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Uncommon Existence of Dual Posterior Superior Alveolar Artery on the Maxillary Sinus Basement Spotted via CBCT: A Single Case Study Report

Posterior maxilla prone to bone loss, causing challenges in surgical procedures such as sinus augmentation and dental implant placement.

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2 min read
Rare instance of a posterior superior alveolar artery anomaly on the maxillary sinus floor detected...
Rare instance of a posterior superior alveolar artery anomaly on the maxillary sinus floor detected via CBCT imaging: A single case study report

Uncommon Existence of Dual Posterior Superior Alveolar Artery on the Maxillary Sinus Basement Spotted via CBCT: A Single Case Study Report

In a recent case study, a 36-year-old male patient presented for implant treatment in the posterior maxilla with a rare anatomical variation of the PSAA. The artery was observed bilaterally on the floor of the maxillary sinus instead of its typical lateral wall position.

The Posterior Superior Alveolar Artery (PSAA) is a branch of the maxillary artery that usually enters the posterior wall of the maxillary sinus through the pterygomaxillary fissure or a foramen on the posterior maxilla. It typically runs along or near the lateral wall of the maxillary sinus within the bony canal or groove before branching to supply the maxillary sinus mucosa, molar teeth, and surrounding structures.

However, in this case, the PSAA was found in an unusual position, with the artery lying on the floor of the maxillary sinus. The dimensions of the artery on the right side were 2.4 × 2.7 mm, and on the left side, they were 1.8 × 2.2 mm. The distance of the artery from the crest of the ridge was measured at 15 mm on the right side and 17 mm on the left side.

Preoperative Cone Beam Computed Tomography (CBCT) imaging is essential in identifying such uncommon anatomical variations of the PSAA to ensure safe and effective surgical outcomes in the posterior maxilla. In this case, a CBCT scan of the maxilla was performed using NewTom VGi with specific parameters. The patient's CBCT scan report was sent to the periodontics department for consideration before any intervention.

This case highlights the importance of CBCT in identifying such variations for safe and effective surgical outcomes in the posterior maxilla. Variations in the location of the PSAA canal require careful preoperative assessment to avoid damaging the artery during lateral window osteotomies or implant drilling. If the artery is located very close to or crosses the proposed osteotomy site, the surgeon must modify the window design or use atraumatic techniques to preserve vascular integrity.

Injury to the PSAA can result in postoperative complications such as hematoma, swelling, and delayed healing, which affect implant success. Therefore, early identification of such variations can guide surgical planning, prevent complications, and enhance patient safety.

The maxillary sinus receives its primary blood supply from the branches of the maxillary artery, namely the PSAA and the infraorbital artery (IOA). The PSAA is essential for supplying blood to the posterior maxilla. Knowledge of anatomical and structural details and the variations of the maxillary sinuses is essential prior to performing any surgery involving the posterior maxilla.

The posterior maxilla is prone to bone resorption and presents challenges for surgical interventions such as sinus augmentation and dental implant placement. The CBCT scan was used to measure the bone dimensions prior to the placement of dental implants. Careful planning and precise execution of surgical procedures are necessary to ensure successful outcomes in these complex cases.

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