[Detection and management of the vascular paths in the lateral sinus wall using cone beam computed tomography].

OBJECTIVE: To detect the vascular paths in the lateral wall of maxillary sinus using cone beam computer tomography (CBCT), and to retrospect the surgical managements of avoiding bleeding complication during the lateral approach maxillary sinus elevation.

METHODS: The documents of 71 consecutive patients with 81 sides maxillary sinus elevation surgery were collected. The vascular paths in the lateral wall of maxillary sinus were detected by the preoperative CBCT, and the messages about the vascular in surgical records were analyzed.

RESULTS: The paths of the vascular could be detected in 77 (95.1%) sides maxillary sinus in the reconstruction panoramic images of CBCT. At the position of the first molar, the paths of the vascular of the lateral maxillary sinus walls could be detected in 54 sides (66.7%) in the reconstruction coronal images of CBCT, and the other 27 sides (33.3%) could not be detected. Two approximately parallel paths of the vascular were found in 3 sides (3.7%) of the lateral maxillary sinus walls. The different diagnoses occurred in 6 sinuses between two observers. The kappa of diagnostic consistency of the two observers was 0.842 (P<0.001). The mean distance between the lower border of the vascular path to the plane of the alveolar crest of 54 sides maxillary sinuses was about (13.0±4.7) mm. The mean distance between lower border of vascular path to the plane of the floor of the sinus was (9.3±4.8) mm. The vascular path was located in the floor wall in 1 sinus. During the lateral approach maxillary sinus elevation operation, intraosseous vessels were dissected in 4 sides sinus lateral wall, the vascular path was avoided consciously in 3 sides, and the sinus elevation surgery had to be given up in 1 side for the vessel was torn and bleeding. There were no vascular related messages in 73 sides of the lateral approach maxillary sinus elevation operation records.

CONCLUSION: The vascular paths of maxillary sinus wall could be detected by CBCT in most cases. Preoperative CBCT examination was proved to be reliable. The vascular paths of maxillary sinus wall should be examined carefully. It was helpful to make the surgical design perfectible and reduce the risk of tearing the vessel in operation.