口腔种植学是口腔教育中较新的学科。虽然现在我们都有共识，种植⽛相关的理论知识，⽆论是治疗⽅案的规划，还是后期的随访和维护，对于每⼀个职业⽛医都⾮常重要。然⽽，在当下全球的口腔医学本科培养体系中，它的覆盖程度还远远落后于其重要性。 在此背景下，香港大学口腔医学院联合⾹港⼤学的线上教育专业团队，历时⼀年有余，设计并制作了这门为期五周的⽹络公开课，旨在传播以循证医学为基础的，客观、全⾯的⽛种植学相关知识。这门课程⾯向全球，双语教学，完全免费。学员将在20 多位全球领先的种植学专家的带领下，完成五个模块，系统地学习⽛种植学。
解剖学：上颌骨
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From the course by The University of Hong Kong
口腔种植学 （Implant Dentistry）
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From the lesson
种植牙和患者
患者选择和治疗计划是种植牙成功的基石。本模块中，我们将评估所有系统性，解剖学和行为上的风险，并帮助你设计综合治疗计划中的所有步骤，以满足患者的实际需求。
Meet the Instructors
Nikos MattheosClinical Associate Professor in Implant Dentistry
The University of Hong Kong
Welcome to the two-part lecture on clinical anatomy.
In this series, we will discuss about
the important structures of the maxilla and the mandible,
with respect to implant surgery.
Michael, first of all, why learning anatomy is important?
Anatomy is taught in the early stage of one’s career.
Therefore, we tend to forget the details.
Even if we remember some anatomy,
no pathology is involved in our education
and the clinical relevance is only appreciated
after practicing for some time.
Besides, the way by which the cadavers are dissected
is from the outer layer towards inner layers,
or the specimens are cut in ideal planes
such as sagittal section.
The approach in surgery is in contrast,
not necessarily following the same manner.
Learning surgical anatomy can help the surgeons appreciate
the structures being cut
and improve their confidence in doing surgery.
Another point is that
a good knowledge of anatomy can help us recognize
anatomical variations before doing the surgery,
for example, a bifid of the mandibular canal.
Nowadays, with newer technologies
such as CT-Scan and 3D printing,
surgeons can practice the procedures in models
before the actual surgery,
and the relevant anatomy can be appreciated more.
The maxilla is formed by two maxillae bone
joining at the center,
and they form part of the orbital floors,
nasal cavities, hard palate and the alveolar process.
The maxillary sinuses are contained in the body.
The relevant openings in the maxilla
where the blood vessels and nerves travel through
include the infra-orbital foramen,
posterior superior alveolar foramina, and incisive foramen.
The greater and lesser palatine foramen
of the palatine bones are located posteriorly.
Following teeth loss in the upper jaw,
the alveolar process of the maxilla resorbs mainly
at labial and buccal aspects,
and finally in a superior direction,
which results in a smaller alveolar ridge.
If bone quantity is inadequate,
we need to consider various bone grafting techniques
as adjunctive procedures.
For the quality of bone,
the maxilla usually consists
of type III or type IV bones,
which indicates a thinner outer cortex
with larger cancellous space.
When placing implants in soft bones,
we need to modify the drilling protocol
in order to achieve a better primary stability
of the implant fixture.
- Division of the trigeminal nerve
contributes to the general sense of the maxilla.
Three cutaneous branches help
to supply the skin of the face.
The maxillary division emerges from the cranium
through the foramen rotundum.
The main trunk travels forward
and emerges between the eye and the maxillary sinus
to end as the infraorbital nerve.
Along its course,
three alveolar branches emerge to supply the sinus
and the upper teeth.
The posterior superior alveolar nerves
supplies the molars.
The anterior superior alveolar nerve
that supply the front teeth emerges from the main trunk
a short distance before it exits the maxilla.
There may be a third branch that supplies the premolars,
which is called the middle superior alveolar nerve.
At the pterygopalatine fossa,
the maxillary division branches off
to the pterygopalatine ganglion.
Here it supplies the palate below
through the greater and lesser and palatine nerves.
It also has a medial branch
that supplies the nasal cavity and its glands.
The lateral wall of the nose receives
the posterior lateral nasal branches
while nasal septum receives
the nasopalatine nerve
that emerges as the incisive nerve
that supplies the mucosa of the premaxilla.
The blood supply of the maxilla is derived from the branches
of the external carotid arteries.
The most important one is the maxillary artery,
which gives rise to many branches
in the infra-temporal fossa and pterygopalatine fossa.
The veins of the maxilla drains posteriorly
to the pterygoid plexus in the infratemporal fossa.
It then joins the retromandibular vein
and finally drains to the external jugular vein.
There are certain adjunctive surgical procedures
at the maxilla that may cause damage
of the maxillary artery.
For example, during harvesting of a connective tissue graft
from the palate, the greater palatine arteries
could be ruptured by blade if the graft is taken too deeply.
Another procedure that may be associated with bleeding
is the external sinus lift operation.
Extra-osseous and intra-osseous anastomosis
between the posterior superior alveolar artery
and the infra-orbital artery could be formed.
In this situation, the blood vessels could be damaged
during flap elevation or preparation of the bony window.
Maxillary sinus is an air-filled space in the face
that is covered with a respiratory mucosa.
It is pyramidal in shape with a size of a pea
at birth but grows continuously in life.
The maxillary sinus has a base at the lateral wall
of the nose and an apex pointing at the zygomatic bone.
The roof is formed by the orbit,
and posteriorly, it extends to the infratemporal fossa
and pterygopalatine fossa.
Anteriorly, it is formed by
the facial surface of the maxilla.
The covering membrane is called Schneiderian membrane.
The cilia present on the surface of this membrane
beat in a synchronized manner
to drain the mucous layer towards the ostium of the sinus.
In infection, debris and pus has to travel against
the gravity to be successfully removed.
Therefore, it is a site prone to infection.
Underwood described the presence of a septum
separating the sinus into two compartments.
Two types of septa are present.
One is a sagittal septum.
The other is a transverse septum.
Special attention should be paid to these structures
to avoid complications during sinus surgery.
That’s all we want to discuss for the maxilla.
In the second part we will talk about the mandible.
See you in the next video.
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