Maxillary Sinus Arterial Supply

Dan Holtzclaw, DDS, MS, DABP, DICOI

When performing maxillary open sinus lifts, the arterial supply of the maxillary sinus must be considered.  Depending on the location of your window preparation, you may occasionally encounter extraosseous or intraosseous arterial branches.  How do you deal with them?  

First, one needs to know where the basics of maxillary sinus arterial supply.  The diagram below gives a nice representation:

 

(Solar 1999)


Second, one needs to have a rough idea of how often they can expect to encounter the arterial supply of the maxillary sinus.

On average, the intraosseous loop is present 100% of the time, while the extraosseous loop is present only 44% of the time.1,2

Intraosseous Arterial Branch

Third, one needs to know where they can expect to encounter these arterial branches when creating windows into the maxillary sinus.

On average, the intraosseous arterial branch is located anywhere from 16.4 to 18.9mm from the alveolar crest. Therefore, if the apical border of your window preparation approaches these measurements from the crest, you can expect to encounter an artery.1,2

Intraosseous Arterial Branch

So, if you do encounter the intraosseous arterial supply in the lateral maxillary sinus wall, what do you do?  Well, it depends on how you are preparing your window.  If you are using rotary instruments, there is a pretty good chance that you are going to cut this vessel should you encounter it.  This has happened to me on a number of occasions.  I can tell you that when this happens, the strong arterial pulses will literally shoot blood 2 feet across the surgical field.  In most cases, because of the small diameter of this artery, complete transection will cause the artery to retract and self-close.  If this does not work, you can dissect the artery and apply pressure, cauterize, or tie it off.  In my cases, I always continued my window preparation and the artery always closed itself with retraction.

Conventional Open Sinus Window Prepartion

Nowadays, I use piezoelectric surgical units when performing open sinus lifts.  I find this much faster, easier, and safer that rotary preparation.  Because the piezosurgical units selectively cut hard tissue while sparing soft tissue, it is possible to remove the lateral maxillary sinus wall without damaging the intraosseous arterial supply.  While this reduces the risk of cutting the arterial branch, it does add a little complication to elevating the Schneiderian membrane.  Now, not only do you have to worry about lifting the membrane without perforation, you now have to deal with elevating the arterial supply as well.  This is usually not a problem, but it can add a few minutes onto your procedure time.

      

Before and after shots of Scneiderian membrane + maxillary sinus arterial supply elevation

Conclusion

Managing the arterial supply to the maxillary sinus when performing open lifts is relatively simple, so long as you know what to expect and where to expect it.

Correspondence

Dan Holtzclaw, DDS, MS, DABP, DICOI

dholtzclaw@jiacd.com


1. Solar P, et al. Blood supply to the maxillary sinus relevant to sinus floor elevation procedures. Clin Oral Impl Res 1999; 10: 34-44
2. Elian N, et al. Distribution of the Maxillary Artery as it Relates to Sinus Floor Augmentation.  Int J Oral Maxillofac Implants 2005; 20: 784-787