上顎後牙缺牙區上顎竇解剖構造之錐狀束電腦斷層的研究

隨著植牙的發展，上顎竇手術成為植牙前經常施行的術式之一；而進行上顎竇增高術前，瞭解上顎竇的解剖構造以及上顎竇內施術區域的情況是重要的。後上齒槽動脈(PSAA)是供應上顎竇側壁的主要血管之一，其行走路徑與施術區域相近，容易於手術中受影響而血流不止。然而有關於台灣族群中上顎竇解剖構造以及其相關器官的研究較少。因此本研究利用錐狀束電腦斷層影像，探討台灣族群上顎後牙無牙脊區之上顎竇以及後上齒槽動脈解剖構造。本研究使用錐狀束電腦斷層之冠狀切面檢視401個上顎竇影像，紀錄並計算無牙脊區後上齒槽動脈的孔徑發現機率、動脈孔徑直徑、動脈行走位置、動脈與無牙脊頂點之垂直距離、上顎竇底至無牙脊頂點之垂直距離、上顎竇中隔以及上顎竇黏膜增厚的情形。無牙脊區後上齒槽動脈孔徑發現機率為89.3%，並且位於無牙脊根尖向往上平均16.87±4.02 mm處。後上齒槽動脈孔徑之直徑平均為1.29±0.44mm，男性之動脈孔徑直徑會顯著大於女性之動脈孔徑直徑(p<0.0001)。在台灣族群中，無牙脊區動脈最常行走於上顎骨板內(44.6%)，有43.4%行走於上顎竇膜下，而最少行走於上顎骨板外(1.2%)。上顎竇底部至無牙脊頂點之垂直高度，在後上齒槽動脈缺失時會是最短的(6.27±2.84 mm)；然而當後上齒槽動脈行走於上顎骨板內則是最長的(9.26±4.23 mm) (p<0.0001)。在無牙脊區域上顎竇內中隔盛行率為11.97%，上顎竇黏膜增厚機率為46.1%，男性上顎竇黏膜增厚機率(57.8%)顯著高於女性(36.1%) (p<0.0001)。施術前，瞭解後上齒槽動脈以及上顎竇的特徵是必須的，本研究主要目地為提供醫師臨床參考以及幫助治療計畫的實施，增進病人的術中安全以及術後併發症的減少。

Before performing maxillary sinus augmentation, it is important for clinicians to understand the anatomy of the maxillary sinus. One of the major arteries that supplies the maxillary sinus is posterior superior alveolar artery (PSAA), which lies in close proximity with operative area during maxillary sinus augmentation and can result in hemorrhage if affected. However, there are limited information on the anatomy of maxillary sinus and associated organs among Taiwanese population. Therefore, in this study we aimed to investigate the anatomy of maxillary sinus and PSAA. In this study, 401 images of maxillary sinus were examined using Cone beam computed tomography (CBCT). Prevalence, canal size, location of PSAA, the vertical distance between the PSAA and residual alveolar ridge, the vertical distance from the maxillary sinus floor to the residual ridge, the presence of maxillary sinus septum, and mucosal thickening were recorded. The detected PSAA canal (89%) were located at an average of 16.87±4.02 mm above the edentulous ridge. The average PSAA canal diameter was 1.29±0.44mm, and it was significantly larger in men than in women (p<0.0001). Among Taiwanese population, PSAA located mostly intraosseous (44.6%), 43.4% were below the Schneiderian membrane and 1.2% on the outer cortex of the lateral sinus wall. The vertical height from the maxillary sinus floor to the edentulous ridge were found shortest (6.27±2.84 mm) when absent of PSAA canal and longest (9.26±4.23 mm) when PSAA canal located intraosseous (p<0.0001). In the edentulous area, the prevalence of septum in the maxillary sinus was 11.97%, and the rate of mucosal thickening of the maxillary sinus was 46.1%. The rate of thickening of the maxillary sinus mucosa in men (57.8%) was higher than that in women (36.1%) (p<0.0001). With these data, this study aimed to help clinicians in treatment planning and operation in order to promote a safer procedure with less post-complications .