Anatomical Variations of PSAA Related to Sinus Augmentation: CBCT Analysis

Objectives: Accidental severing of maxillary sinus vasculature, particularly the posterior superior alveolar artery (PSAA), is a common intraoperative complication during lateral sinus augmentation. The hemorrhage may impair surgical field visualization, potentially leading to Schneiderian membrane perforation, the most common surgical complication of the procedure. The aims of this retrospective study were: (1) to assess the prevalence, diameter, and location of the PSAA related to lateral sinus augmentation and (2) to investigate possible associations between anatomical variations of the PSAA and membrane perforations.
Methods: Patients who received lateral sinus augmentation at Tufts University School of Dental Medicine from July 1, 2006 to June 30, 2017 with pre-operative cone-beam computed tomography (CBCT) images were included in this study. The CBCT images were analyzed to evaluate possible associations between prevalence of the PSAA, diameter of the PSAA, location of the PSAA, distance of the PSAA from the alveolar crest, distance of the PSAA from the sinus floor, residual bone height, and Schneiderian membrane perforation. Statistical analysis was performed using the independent samples t-test and Wilcoxon rank sum test at P <0.05 level.
Results: A total of 204 patients were included in the study. 64 patients (31.37%) had membrane perforation. The PSAA was prevalent in 62.75% of the sinuses on CBCT images and the most frequent location of PSAA was intraosseous (57.0%). Variations in anatomical factors of the PSAA and residual bone height were compared between perforation and non-perforation groups (Table 1). There were no statistically significant differences in prevalence of PSAA, diameter of PSAA, distance of PSAA from the alveolar crest, distance of PSAA from the sinus floor, and residual bone height between the perforation and non-perforation groups.
Conclusions: Within the limitations of this study, there were no associations between certain anatomical variations of the PSAA and membrane perforation during lateral sinus augmentation.