J Korean Assoc Oral Maxillofac Surg.  2023 Aug;49(4):192-197. 10.5125/jkaoms.2023.49.4.192.

Radiographic evaluation before surgical extraction of impacted third molar to reduce the maxillary sinus related complication

• Seo MH
• Sodnom-Ish B
• Eo MY
• Myoung H
• Kim SM

• KMID: 2545584
• DOI: http://doi.org/10.5125/jkaoms.2023.49.4.192

Abstract

Objectives
Surgical extraction of maxillary third molars is routine in departments devoted to oral and maxillofacial surgery. Because maxillary third molars are anatomically adjacent to the maxillary sinus, complications such as oroantral fistula and maxillary sinusitis can occur. Here we explore the factors that can cause radiographic postoperative swelling of the maxillary sinus mucosa after surgical extraction.
Materials and Methods
This retrospective study reviewed the clinical records and radiographs of patients who underwent maxillary third-molar extraction. Preoperative panoramas, Waters views, and cone-beam computed tomography were performed for all patients. The patients were divided into two groups; those with and those without swelling of the sinus mucosa swelling or air-fluid level in a postoperative Waters view. We analyzed the age and sex of patients, vertical position, angulation, number of roots, and relation to the maxillary sinus between groups. Statistical analysis used logistic regression and P<0.05 was considered statistically significant.
Results
A total of 91 patients with 153 maxillary third molars were enrolled in the study. Variables significantly related to swelling of the maxillary sinus mucosa after surgical extraction were the age and the distance between the palatal cementoenamel junction (CEJ) and the maxillary sinus floor (P<0.05). Results of the analysis show that the relationship between the CEJ and sinus floor was likely to affect postoperative swelling of the maxillary sinus mucosa.
Conclusion
Maxillary third molars are anatomically adjacent to the maxillary sinus and require careful handling when the maxillary sinus is pneumatized to the CEJ of teeth.

Keyword

Maxilla; Third molar; Maxillary sinus; Cone-beam computed tomography; Panoramic radiography

Figure

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  Fig. 1 Vertical position of the maxillary third molar in the panoramic view. If the occlusal surface was at or below the cementoenamel junction (CEJ) of the maxillary second molar, it was classified as level 1. If it was between the CEJ and the apex of the maxillary second molar, it was classified as level 2, and if it was above the apex, it was classified as level 3.

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  Fig. 2 Angulation of the maxillary third molar. A. Mesial angulation. B. Vertical angulation. C. Distal angulation.

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  Fig. 3 Analysis of the maxillary third molar in a coronal section of cone-beam computed tomography. The distance from the tooth to the floor of the maxillary sinus was measured. The shortest distance from the buccal and palatal sides of the cementoenamel junction (A, B) and root apex (C, D) to the floor of the maxillary sinus were measured. Depending on the angle between the vertical line passing through the midpalate and the long axis of the tooth, inclination was divided into buccal, vertical, and palatal (E).

Reference

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