaguer-Martí, J.-C., Peñarrocha-Oltra, D., Balaguer-Martínez, J. and Peñarrocha-Diago, M. (2015) Immediate Bleeding Complications in Dental Implants: A Systematic Review. Medicina Oral, Patologia Oral, Cirugia Bucal, 20, e231-e238. https://doi.org/10.4317/medoral.20203
[11]
Rosano, G., Taschieri, S., Gaudy, J.-F., Weinstein, T. and Del Fabbro, M. (2011) Maxillary Sinus Vascular Anatomy and Its Relation to Sinus Lift Surgery. Clinical Oral Implants Research, 22, 711-715. https://doi.org/10.1111/j.1600-0501.2010.02045.x
[12]
Rysz, M., Ciszek, B., Rogowska, M. and Krajewski, R. (2014) Arteries of the Anterior Wall of the Maxilla in Sinus Lift Surgery. International Journal of Oral and Maxillofacial Surgery, 43, 1127-1130. https://doi.org/10.1016/j.ijom.2014.02.018
[13]
Ella, B., Sédarat, C., Noble, R.D.C., et al. (2008) Vascular Connections of the Lateral Wall of the Sinus: Surgical Effect in Sinus Augmentation. The International Journal of Oral & Maxillofacial Implants, 23, 1047-1052.
[14]
Chan, H.-L. and Wang, H.-L. (2011) Sinus Pathology and Anatomy in Relation to Complications in Lateral Window Sinus Augmentation. Implant Dentistry, 20, 406-412. https://doi.org/10.1097/ID.0b013e3182341f79
[15]
Rahpeyma, A., Khajehahmadi, S. and Amini, P. (2014) Alveolar Antral Artery: Does Its Diameter Correlate with Maxillary Lateral Wall Thickness in Dentate Patients? Iranian Journal of Otorhinolaryngology, 26, 163-167.
[16]
Kim, J.H., Ryu, J.S., Kim, K.-D., Hwang, S.H. and Moon, H.S. (2011) A Radiographic Study of the Posterior Superior Alveolar Artery. Implant Dentistry, 20, 306-310. https://doi.org/10.1097/ID.0b013e31822634bd
[17]
Testori, T., Rosano, G., Taschieri, S. and Del Fabbro, M. (2010) Ligation of an Unusually Large Vessel during Maxillary Sinus Floor Augmentation. A Case Report. European Journal of Oral Implantology, 3, 255-258.
[18]
Jensen, S.S., Eriksen, J. and Schiodt, M. (2012) Severe Bleeding after Sinus Floor Elevation Using the Transcrestal Technique: A Case Report. European Journal of Oral Implantology, 5, 287-291.
[19]
Albuquerque, D., Manhães, J.L., Silva, M., Francischone, C., Franco, A. and Junqueira, J. (2020) Alveolar Antral Artery in Edentulous Patients and Their Visualization through Cone Beam Computed Tomography. Morphologie, 105, 64-68. https://doi.org/10.1016/j.morpho.2020.08.003
[20]
Kolte, R.A., Kolte, A.P., Rahate, P.S. and Bawankar, P.V. (2020) Association of Location and Diameter of Alveolar Antral Artery to Crest of Alveolar Bone in Dentate and Partially Edentulous Patients—A Cone-Beam Computed Tomography Study. Journal of Indian Society of Periodontology, 25, 55-60. https://doi.org/10.4103/jisp.jisp_603_19
[21]
Laovoravit, V., Kretapirom, K. and Pornprasertsuk-Damrongsri, S. (2020) Prevalence and Morphometric Analysis of the Alveolar Antral Artery in a Group of Thai Population by Cone Beam Computed Tomography. Oral Radiology. https://doi.org/10.1007/s11282-020-00478-3
[22]
Solar, P., Geyerhofer, U., Traxler, H., Windisch, A., Ulm, C. and Watzek, G. (1999) Blood Supply to the Maxillary Sinus Relevant to Sinus Floor Elevation Procedures. Clinical Oral Implants Research, 10, 34-44. https://doi.org/10.1034/j.1600-0501.1999.100105.x
[23]
Varela-Centelles, P., Loira-Gago, M., Gonzalez-Mosquera, A., Seoane-Romero, J.-M., Garcia-Martin, J.-M. and Seoane, J. (2016) Distance of the Alveolar Antral Artery from the Alveolar Crest. Related Factors and Surgical Considerations in Sinus Floor Elevation. Medicina Oral, Patologia Oral, Cirugia Bucal, 21, e758-e765. https://doi.org/10.4317/medoral.21475
[24]
Park, W.-H., Choi, S.-Y. and Kim, C.-S. (2012) Study on the Position of the Posterior Superior Alveolar Artery in Relation to the Performance of the Maxillary Sinus Bone Graft Procedure in a Korean Population. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 38, 71. https://doi.org/10.5125/jkaoms.2012.38.2.71
[25]
Varela-Centelles, P., Seoane, J., Loira-Gago, M., González-Mosquera, A. and Seoa-ne-Romero, J.M. (2017) Diameter of Alveolar Antral Artery in the Lateral Sinus Wall: Study of Related Factors. British Journal of Oral and Maxillofacial Surgery, 55, 413-415. https://doi.org/10.1016/j.bjoms.2016.12.001
[26]
Rodella, L.F., Labanca, M., Boninsegna, R., Favero, G., Tschabitscher, M. and Rezzani, R. (2010) Intraosseous Anastomosis in the Maxillary Sinus. Minerva Stomatologica, 59, 349-354.
[27]
Valente, N.A. (2016) Anatomical Considerations on the Alveolar Antral Artery as Related to the Sinus Augmentation Surgical Procedure. Clinical Implant Dentistry and Related Research, 18, 1042-1050. https://doi.org/10.1111/cid.12355
[28]
Kang, S.-J., Shin, S.-I., Herr, Y., Kwon, Y.-H., Kim, G.-T. and Chung, J.-H. (2013) Anatomical Structures in the Maxillary Sinus Related to Lateral Sinus Elevation: A Cone Beam Computed Tomographic Analysis. Clinical Oral Implants Research, 24, 75-81. https://doi.org/10.1111/j.1600-0501.2011.02378.x
[29]
Mardinger, O., Abba, M., Hirshberg, A. and Schwartz-Arad, D. (2007) Prevalence, Diameter and Course of the Maxillary Intraosseous Vascular Canal with Relation to Sinus Augmentation Procedure: A Radiographic Study. International Journal of Oral and Maxillofacial Surgery, 36, 735-738. https://doi.org/10.1016/j.ijom.2007.05.005
[30]
Ilgüy, D., Ilgüy, M., Dolekoglu, S. and Fisekcioglu, E. (2013) Evaluation of the Posterior Superior Alveolar Artery and the Maxillary Sinus with CBCT. Brazilian Oral Research, 27, 431-437. https://doi.org/10.1590/S1806-83242013000500007
[31]
Bernardi, S., Mummolo, S., Ciavarelli, L.M., Li Vigni, M., Continenza, M.A. and Marzo, G. (2016) Cone Beam Computed Tomography Investigation of the Antral Artery Anastomosis in a Population of Central Italy. Folia Morphologica (Warsz), 75, 149-153. https://doi.org/10.5603/FM.a2015.0095
[32]
Kalabalik, F. and Akçay, H. (2019) Evaluation of the Alveolar Antral Artery Position in the Lateral Sinus Wall Using Cone-Beam Computed Tomography. Annals of Clinical and Analytical Medicine, 11, 330-334. https://doi.org/10.4328/ACAM.20084
[33]
Ferneini, E.M. and Bennett, J.D. (2018) Perioperative Assessment of the Maxillofacial Surgery Patient: Problem-Based Patient Management. Springer International Publishing, Berlin. https://www.springer.com/gp/book/9783319588674 https://doi.org/10.1007/978-3-319-58868-1
[34]
Flanagan, D. (2005) Arterial Supply of Maxillary Sinus and Potential for Bleeding Complication during Lateral Approach Sinus Elevation. Implant Dentistry, 14, 336-338. https://doi.org/10.1097/01.id.0000188437.66363.7c
[35]
Onlineredaktion QV-G Berlin, Testori/del Fabbro/Weinstein, et al. (2019) Maxillary Sinus Surgery and Alternatives in Treatment. Quintessence Publishing, Berlin. https://www.quintessenz.de/books.php?idp=14431&qtw_language=en
[36]
Jung, J., Yim, J.-H., Kwon, Y.-D., et al. (2011) A Radiographic Study of the Position and Prevalence of the Maxillary Arterial Endosseous Anastomosis Using Cone Beam Computed Tomography. The International Journal of Oral & Maxillofacial Implants, 26, 1273-1278.
[37]
Valente, N.A., Harogiannis, K. and Andreana, S. (2015) Alveolar Antral Artery Management during Sinus Elevation: A Case Report of a Novel Approach with Review of the Literature. International Journal of Contemporary Dental and Medical Reviews, 2015, Article ID: 100215.
[38]
Rahpeyma, A. and Khajehahmadi, S. (2018) Indications for Palatal Sinus Lift: Case Series. Journal of Indian Society of Periodontology, 22, 254-256. https://doi.org/10.4103/jisp.jisp_357_17
[39]
Maridati, P., Stoffella, E., Speroni, S., Cicciu, M. and Maiorana, C. (2014) Alveolar Antral Artery Isolation during Sinus Lift Procedure with the Double Window Technique. The Open Dentistry Journal, 8, 95-103. https://doi.org/10.2174/1874210601408010095
[40]
Orhan, K., Kusakci, S.B., Aksoy, S., Bayindir, H., Berberoğlu, A. and Seker, E. (2013) Cone Beam CT Evaluation of Maxillary Sinus Septa Prevalence, Height, Location and Morphology in Children and an Adult Population. Medical Principles and Practice, 22, 47-53. https://doi.org/10.1159/000339849
[41]
Neugebauer, J., Ritter, L., Mischkowski, R.A., et al. (2010) Evaluation of Maxillary Sinus Anatomy by Cone-Beam CT Prior to Sinus Floor Elevation. The International Journal of Oral & Maxillofacial Implants, 25, 258-265.
[42]
Lana, J.P., Carneiro, P.M.R., Machado V de, C., de Souza, P.E.A., Manzi, F.R. and Horta, M.C.R. (2012) Anatomic Variations and Lesions of the Maxillary Sinus Detected in Cone Beam Computed Tomography for Dental Implants. Clinical Oral Implants Research, 23, 1398-1403. https://doi.org/10.1111/j.1600-0501.2011.02321.x
[43]
Shahidi, S., Zamiri, B., Momeni, D.S., Salehi, S. and Hamedani, S. (2016) Evaluation of Anatomic Variations in Maxillary Sinus with the Aid of Cone Beam Computed Tomography (CBCT) in a Population in South of Iran. Journal of Dentistry (Shiraz), 17, 7-15.
[44]
Traxler, H., Windisch, A., Geyerhofer, U., Surd, R., Solar, P. and Firbas, W. (1999) Arterial Blood Supply of the Maxillary Sinus. Clinical Anatomy, 12, 417-421. https://doi.org/10.1002/(SICI)1098-2353(1999)12:6<417::AID-CA3>3.0.CO;2-W
[45]
Taschieri, S. and Rosano, G. (2010) Management of the Alveolar Antral Artery during Sinus Floor Augmentation Procedures. Journal of Oral and Maxillofacial Surgery, 68, 230. https://doi.org/10.1016/j.joms.2009.06.036
