• Journal of Dental Anesthesia and Pain Medicine
• /
• v.17 no.4
• /
• pp.317-321
• /
• 2017

The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.35 no.3
• /
• pp.195-199
• /
• 2013

Pseudoaneurysms are rare complications of orgthognathic surgery, trauma or other surgical procedures in the head and neck regions. Surgical approach is a routine procedure of bleeding control. However, bleeding control using angiography and embolization can also be an excellent method. We experienced pseudoaneurysm of the inferior alveolar artery occurring after surgical curettage of cystic lesion. The 33-year-old man who underwent surgical curettage of keratocystic odontogenic tumor was presented with severe bleeding in the right mandible ramal inner surface 14 days after the surgical curettage. After hemostasis with vaseline gauze packing and pressure, bleeding temporarily stopped. However, bleeding started after 14 days and soon it has been continued. Finally, the patient was diagnosed as pseudoaneurysm of the inferior alveolar artery from the enhanced-computed tomography images, and angiographic embolization was performed successfully. We report a rare case of pseudoaneurysm of the inferior alveolar artery after benign tumor curettage and review of the previewer's literature.

• Imaging Science in Dentistry
• /
• v.51 no.1
• /
• pp.35-40
• /
• 2021

Purpose: This study was conducted to evaluate the accuracy of cone-beam computed tomography (CBCT) in detecting the posterior superior alveolar(PSA) artery canal in a sample of the Egyptian population. Materials and Methods: CBCT images of 600 maxillary sinuses of patients were examined for the presence or absence of the PSA artery along the lateral wall of the maxillary sinus, and for the diameter and type of the canal in relation to age and sex. The distances from the canal to the alveolar crest and sinus floor were also measured. Each canal was assessed to determine whether it was bifid. Results: The PSA artery canal could be detected in 92.0% of the sinuses. The mean distance from the inferior border of the PSA artery canal to the sinus floor was 8.2±2.2 mm (range, 3.2-13.6 mm) in males and 7.3±2.1 mm (range, 3.0-13.1 mm) in females. The mean distance from the inferior border of the PSA artery canal to the alveolar crest was 18.2±2.7 mm (range, 11.0-23.9 mm) in males and 17.4±2.3 mm (range, 10.8-23.5 mm) in females. The mean diameter of the PSA artery canal was larger in male subjects. The PSA artery canal was bifid in 8.7% of cases. The most frequently observed location of the PSA artery canal was intraosseous(82.2%). Conclusion: CBCT was confirmed to be a valuable tool for evaluation and localization of the PSA artery before maxillary sinus lift surgery to avoid intraoperative bleeding.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.38 no.2
• /
• pp.71-77
• /
• 2012

Objectives: This study sought to investigate the positioning of the posterior superior alveolar artery in relation to the performance of the maxillary sinus bone graft procedure in a Korean population. Materials and Methods: We identified the position of the posterior superior alveolar artery relative to 93 maxillary sinuses in 58 patients and determined the distance from the inferior border of the artery in the premolar and molar areas to the alveolar ridge and sinus floor. Results: The mean distance from the alveolar ridge to the posterior superior alveolar artery in the dentate group ($20.62{\pm}3.05mm$ in the premolar region, $17.50{\pm}2.84mm$ in the molar region) was greater than as compared to the edentulous group ($18.83{\pm}2.79mm$ in the premolar region, $15.50{\pm}1.64mm$ in the molar region), and this difference was statistically significant (P<0.05). In contrast, there was no statistically significant difference (P>0.05) between the mean distance from the sinus floor to the posterior superior alveolar artery in the dentate group ($8.21{\pm}2.79mm$ in the premolar region, $7.52{\pm}2.07mm$ in the molar region) or in the edentulous group ($7.75{\pm}3.31mm$ in the premolar region, $7.97{\pm}2.31mm$ in the molar region). Conclusion: Prior to surgery, it is important to evaluate the position of the posterior superior maxillary artery by using computed tomography scans. The premolar area is safer than the molar area for performing the maxillary sinus bone graft without bleeding.

• Imaging Science in Dentistry
• /
• v.47 no.1
• /
• pp.39-44
• /
• 2017

Purpose: Insufficient knowledge of the anatomy of the maxillary sinuses prior to sinus graft surgery may lead to perioperative or postoperative complications. This study sought to characterize the position of the posterior superior alveolar artery (PSAA) within the maxillary sinuses using cone-beam computed tomography (CBCT). Materials and Methods: A total of 300 patients with edentulous posterior maxillae, including 138 females and 162 males with an age range of 33-86 years, who presented to a radiology clinic between 2013 and 2015 were enrolled in this retrospective cross-sectional study. The distance from the inferior border of the PSAA to the alveolar crest according to the residual ridge classification by Lekholm and Zarb, the distance from the PSAA to the nasal septum and zygomatic arch, and the diameter and position of the PSAA were all assessed on patients' CBCT scans. The data were analyzed using the Mann-Whitney test and the t-test. Results: The PSAA was detected on the CBCT scans of 87% of the patients; it was located beneath the sinus membrane in 47% of cases and was intraosseous in 47% of cases. The diameter of the artery was between 1 and 2 mm in most patients (72%). The mean diameter of the artery was $1.29{\pm}0.39mm$, and the mean distances from the PSAA to the zygomatic arch, nasal septum, and alveolar crest were $22.59{\pm}4.89mm$, $26.51{\pm}3.52mm$, and $16.7{\pm}3.96mm$, respectively. Conclusion: The likelihood of detecting the PSAA on CBCT scans is high; its location is intraosseous or beneath the sinus membrane in most patients. Determining the exact location of the PSAA on CBCT scans preoperatively can help prevent it from being damaged during surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.34 no.4
• /
• pp.475-479
• /
• 2008

Aim: The aim of this study was to investigate the arterial arcade of maxillary sinus by determining the distance between the alveolar crest and the inferior border of the vessels in Korean population. Materials and methods: 76 patients and 87 available sinuses were determined by CT scan (Implagraphy, Vatech, Seoul, Korea). The distance between alveolar crest and inferior border of the vessel was determined considering the tooth area of posterior maxilla. Results: The lowest distance was observed on first molar area and the average distance is 16.9 mm. Discussions: it is important in sinus lift surgery that the vessels not to be damaged and that the anastomosis is situated in the lateral wall of maxillary sinus, which has to be exposed to gain access to the maxillary sinus. The knowledge of arterial arcade of maxillary sinus is important to perform the sinus floor elevation procedure effectively.

• Archives of Craniofacial Surgery
• /
• v.12 no.2
• /
• pp.86-92
• /
• 2011

Purpose: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. Methods: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. Results: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78 mm and 48 mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. Conclusion: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.39 no.6
• /
• pp.263-268
• /
• 2013

Objectives: The interforminal region, between the mandibular foramen, is known as a relatively safe area that is free of anatomic structures, such as inferior alveolar nerve, submandibular fossa, and lingual side of the mandible is occasionally neglected for its low clinical importance. Even in the case of a severely constricted alveolus, perforation of the lingual cortical bone had been intended. However, anterior extension of the inferior alveolar canal, important anatomic structure, such as concavity of lingual bone, lingual foramina, and lingual canal, has recently been reported through various studies, and untypical bleeding by perforation of the lingual plate on implantation has also been reported. Therefore, in this study, we performed radiographic and statistical analysis on distribution and appearance frequencies of the lingual foramina that causes perforation of the mandibular lingual cortical bone to prevent complications, such as untypical bleeding, during surgical procedure. Materials and Methods: We measured the horizontal length from a midline of the mandible to the lingual foramina, as well as the horizontal length from the alveolar crest to the lingual foramina and from the lingual foramina to the mandibular border by multi-detector computed tomography of 187 patients, who visited Dankook University Dental Hospital for various reasons from January 1, 2008 to August 31, 2012. Results: From a total of 187 human mandibles, 110 (58.8%) mandibles had lingual foramina; 39 (20.9%) had bilateral lingual foramen; 34 (18.2%) had the only left lingual foramen; and 37 (19.8%) had the only right lingual foramen. Conclusion: When there is consistent bleeding during a surgical procedure, clinicians must consider damages on the branches of the sublingual artery, which penetrate the lingual foramina. Also, when there is a lingual foramina larger than 1 mm in diameter on a pre-implantation computed tomography, clinicians must beware of vessel damage. In order to prevent these complications and progress with a safe surgical procedure, a thorough radiographic examination before the surgery is indispensable. Further, clinicians should retract lingual flap definitely to confirm the shape of the lingual bone and existence of the lingual foramina.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
• /
• v.25 no.1
• /
• pp.133-140
• /
• 1995

The arteriovenous malformation, an uncommon lesion, is a direct communication between an artery and a vein that bypasses the intervening capillary bed. The authors experienced two cases of arteriovenous malformation in 17-year-old and 18-year-old female patients who had suffered from mandibular pain and gingival bleeding. As a result of careful analysis of clinical and angiographic radiological examinations, we diagnosed them as arteriovenous malformations, and the results were as follows : 1. Main clinical symptoms were dull pain and gingival bleeding on the mandibular body area, and reddness, pain on palpation, thrill and palpitation in the lesional sites were also observed. 2. Radiographically, well-defined radiolucent lesions with multiple osteolytic defects were observed. In radio-nuclide scan, increased uptakes of radioisotope were observed in the lesional sites. 3. Increased venous shunt supplied by the facial, lingual and inferior alveolar arteries was observed in angiography. After embolotherapy was performed, no recurrence was reported during 3 to 6 months follow up.

• Imaging Science in Dentistry
• /
• v.51 no.3
• /
• pp.313-321
• /
• 2021

Ankylosis of the temporomandibular joint (TMJ) is a disabling disease resulting from fibrous or bony fusion of the mandibular condyle and the glenoid fossa. Early diagnosis and surgical treatment are essential to prevent facial deformity and other complications. Conventional radiography has limitations in demonstrating the true extent of ankylosis. It is important for surgeons to be aware of the size and degree of bony ankylosis in order to perform complete resection of the ankylotic mass. In addition, a detailed evaluation of the relationship with adjacent vital structures such as the internal maxillary artery, inferior alveolar nerve canal, external auditory canal, and skull base are crucial to avoid iatrogenic injury. Multidetector computed tomography (MDCT) is the current imaging modality of choice for preoperative assessments. Herein, the authors propose a structured CT reporting template for TMJ ankylosis to strengthen the value of the preoperative imaging report and to reduce the rates of intraoperative complications and recurrence.