Clinical Anatomy of the Maxilla
https://doi.org/10.18499/2225-7357-2024-13-4-82-89
Abstract
The upper jaw is the most important structure of the middle third of the face. It is of great functional and aesthetic importance, and is also a clinically critical area in which a variety of surgical interventions are performed, such as the installation of dental implants, cyst removal, and endodontic dental treatment. To avoid iatrogenic complications of these manipulations (bleeding and/or neurological disorders), detailed knowledge of maxillary anatomy is required. This review, based on modern literature data and our own observations, outlines the clinical anatomy of the upper jaw with a description of the features of its morphology, identified using cone beam computed tomography, a modern technology for visualizing the bone structures of the maxillofacial region used in clinical practice. A description of a number of structures, such as the accessory infraorbital foramina, canalis sinuosus, alveolo-antral artery, nasopalatine (incisive) canal and maxillary sinus septa, is absent in human anatomy textbooks for students and is not detailed in Russian-language medical journals. The article presents radiographic images of these structures, their linear dimensions, frequency of occurrence in the population, and provides classifications of individual variants of intraosseous canals. The practical significance of each of these anatomical variations is discussed. All images used in the article are original and have not been published previously.
About the Authors
S. L. Kabak
Belarusian State Medical University
Belarus
Belarus
Sergei L. Kabak – Doct. Sci. (Med.), Professor, Head of Human Morphology Department
pr-t. Dzerzhinskogo, 3, Minsk, 220116
Yu. M. Mel'nichenko
Belarusian State Medical University
Belarus
Belarus
Yuliya M. Mel'nichenko – Cand. Sci. (Med.), Associate Professor of Human Morphology Department
Minsk
A. V. Pil'chuk
Medical Center “Novy Lekar”
Belarus
Belarus
Anna V. Pil'chuk – radiologist
Minsk
References
1. Avanesov A.M., Sergeev N.I., Nudnov N.V., Sedov Yu.G. Analiz osvedomlennosti vrachejstomatologov, zanimajushhihsja dental'noj implantaciej, v otnoshenii anatomicheskih struktur verhnej i nizhnej cheljustej [Analysis of dentists’ awareness practicing dental implantation in relation anatomical structures of upper and lower jaws]. Medical alphabet. 2019;2(11):36-39. (in Russ.).
2. Melnichenko Y.M., Kabak S.L., Mekhtiev R.S., Sinovskaja A.V. Osvedomlennost' stomatologov otnositel'no anatomicheskih faktorov dental'noj implantacii v bokovyh otdelah verhnej cheljusti [Awareness among dentists regarding anatomical risk factors in dental implantation in the posterior maxilla]. Meditsinskie novosti. 2023;3:35-37. (in Russ.).
3. Melnichenko Y.M., Kabak S.L., Savrasova N.A., Zhuravleva N.V. Diagnosticheskie kriterii gipoplazii verhnecheljustnoj pazuhi po dannym konusno-luchevoj komp'juternoj tomografii [Diagnostic criteria of maxillary sinus hypoplasia using cone-beam computed tomography]. Vestnik Oto-Rino-Laringologii. 2023;88(1):44-49. (in Russ.).
4. Mekhtiev R.S., Melnichenko Y.M., Kabak S.L., Savrasova N.A., Zatochnaya V.V. Vzaimootnoshenija kornej moljarov s nizhnej stenkoj verhnecheljustnoj pazuhi [Relationships between the inferior wall of maxillary sinus and the roots of the maxillary molars]. Stomatologiya. 2023;102(1):52-59. (in Russ.).
5. Mekhtiev R.S., Melnichenko Y.M., Kabak S.L., Savrasova N.A. Topografija sosudistogo anastomoza v stenke verhnecheljustnoj pazuhi po dannym konusno-luchevoj komp'juternoj tomografii [Topographic assessment of the vascular anastomosis in the maxillary sinus wall using cone-beam computed tomography]. Stomatologiya. 2022;101(1):60-65. (in Russ.). DOI: 10.17116/stomat202210101160.
6. Mekhtiev R.S. Topografija sept v oblasti dna verhnecheljustnoj pazuhi [Topography of septa of the maxillary sinus floor]. Medical Journal. 2023;4:86–92. (in Russ.).
7. Savrasova N.A., Melnichenko Y.M., Kabak S.L, Perminov AB. Pnevmocele verhnecheljustnoj pazuhi [Maxillary Sinus Pneumocele]. Journal of radiology and nuclear medicine. 2022;103(1-3):55-61. (in Russ.).
8. Sedov Y.G., Avanesov A.M., Chibisova M.A., Mordanov O.S. Analiz vstrechaemosti i topograficheskih dannyh al'veoloantral'noj arterii na osnove obzora literatury [The alveolar antral artery prevalence and topography according to literature review]. Stomatologiya. 2020;99(4):76-80. (in Russ.).
9. Sedov Yu.G., Avanesov A.M., Chibisova M.A., Khaydar D.A., Mustafaeva R.S., Zurnacheva D.D. et al. Analiz al'veolo-antral'noj arterii na osnove konusno-luchevoj komp'juternoj tomografii u pacientov s tjazheloj atrofiej al'veoljarnogo grebnja v bokovom otdele verhnej cheljusti [Alveolar antral artery analysis with cone beam computed tomography in patients with severe alveolar ridge atrophy in the posterior maxilla]. The Dental Institute. 2019;1(82):36-39. (in Russ).
10. Aggarwal A, Kaur H, GuptaT, Tubbs RS, Sahni D, Batra YK et al. Anatomical study of the infraorbital foramen: a basis for successful infraorbital nerve block. Clinical Anatomy. 2015;28:753-760.
11. Acar G, Ozen KE, Guler I, Buyukmumcu M. Computed tomography evaluation of the morphometry and variations of the infraorbital canal relating to endoscopic surgery. Brazilian Journal of Otorhinolaryngology. 2018;84(6):713-721.
12. An D, K C K, Vorakulpipat C, Ngamsom S, Kumchai T, Ruangsitt S et al. Accessory infraorbital foramen location using cone-beam computed tomography. Journal of Dental Anesthesia and Pain Medicine. 2023;23(5):257- 264. DOI: 10.17245/jdapm.2023.23.5.257.
13. Aoki R, Massuda M, Zenni LTV, Fernandes KS. Canalis sinuosus: anatomical variation or structure? Surgical and Radiologic Anatomy. 2020;42(1):69-74. DOI: 10.1007/s00276-019-02352-2.
14. Apostolakis D, Bissoon AK. Radiographic evaluation of the superior alveolar canal: measurements of its diameter and of its position in relation to the maxillary sinus floor: a cone beam computerized tomography study. Clinical Oral Implants Research. 2014;25:553-559. DOI: 10.1111/clr.12119.
15. Arruda JA, Silva P, Silva L, Álvares P, Silva L, Zavanelli R et al. Dental Implant in the Canalis Sinuosus: A Case Report and Review of the Literature. Case Rep Dent. 2017;2017:4810123. DOI: 10.1155/2017/4810123.
16. Baena-Caldas GP, Rengifo-Miranda HL, HerreraRubio AM, Peckham X, Zúñiga JR. Frequency of Canalis Sinuosus and its Anatomic Variations in Cone Beam Computed Tomography Images. International Journal of Morphology. 2019;37(3):93-97.
17. Bedelog˘lu E, Yalçın M. Evaluation of the Posterior Superior Alveolar Artery Prior to Sinus Floor Elevation via Lateral Window Technique: A Cone-Beam Computed Tomography Study. Journal of Advanced Oral Research. 2020;11(2): 215-223. DOI: 10.1177/2320206820940463.
18. Beyzade Z, Yılmaz HG, Ünsal G, Çaygür-Yoran A. Prevalence, Radiographic Features and Clinical Relevancy of Accessory Canals of the Canalis Sinuosus in Cypriot Population: A Retrospective Cone-Beam Computed Tomography (CBCT) Study. Medicina (Kaunas). 2022;58(7):930. DOI: 10.3390/medicina58070930.
19. Bischof FM, Bornstein MM, Suter VGA, Lello RIE, von Arx T. Proximity of Vascular Bone Channel in the Lateral Sinus Wall to Root Apices of Maxillary First Molars: A Cone-beam Computed Tomographic Analysis. Journal of Endodontics. 2019; 45(12):1472-1478. D: 10.1016/j.joen.2019.09.004.
20. Cavallaro J, Tsuji S, Chiu TS, Greenstein G. Management of the Nasopalatine Canal and Foramen Associated With Dental Implant Therapy. Compend Contin Educ Dent. 2016 Jun;38(6):367-372; quiz 374.
21. Danesh-Sani SA, Movahed A, ElChaar ES, Chong Chan K, Amintavakoli N. Radiographic evaluation of maxillary sinus lateral wall and posterior superior alveolar artery anatomy: a cone-beam computed tomographic study. Clin Implant Dent Relat Res. 2017;19:151-160.
22. de Azevedo RA, Correa MB, Torriani MA, Lund RG. Optimizing quality of dental carving by preclinical dental students through anatomy theory reinforcement. Anat Sci Educ. 2018 Jul;11(4):377-384. DOI: 10.1002/ase.1752.
23. Ella B, Sédarat C, Noble Rda C, Normand E, Lauverjat Y, Siberchicot F et al. Vascular connections of the lateral wall of the sinus: surgical effect in sinus augmentation. The International Journal of Oral & Maxillofacial Implants. 2008;23(6):1047-52.
24. Ferlin R, Pagin BSC, Yaedú RYF. Canalis sinuosus: a systematic review of the literature. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2019;127(6):545-551. DOI: 10.1016/j.oooo.2018.12.017.
25. Fitzpatrick TH, Brizuela M, Downs BW. Anatomy, Head and Neck, Nasopalatine Nerve. 2024 Jun 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
26. Gupta T. Localization of important facial foramina encountered in maxillo-facial surgery. Clinical Anatomy. 2008;21(7):633-40. DOI: 10.1002/ca.20688.
27. Irinakis T, Dabuleanu V, Aldahlawi S. Complications during Maxillary Sinus Augmentation Associated with Interfering Septa: A New Classification of Septa. The Open Dentistry Journal. 2017;11:140-150. DOI: 10.2174/1874210601711010140.
28. Iizuka N, Kawashima Y, Tokunaga S, Ito K, Hara Y, Hirahara N. et al. Forms of Maxillary Sinus with Septa can Cause by Mucosal Thickening of Maxillary Sinus: Computed Tomographic Study. International Journal of Oral-Medical Sciences. 2019;18(1):57-61.
29. Iwanaga J, Kikuta S, Kusukawa J, Tomaszewski KA, Walocha JA, Tubbs RS. Anatomic study of accessory infraorbital nerves and foramina: application for a better understanding of complications of le fort fractures and osteotomy. Journal of Oral and Maxillofacial Surgery. 2020;78(5):717-723.
30. Jones FW. The anterior superior alveolar nerve and vessels. Journal of Anatomy. 1939;73:583-591.
31. Kedar E, Koren I, Medlej B, Hershkovitz I. The Associations between the Maxillary Sinus Volume, Infraorbital Ethmoid Cells, and the Infraorbital Canal: A CT-Based Study. Diagnostics (Basel). 2023;13(23):3593. DOI: 10.3390/diagnostics13233593.
32. Lantos JE, Pearlman AN, Gupta A, Chazen JL, Zimmerman RD, Shatzkes DR et al. Protrusion of the Infraorbital Nerve into the Maxillary Sinus on CT: Prevalence, Proposed Grading Method, and Suggested Clinical Implications. American Journal of Neuroradiology. 2016;37(2):349-53. DOI: 10.3174/ajnr.A4588.
33. Laovoravit V, Kretapirom K, PornprasertsukDamrongsri S. Prevalence and morphometric analysis of the alveolar antral artery in a group of Thai population by cone beam computed tomography. Oral Radiology. 2020. DOI: 10.1007/s11282-020-00478-3.
34. Lee T, Lee H, Baek S. A three-dimensional computed tomographic measurement of the location of infraorbital foramen in East Asians. Journal of Craniofacial Surgery. 2012;23(4):1169-1173. DOI: 10.1097/SCS.0b013e31824f658a.
35. Lopes Dos Santos G, Ikuta CRS, Salzedas LMP, Miyahara GI, Tjioe KC. Canalis sinuosus: An Anatomic Repair that May Prevent Success of Dental Implants in Anterior Maxilla. Journal of Prosthodontics. 2020;29(9):751-755. DOI: 10.1111/jopr.13256.
36. Mandalaywala D, Pillai JP, Monpara P, Gadhavi T. Perception of dental anatomy among dental students, dental practitioners, and dental academicians: A questionnaire-based crosssectional study. Journal of Academy of Dental Education. 2022;8:9-14. DOI:10.25259/JADE_2_2022.
37. Meghji S, Qureshi W, Henderson B, Harris M. The role of endotoxin and cytokines in the pathogenesis of odontogenic cysts. Archives of Oral Biology. 1996;41:523-531. DOI: 10.1016/0003-9969(96)00032-5.
38. Orhan K, Gorurgoz C, Akyol M, Ozarslanturk S, Avsever H. An anatomical variant: evaluation of accessory canals of the canalis sinuosus using cone beam computed tomography. Folia Morphologica (Warsz). 2018;77(3):551-557. DOI: 10.5603/FM.a2018.0003.
39. Polo CL, Abdelkarim AZ, von Arx T, Lozanoff S. The Morphology of the Infraorbital Nerve and Foramen in the Presence of an Accessory Infraorbital Foramen. Journal of Craniofacial Surgery. 2019;30(1):244-253. DOI: 10.1097/SCS.0000000000004889.
40. Radmand F, Razi T, Baseri M, Gavgani LF, Salehnia F, Faramarzi M. Anatomic evaluation of the posterior superior alveolar artery using conebeam computed tomography: A systematic review and meta-analysis. Imaging Science in Dentistry. 2023;53(3):177-191. DOI: 10.5624/isd.20230009.
41. Shah PN, Arora AV, Kapoor SV. Accessory branch of canalis sinuosus mimicking external root resorption: A diagnostic dilemma. J Conserv Dent. 2017 Nov-Dec;20(6):479-481. doi: 10.4103/JCD.JCD_375_16.
42. Shin KJ, Lee SH, Park MG, Shin HJ, Lee AG. Location of the accessory infraorbital foramen with reference to external landmarks and its clinical implications. Scientific Reports. 2020;10(1):8566. DOI: 10.1038/s41598-020-65330-4.
43. Shintaku WH, Ferreira CF, Venturin JS. Invasion of the canalis sinuosus by dental implants: A report of 3 cases. Imaging Sci Dent. 2020;50(4):353-357. DOI: 10.5624/isd.2020.50.4.353.
44. Sirikci A, Bayazit Y, Gümüsburun E, Bayram M, Kanlikama M. A new approach to the classification of maxillary sinus hypoplasia with relevant clinical implications. Surgical and Radiologic Anatomy. 2000;22(5):243-247. DOI: 10.1007/s00276-000-02438.
45. Soriano RM, Das JM. Anatomy, Head and Neck, Maxilla. 2022 Sep 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
46. Suter VG, Jacobs R, Brücker MR, Furher A, Frank J, von Arx T. et al. Evaluation of a possible association between a history of dentoalveolar injury and the shape and size of the nasopalatine canal. Clinical oral investigations. 2016;20:553- 561. DOI: 10.1007/s00784-015-1548-7.
47. Tanaka R, Hayashi T, Ohshima H, Ida-Yonemochi H, Kenmotsu SI, Ike M. CT anatomy of the anterior superior alveolar nerve canal: a macroscopic and microscopic study. Oral Radiology. 2011;27:93–97. DOI: 10.1007/s11282-011-0067-8.
48. Varela-Centelles P, Loira M, González-Mosquera A, Romero-Mendez A, Seoane J, García-Pola MJ et al. Study of factors influencing preoperative detection of alveolar antral artery by CBCT in sinus floor elevation. Sci Rep. 2020;10(1):10820. DOI: 10.1038/s41598-020-67644-9.
49. von Arx T, Lozanoff S. Clinical Oral Anatomy: A Comprehensive Review for Dental Practitioners and Researchers. Springer, 2017. 587 p.
50. von Arx T, Lozanoff S, Sendi P, Bornstein MM. Assessment of bone channels other than the nasopalatine canal in the anterior maxilla using limited cone beam computed tomography. Surgical and Radiologic Anatomy. 2013;35:783-790. DOI: 10.1007/s00276-013-1110-8.
Review
For citations:
Kabak S.L., Mel'nichenko Yu.M., Pil'chuk A.V. Clinical Anatomy of the Maxilla. Journal of Anatomy and Histopathology. 2024;13(4):82-89. (In Russ.) https://doi.org/10.18499/2225-7357-2024-13-4-82-89
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