Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 95

Brisk and pulsatile arterial bleeding can also occur during a maxillary sinus grafting procedure prior to an implant placement. The maxillary sinus receives blood supply from the posterior superior alveolar, infraorbital, and posterior lateral nasal arteries, and they are at risk of being injured with rotary instruments. The intraosseous course of the posterior superior alveolar artery, known as the alveolar antral artery, may be visible during exposure of the lateral maxillary wall for sinus grafting and attempts should be made to either avoid it, if possible, or cauterize it, prior to creation of the lateral bony window. The alveolar antral artery, or the intraosseous posterior superior alveolar artery (PSA) or anastomosis of the terminal branches of the infraorbital artery and PSA, is usually located 19 mm above the maxillary alveolar crest. Due to the caliber of the blood vessels and its retraction into the osseous canal, tamponade with gauze pressure may not be entirely effective. Bone wax may not adhere due to constant bleeding, and burnishing of the bone may not be possible. Therefore, use of hemostatic agents such as a topical thrombin sponge (or gelatin sponge [gelfoam]) or microfibrillar collagen (Avitene) should be considered [31] (Algorithm 3.4).