{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:46:01Z","timestamp":1789501561766,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T00:00:00Z","timestamp":1711238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>The study of the maxillary sinus anatomy should consider the presence of two features of clinical importance. The arterial supply course and the presence of the so-called Underwood septa are two important factors to consider when planning surgical treatment to reduce the risk of surgical complications such as excessive bleeding and Schneiderian membrane perforations. This study aimed to investigate the above-mentioned anatomical structures to improve the management of eventual vascular and surgical complications in this area. This study included a total of 200 cone-beam computed topographies (CBCTs) divided into two groups of 100 CBCTs to evaluate the arterial supply (AAa) course through the lateral sinus wall and Underwood\u2019s septa, respectively. The main parameters considered on 3D imaging were the presence of the AAa in the antral wall, the length of the arterial pathway, the height of the maxillary bone crest, the branch sizes of the artery in the first group, and the position of the septa, the length of the septa, and their gender associations in the second group. The CBCT analysis showed the presence of the arterial supply through the bone wall in 100% of the examined patients, with an average size of 1.07 mm. With regard to the septa, 19% of patients presented variations, and no gender difference was found to be statistically significant. The findings add to the current understanding of the clinical structure of the maxillary sinus, equipping medical professionals with vital details for surgical preparation and prevention of possible complications.<\/jats:p>","DOI":"10.3390\/tomography10040034","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T14:14:12Z","timestamp":1711376052000},"page":"444-458","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Anatomy of Maxillary Sinus: Focus on Vascularization and Underwood Septa via 3D Imaging"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6130-8533","authenticated-orcid":false,"given":"Sara","family":"Bernardi","sequence":"first","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3731-5463","authenticated-orcid":false,"given":"Serena","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0080-1743","authenticated-orcid":false,"given":"Davide","family":"Gerardi","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Petrelli","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, Dental School, \u2018G. D\u2019Annunzio\u2019 University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, Dental School, \u2018G. D\u2019Annunzio\u2019 University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Piattelli","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, Dental School, \u2018G. D\u2019Annunzio\u2019 University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9182-0586","authenticated-orcid":false,"given":"Guido","family":"Macchiarelli","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7501-0794","authenticated-orcid":false,"given":"Giuseppe","family":"Varvara","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, Dental School, \u2018G. D\u2019Annunzio\u2019 University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.5115\/acb.2013.46.4.235","article-title":"Evolution of the paranasal sinuses\u2019 anatomy through the ages","volume":"46","author":"Mavrodi","year":"2013","journal-title":"Anat. Cell Biol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1002\/ca.23366","article-title":"Anatomical Variations in Clinical Dentistry","volume":"32","author":"Iwanaga","year":"2019","journal-title":"Anat. Var. Clin. Dent."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.5115\/acb.2019.52.1.17","article-title":"Clinical anatomy of the maxillary sinus: Application to sinus floor augmentation","volume":"52","author":"Iwanaga","year":"2019","journal-title":"Anat. Cell Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.omsc.2018.02.002","article-title":"Giant follicular cysts extended in pterygo-maxillary fossa, antro-naso-ethmoidal and orbital space associated to exophtalmos and diplopia in young patients","volume":"4","author":"Bernardi","year":"2018","journal-title":"Oral Maxillofac. Surg. Cases"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.jcms.2021.09.005","article-title":"Management of orbital and brain complications of sinusitis: A practical algorithm","volume":"49","author":"Raponi","year":"2021","journal-title":"J. Cranio-Maxillo-Facial Surg. Off. Publ. Eur. Assoc. Cranio-Maxillo-Facial Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e359","DOI":"10.1097\/SCS.0000000000005365","article-title":"Minimally-Invasive Endoscopic-Assisted Sinus Augmentation","volume":"30","author":"Giovannetti","year":"2019","journal-title":"J. Craniofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.sdentj.2020.11.001","article-title":"Retrospective analysis of maxillary sinus septa\u2014A cone beam computed tomography study","volume":"33","author":"Alhumaidan","year":"2021","journal-title":"Saudi Dent. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jormas.2019.12.021","article-title":"Evaluation of maxillary sinus anatomical variations and lesions: A retrospective analysis using cone beam computed tomography","volume":"121","author":"Amine","year":"2020","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1034\/j.1600-0501.1999.100105.x","article-title":"Blood supply to the maxillary sinus relevant to sinus floor elevation procedures","volume":"10","author":"Solar","year":"1999","journal-title":"Clin. Oral Implants Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1002\/(SICI)1098-2353(1999)12:6<417::AID-CA3>3.0.CO;2-W","article-title":"Arterial blood supply of the maxillary sinus","volume":"12","author":"Traxler","year":"1999","journal-title":"Clin. Anat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.ijom.2007.05.005","article-title":"Prevalence, diameter and course of the maxillary intraosseous vascular canal with relation to sinus augmentation procedure: A radiographic study","volume":"36","author":"Mardinger","year":"2007","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/SCS.0b013e31819ba1c1","article-title":"Clinical implications of the topography and distribution of the posterior superior alveolar artery","volume":"20","author":"Hur","year":"2009","journal-title":"J. Craniofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1097\/SCS.0b013e3181a2d77f","article-title":"Maxillary sinus vascularization: A cadaveric study","volume":"20","author":"Rosano","year":"2009","journal-title":"J. Craniofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.joms.2009.06.036","article-title":"Management of the Alveolar Antral Artery During Sinus Floor Augmentation Procedures","volume":"68","author":"Taschieri","year":"2010","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00276-020-02468-w","article-title":"Revisiting major anatomical risk factors of maxillary sinus lift and soft tissue graft harvesting for dental implant surgeons","volume":"42","author":"Iwanaga","year":"2020","journal-title":"Surg. Radiol. Anat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s00276-022-03055-x","article-title":"Anatomical study of the maxillary sinus: Which characteristics can influence its volume?","volume":"45","author":"Lessa","year":"2023","journal-title":"Surg. Radiol. Anat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/ca.22800","article-title":"Development of the Anatomical Quality Assurance (AQUA) checklist: Guidelines for reporting original anatomical studies","volume":"30","author":"Tomaszewski","year":"2017","journal-title":"Clin. Anat."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"149","DOI":"10.5603\/FM.a2015.0095","article-title":"Cone beam computed tomography investigation of the antral artery anastomosis in a population of Central Italy","volume":"75","author":"Bernardi","year":"2016","journal-title":"Folia Morphol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/ID.0000000000000380","article-title":"Determination of the Prevalence, Height, and Location of the Maxillary Sinus Septa Using Cone Beam Computed Tomography","volume":"25","author":"Sakhdari","year":"2016","journal-title":"Implant Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/j.1600-0501.2010.02045.x","article-title":"Maxillary sinus vascular anatomy and its relation to sinus lift surgery","volume":"22","author":"Rosano","year":"2011","journal-title":"Clin. Oral Implants Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1111\/clr.12318","article-title":"Prevalence of the posterior superior alveolar canal in cone beam computed tomography scans","volume":"26","author":"Anamali","year":"2015","journal-title":"Clin. Oral Implants Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1111\/clr.12119","article-title":"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","volume":"25","author":"Apostolakis","year":"2014","journal-title":"Clin. Oral Implants Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1590\/S1806-83242013000500007","article-title":"Evaluation of the posterior superior alveolar artery and the maxillary sinus with CBCT","volume":"27","author":"Dolekoglu","year":"2013","journal-title":"Braz. Oral Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.11607\/prd.2172","article-title":"Location of Posterosuperior Alveolar Artery and Correlation with Maxillary Sinus Anatomy","volume":"35","author":"Hayek","year":"2015","journal-title":"Int. J. Periodontics Restorative Dent."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1002\/ca.23888","article-title":"Pediatric paranasal sinuses\u2014Development, growth, pathology, & functional endoscopic sinus surgery","volume":"35","author":"Lee","year":"2022","journal-title":"Clin. Anat."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/cid.12426","article-title":"Radiographic Evaluation of Maxillary Sinus Lateral Wall and Posterior Superior Alveolar Artery Anatomy: A Cone-Beam Computed Tomographic Study","volume":"19","author":"Movahed","year":"2017","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"606","DOI":"10.12659\/PJR.899221","article-title":"Evaluation of the Posterior Superior Alveolar Artery Using Cone Beam Computed Tomography","volume":"81","author":"Pandharbale","year":"2016","journal-title":"Polish J. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.ijom.2015.07.001","article-title":"Detection of the posterior superior alveolar artery in the lateral sinus wall using computed tomography\/cone beam computed tomography: A prevalence meta-analysis study and systematic review","volume":"44","author":"Takkouche","year":"2015","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e116","DOI":"10.1097\/SCS.0000000000004083","article-title":"Vascular Precautions Before Sinus Lift Procedure","volume":"29","author":"Abdulrazaq","year":"2018","journal-title":"J. Craniofac. Surg."},{"key":"ref_30","first-page":"e394","article-title":"Evaluation of the position of the posterior superior alveolar artery in relation to the maxillary sinus using the Cone-Beam computed tomography scans","volume":"9","author":"Chitsazi","year":"2017","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_31","first-page":"1","article-title":"Radiological evaluation of maxillary sinus anatomy: A cross-sectional study of 300 patients","volume":"214","author":"Gehrke","year":"2017","journal-title":"Ann. Anat. = Anat. Anzeiger Off. organ Anat. Ges."},{"key":"ref_32","first-page":"63","article-title":"The study of the alveolar antral artery canal in using cone beam computed tomography","volume":"37","author":"Aung","year":"2017","journal-title":"M Dent. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.5624\/isd.2017.47.1.39","article-title":"Prevalence and location of the posterior superior alveolar artery using cone-beam computed tomography","volume":"47","author":"Tehranchi","year":"2017","journal-title":"Imaging Sci. Dent."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/cid.12703","article-title":"The potential clinical relevance of anatomical structures and variations of the maxillary sinus for planned sinus floor elevation procedures: A retrospective cone beam computed tomography study","volume":"21","author":"Daltaban","year":"2019","journal-title":"Clin. Implant Dent. Relat. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1097\/ID.0000000000000771","article-title":"Cone Beam Computed Tomography Evaluation of the Artery in the Lateral Wall of the Maxillary Sinus: Retrospective Analysis of 602 Sinuses","volume":"27","author":"Rostetter","year":"2018","journal-title":"Implant Dent."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1563\/aaid-joi-D-17-00129","article-title":"Evaluation of the Anastomosis Canal in Lateral Maxillary Sinus Wall With Cone Beam Computerized Tomography: A Clinical Study","volume":"44","author":"Sun","year":"2018","journal-title":"J. Oral Implantol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.1016\/j.joms.2019.07.009","article-title":"Relationship Between the Posterior Superior Alveolar Artery and Maxillary Sinus Pathology: A Cone-Beam Computed Tomography Study","volume":"77","author":"Yalcin","year":"2019","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.sdentj.2019.10.010","article-title":"Quantitative and qualitative assessments of intraosseous neurovascular canals in dentate and posteriorly edentulous individuals in lateral maxillary sinus wall","volume":"32","author":"Yusof","year":"2020","journal-title":"Saudi Dent. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.morpho.2020.08.003","article-title":"Alveolar antral artery in edentulous patients and their visualization through cone beam computed tomography","volume":"105","author":"Albuquerque","year":"2021","journal-title":"Morphologie"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.4067\/S0717-95022020000601760","article-title":"Analysis of the presence, location and morphometry of the \u00abalveolar antral artery\u00bb by cone-beam computed tomography in chilean adults","volume":"38","author":"Alves","year":"2020","journal-title":"Int. J. Morphol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4103\/jomr.jomr_27_19","article-title":"Tomographic evaluation of the prevalence of the intraosseous branch of the posterior superior alveolar artery","volume":"7","author":"Dias","year":"2019","journal-title":"J. Oral Maxillofac. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/ahe.12584","article-title":"Important anatomical variations of the superior posterior alveolar artery: Studied by cone beam computed tomography","volume":"49","author":"Padovani","year":"2020","journal-title":"Anat. Histol. Embryol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1002\/JPER.20-0560","article-title":"Evaluation of length and location of the maxillary sinus intraosseous artery using computerized tomography","volume":"92","author":"Tran","year":"2021","journal-title":"J. Periodontol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"35","DOI":"10.5624\/isd.20200146","article-title":"Evaluation of the posterior superior alveolar artery canal by cone-beam computed tomography in a sample of the Egyptian population","volume":"51","author":"Fayek","year":"2021","journal-title":"Imaging Sci. Dent."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1051\/mbcb\/2021007","article-title":"Position of posterior superior alveolar artery in relation to the maxillary sinus using cone beam computed tomography in Indian sub-population","volume":"27","author":"Godil","year":"2021","journal-title":"J. Oral Med. Oral Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s00276-023-03091-1","article-title":"Frequency, location, and diameter of the anastomosis between the posterior superior alveolar artery and the infraorbital artery in imaging studies: Systematic review and meta-analysis","volume":"45","author":"Alves","year":"2023","journal-title":"Surg. Radiol. Anat."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.ijom.2021.10.008","article-title":"Prevalence of maxillary sinus septa: Systematic review and meta-analysis","volume":"51","author":"Henriques","year":"2022","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"140","DOI":"10.2174\/1874210601711010140","article-title":"Complications During Maxillary Sinus Augmentation Associated with Interfering Septa: A New Classification of Septa","volume":"11","author":"Irinakis","year":"2017","journal-title":"Open Dent. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"47","DOI":"10.36253\/ijae-14681","article-title":"Volumetric evaluation of maxillary sinuses using CBCTS: Radiographic study","volume":"127","author":"Rinaldi","year":"2023","journal-title":"Ital. J. Anat. Embriol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/cid.12877","article-title":"Long-term outcomes of the implants accidentally protruding into nasal cavity extended to posterior maxilla due to inferior meatus pneumatization","volume":"22","author":"Park","year":"2020","journal-title":"Clin. Implant. Dent. Relat. Res."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/4\/34\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:17:57Z","timestamp":1760105877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/4\/34"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,24]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["tomography10040034"],"URL":"https:\/\/doi.org\/10.3390\/tomography10040034","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,24]]}}}