DETERMINATION OF THE FEATURES OF THE MAXILLARY SINUSES FLOOR CONTOURS IN PATIENTS WITH DIFFERENT FORMS OF THE FACIAL SKELETON FOR PREPARATION TO OPEN SINUS LIFT SURGERY
DOI:
https://doi.org/10.32782/3041-1394.2024-2.2Keywords:
contours of the maxillary sinus floor, shape of the facial skull, open sinus lift, damage of the Schneiderian membrane, prognostic factors of perforationAbstract
The most frequent intraoperative complication of open sinus lift is the perforation of the Schneiderian membrane. The topographic and anatomical features of the maxillary sinus, the shape and floor contours can significantly affect the effectiveness of the sinus mucosa elevation during this procedure. A statistically significant correlation is between the dimensions and configuration of the maxillary sinuses correlate and the parameters of the midface skeleton. The aim of the study – to determine the individual anatomical features of the maxillary sinuses floor contours in patients with different forms of the facial skeleton on computed tomography scan images and to identify possible predictors of the Schneiderian membrane perforation during open sinus lift surgery. Materials and methods. Craniometric examinations were performed on CT images of 92 skulls. The facial index was determined by the Garson’s formula, based on classification of L. Niu, J. Wang and co-authors (2018) the contours of the floor of maxillary sinuses at their slices at the level of the first and second molar sockets were detected in the coronal view of the skulls. To establish significant differences among the topographic and anatomical parameters obtained in the comparison groups, Pearson’s χ2 test was calculated. Scientific novelty. For the first time, the dependence of some contours of the maxillary sinuses floor on the shape of the patients’ facial part of skulls was revealed. Possible anatomical predictors of Schneiderian membrane perforation during the open sinus surgery among shapes of contours were identified. There were 27.8% of the euriprosops with the irregular shapes of maxillary sinuses floor contours either uneven with recesses (depressions) or zigzag shape, or with the septa/exostoses. Most often, the narrow (conical) shape contours were determined in the leptoprosop category – χ2 = 4.02 (p˂0.05). These topographic and anatomical factors complicate the mechanical detachment of the Schneiderian membrane from the cortical plate of the maxillary sinus floor and contribute to its rupture. At the same time, among the mesoprosops in 22.5% of cases were found square contours of the maxillary sinus floor, in 32.5% – oval ones, and they do not interfere with the full elevation of the Schneiderian membrane. Conclusions. The irregular shape (either with depressions or zigzag, septa/exostoses) of contours of the maxillary sinuses floor are more common for the euriprosops (patients with broad face) – in 27.8% of cases, whereas the narrow (conical) shape of them present more often in the leptoprosops (patients with narrow face) – χ2 = 4.02, p˂0.05, which are prognostic factors for Schneiderian membrane perforation during the open sinus lifting and should be taken into account when planning this surgery.
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