Anatomical Study of the Complications of Intraoral Vertico-Sagittal Ramus Osteotomy

PURPOSE

The present study was performed to determine the variations in anatomical features of the ramus and the course of the maxillary artery to reduce the risk of injury during intraoral vertico-sagittal ramus osteotomy (IVSRO).

MATERIALS AND METHODS

The locations and sizes of anatomical features of the medial aspect of mandibular rami were measured in 94 bilateral sides of 47 dry mandibles as a control group, and the results were compared with 3-dimensional computed tomography images of 44 sides of 22 patients with prognathism. We also dissected 12 sides of 6 mandibles from cadavers in a simulated IVSRO procedure to determine the course of the maxillary artery near the medial aspect of the ramus.

RESULTS

In the dry mandibles and patients with prognathism, the mandibular foramen was located slightly posterior to the center of the width of the mandibular ramus, and the lingula tip was located about one third the distance from the sigmoid notch to the inferior border of the ramus. The distance from the lateral margin of the mandibular foramen to the lateral surface of the mandibular ramus ranged from 3.1 to 4.4 mm. However, these distances showed various ranges. In the mandibles from Asian cadavers, the maxillary artery approached close to the ramus and passed lateral to the lower head of the lateral pterygoid muscle.

CONCLUSIONS

The position of the mandibular foramen in rami varies among individuals and, therefore, should be confirmed preoperatively on axial CT images. In addition, the maxillary artery approaches close to the medial aspect of the sigmoid notch in many cases. Therefore, the medial aspect from the sigmoid notch should be exposed carefully in the IVSRO procedure to avoid damaging the maxillary artery.

Stem cells and distraction osteogenesis: endothelial progenitor cells home to the ischemic generate in activation and consolidation

BACKGROUND

Ischemia is a limiting factor during distraction osteogenesis. The authors sought to determine the extent of ischemia in the distraction zone and whether endothelial progenitor cells home to the distraction zone and participate in local vasculogenesis.

METHODS

Laser Doppler imaging was used to assess the extent of blood flow in the distraction zone in gradually distracted, immediately distracted, and osteotomized rat mandibles during activation and consolidation. Animals (n = 50; 25 rats with unilateral gradual distraction and contralateral osteotomy as an internal control, and 25 rats with unilateral immediate distraction) were examined on postoperative days 4, 6, and 8 of activation, and after 1 and 2 weeks of consolidation. Endothelial progenitor cells isolated from human peripheral blood were labeled with fluorescent DiI dye, and 0.5 x 10 cells were injected intra-arterially under direct vision into each carotid artery at the start of activation in nude rats (n = 18) that then underwent the distraction protocol outlined above.

RESULTS

Doppler flow analysis demonstrated relative ischemia during the activation period in the distraction osteogenesis group and increased blood flow in the osteotomized control group as compared with flow in a normal hemimandible [normal, 1 (standardized); distraction osteogenesis, 0.58 +/- 0.05; control, 2.58 +/- 0.21; p < 0.05 for both results]. We observed a significantly increased endothelial progenitor cell population at the generate site versus controls at midactivation and at 1 and 2 weeks of consolidation [25 +/- 1.9 versus 1 +/- 0.3 DiI-positive cells per high-power field (p < 0.05), 124 +/- 21 versus 8 +/- 4 DiI-positive cells per high-power field (p < 0.05), and 106 +/- 18 versus 9 +/- 3 DiI-positive cells per high-power field (p < 0.05), respectively].

CONCLUSIONS

These data suggest that the distraction zone becomes relatively ischemic during activation and that endothelial progenitor cells home to the ischemic generate site during the activation phase and remain during the consolidation phase. Selective expansion of these stem cells may be useful in overcoming ischemic limitations of distraction osteogenesis. Moreover, their homing capability may be used to effect site-specific transgene delivery to the generate.

Sclerotherapy for venous malformations using a “negative subtraction” technique

We describe a technique of injecting alcohol into venous malformations (VM) under slow digital subtraction angiography (DSA) which eliminates the need to pre-mix the alcohol with a contrast agent. The technique presented here is especially helpful when Metrizamide is not available or not permitted for use. It offers an elegant way to visualize, in real time, the alcohol injected into the VM, while preserving its high concentration and potency as a sclerosing agent.

Incision design in implant dentistry based on vascularization of the mucosa

OBJECTIVES

The delivery of an adequate amount of blood to the tissue capillaries for normal functioning of the organ is the primary purpose of the vascular system. Preserving the viability of the soft tissue segment depends on the soft tissue incision being properly designed in order to prevent impairment of the circulation. A knowledge of the course of the vessels as well as of their supply area are crucial to the decision of the incision. The aim of this study was to visualize the course of the arteries using different techniques, to perform macroscopic- and microscopic analyses, and to develop recommendations for incisions in implant dentistry.

MATERIAL AND METHODS

The vascular systems of seven edentulous human cadavers were flushed out and filled with either red-colored rubber bond or Indian ink and formalin mixture. After fixation a macroscopic preparation was performed to reveal the course, distribution and supply area of the major vessels. In the area of the edentulous alveolar ridge specimens of the mucosa were taken and analyzed microscopically.

RESULTS

The analyses revealed the major features of mucosal vascularization. The main course of the supplying arteries is from posterior to anterior, main vessels run parallel to the alveolar ridge in the vestibulum and the crestal area of the edentulous alveolar ridge is covered by a avascular zone with no anastomoses crossing the alveolar ridge.

CONCLUSION

The results suggest midline incisions on the alveolar ridge, marginal incisions in dentated areas, releasing incisions only at the anterior border of the entire incision line, and avoidance of incisions crossing the alveolar ridge.

Unique origin of the inferior alveolar artery

The inferior alveolar artery is the major blood supply to the mandible and mandibular teeth. This artery has a very consistent path, originating from the maxillary artery and passing inferiorly until it enters the mandibular foramen, accompanied by the inferior alveolar nerve and vein. During routine dissection of a 90-year-old female cadaver, a unique origin of the inferior alveolar artery was observed on the left side. The artery branched off the external carotid artery, just superior to the stylohyoid and posterior belly of the digastric muscle in the posterior region of the submandibular triangle. From its starting point the artery passed superiorly in the stylomandibular fascia and made a curving arch into the pterygomandibular space to enter the mandibular foramen with the inferior alveolar nerve. The position and branching pattern of the maxillary artery were otherwise typical. The inferior alveolar artery on the right side displayed a normal branching pattern within the infratemporal fossa. Results of surgical procedures in this area, such as sliding osteotomy of the mandible, could be impacted by this anomaly.

A rare variation of the inferior alveolar artery with potential clinical consequences

Variations of the inferior alveolar artery are seemingly quite rare, especially with regard to its origin from the maxillary artery. We present an unusual case of an inferior alveolar artery that originated from the external carotid artery. To the best of our knowledge, our case is one of only two reports of the inferior alveolar artery arising from the external carotid artery. The clinician who deals with the mandibular region should be aware of such a variation in the arterial architecture.

The appearance of foramen in the internal aspect of the mental region of mandible from Japanese cadavers and dry skulls under macroscopic observation and three-dimensional CT images

The lingual canal with foramen displays different appearances on the internal surfaces of mandible as confirmed by macroscopic observation and computerized tomography (CT). The lingual canal was observed in the inside of mental region run to the outside of lingual foramen, which is extend internally from mandibular canal in right and left sides of the mandible in cadavers (13 sides out of 88 sides) and in dry skulls (43 out of 94 sides) examined. The spinal foramen connected with mental canal occurred at the midline of mandible in 6 cases (6 out of 47 cases) in dry skulls. In this small foramen, the inferior alveolar artery give some branches to the inside of mental region at the anterior mandible and which may be run pass through the lingual canal to the lingual foramen, where they emerge to enter the mylohyoid or anterior belly of digastric muscles. The observations of these are important considerations for surgical placement of dental implants in the region in the mandible.

Rare courses of the mandibular canal in the molar regions of the human mandible: a cadaveric study

The inferior alveolar artery, vein and nerve send some branches to the molar teeth via the mandibular canal to the mental foramen. The present study attempted to define the presence and course of the mandibular canal in the mandible with the alveolar process by macroscopic cadaveric dissection and computerized tomography (CT) in order to provide information that might prevent injuries to vessels and nerves at risk during root canal treatment. We identified the position of the mandibular canal within a 30% ratio of the distance from inferior border of mandible to the apices of the root for 39 out of 131 sides (mesial root of first molar, 20%; distal root of first molar, 22.6%; mesial root of second molar, 27.8% and distal root of second molar, 47%) on panoramic X-ray observation. In one cadaver (male, 64 years old), the root apex of the second molar was in close proximity to the upper bony mandibular canal. Macroscopic dissection and computerized tomography showed that the main trunks of the inferior alveolar artery, vein, and nerve were in tight contact with the apex of the second molar. These observations of the anatomic course of the mandibular canal will be important to consider during root canal treatment of mandibular teeth.

VEGF-Activated Angiogenesis During Bone Regeneration

PURPOSE

The aim of this study was to investigate the influence of controlled release of recombinant human vascular endothelial growth factor (rhVEGF(165)) on angiogenesis and osteogenesis in a mandibular defect model.

MATERIAL AND METHODS

A total of 56 rabbits were operated and bicortical holes were placed at the lower border of the mandible. The defects were filled with type-I collagen, with collagen complexed with 0.8 mug rhVEGF(165), or left without any filling. After 3, 7, 14, and 28 days, specimens were taken and histologic, histomorphometric, and immunohistologic analyses were carried out concerning number of vessels, cross-sectional area of vessels, and area and density of regenerated bone.

RESULTS

Bone formation occurred in a typical centripetal direction and showed all stages of bone regeneration and maturation. New vessel formation took place in front of the osteogenic regeneration front. The number of vessels increased in all groups until day 14, followed by physiologic regression in the control groups as opposed to persisting high numbers in the study group. The area of newly formed bone showed no difference to the control group but the density of regenerated bone was significantly higher in the study group.

CONCLUSION

Blood vessels are an important component of bone formation and maintenance and the bone tissue differentiation is related to the local presence of blood vessels. The activation of angiogenesis using rhVEGF(165) leads to more intensive angiogenesis and bone regeneration.

Angiogenesis is required for successful bone induction during distraction osteogenesis

The role of angiogenesis during mechanically induced bone formation is incompletely understood. The relationship between the mechanical environment, angiogenesis, and bone formation was determined in a rat distraction osteogenesis model. Disruption of either the mechanical environment or endothelial cell proliferation blocked angiogenesis and bone formation. This study further defines the role of the mechanical environment and angiogenesis during distraction osteogenesis.

INTRODUCTION

Whereas successful fracture repair requires a coordinated and complex transcriptional program that integrates mechanotransductive signaling, angiogenesis, and osteogenesis, the interdependence of these processes is not fully understood. In this study, we use a system of bony regeneration known as mandibular distraction osteogenesis (DO) in which a controlled mechanical stimulus promotes bone induction after an osteotomy and gradual separation of the osteotomy edges to examine the relationship between the mechanical environment, angiogenesis, and osteogenesis.

MATERIALS AND METHODS

Adult Sprague-Dawley rats were treated with gradual distraction, gradual distraction plus the angiogenic inhibitor TNP-470, or acute distraction (a model of failed bony regeneration). Animals were killed at the end of distraction (day 13) or at the end of consolidation (day 41) and examined with muCT, histology, and immunohistochemistry for angiogenesis and bone formation (n = 4 per time-point per group). An additional group of animals (n = 6 per time-point per group) was processed for microarray analysis at days 5, 9, 13, 21, and 41.

RESULTS AND CONCLUSIONS

Either TNP-470 administration or disruption of the mechanical environment prevented normal osteogenesis and resulted in a fibrous nonunion. Subsequent analysis of the regenerate showed an absence of angiogenesis by gross histology and immunohistochemical localization of platelet endothelial cell adhesion molecule in the groups that failed to heal. Microarray analysis revealed distinct patterns of expression of genes associated with osteogenesis, angiogenesis, and hypoxia in each of the three groups. Our findings confirm the interdependence of the mechanical environment, angiogenesis, and osteogenesis during DO, and suggest that induction of proangiogenic genes and the proper mechanical environment are both necessary to support new vasculature for bone induction in DO.

The localization and anthropometry of mental foramen on late Byzantine mandibles

Comprehensive studies of the human skeletal features and variations between and within populations are beneficial both for clinical applications and determination of racial characteristics of populations. The aim of this study was to examine the location and anthropometric characteristics of the mental foramen in 36 adult male mandibles of the Late Byzantine period. The results demonstrated that the most common position of the mental foramen was in line with the longitudinal axis of the second premolar (50% right side; 47% left side) followed by a location between the first and second premolars (33% right side; 36% left side). When compared with the results of previous similar studies, the results obtained in the present study suggest that traits such as the localization of mental foramen may not only differ between populations of different geographic environment but also within the inhabitants of the same geography.

Critical Hemorrhage in the Floor of the Mouth During Implant Placement in the First Mandibular Premolar Position: A Case Report

Although dental implantation is considered to be a safe surgical procedure, this report focuses on a critical hemorrhaging episode associated with implant placement in the first mandibular premolar position. Excessive bleeding and formation of massive lingual, sublingual, and submandibular hematomas were the result of arterial trauma that occurred during the osteotomy preparation. The vascular injury was induced through a perforation of the lingual mandibular cortex. Critical bleeding was conservatively controlled and the case was further handled efficiently with an expectant airway management in a hospital environment. Similar case reports are reviewed in an attempt to draw attention to this rare but potentially life-endangering risk of implant dentistry. Common causes of severe hemorrhage in the floor of the mouth, anatomical considerations, bleeding control measures, and related airway issues are also discussed.

[Diagnosis and treatment of high-flow vascular malformation of the jaws]

OBJECTIVE

To report our experience on diagnosis and treatment of the high-flow vascular malformation of the jaws.

METHODS

Thirty-seven cases of high-flow vascular malformation of the jaws (6 cases in maxilla and 31 in mandible) were comprised this study. Twenty-one patients were embolized with coils and N-buty1-2-cyanoacrylate, and 16 cases underwent surgery. The embolization was carried out with both arterial and venous route.

RESULTS

Different signs of the lesions were demonstrated on X-ray plain film, such as locular, rough of bone trabecula and soap bubble-like changes, frequently accompanied by dilatation of the mandibular nerve canal. CT scan showed unilocular and multilocular radiolucency. T(1)WI and T(2)WI on MRI exhibited low signal, and varix was found on DSA. The high-flow vascular malformation of the jaws classified into two groups: arterial malformation and arteriovenous malformation according to CT and DSA. The acute bleeding of 16 cases was effectively controlled by embolization. The chronic bleeding in the other 5 cases stopped after the 4 - 59 months and new bone formation was found in the follow-up radiography.

CONCLUSIONS

The characteristic signs were not unique on X-ray plain film, and MRI and DSA had diagnostic value. Arteriovenous malformation of the jaws should be embolized by direct puncture in conjunction with endovascular therapy, and arterial malformation be superselectively embolized with NBCA.

[A preliminary study of angiographic classification and treatment of central arteriovenous malformations in jaws]

OBJECTIVE

To elaborate on the angiographic classification of central arteriovenous malformations (AVMs) in jaws, and to evaluate the correlation between this classification and treatment options.

METHODS

X-ray films and angiograms of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of radiolucency, feeding arteries, nidus of the malformations and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation between this classification and treatment options.

RESULTS

The angiographic pictures of 25 cases with central AVMs could be divided into five types: type I (n = 5) was with merely diffused micro-arteriovenous fistulas (AVFs); type II (n = 8) demonstrated a large venous pouch, all the feeding arteries drained into it; type III (n = 7) had a large venous pouch together with diffused micro-AVFs (I + II); type IV (n = 2) had multiple venous pouches; type V (n = 3) had multiple venous pouches and diffused micro-AVFs (I + IV). The angioarchitecture corresponded well to the radiographic appearance in all except one case. With respect to the treatment, type II, III, IV AVMs gained clinical cure in 100% of cases, whereas type I and type V AVMs obtained clinical cure only in 3 of 5 and 1 of 3 cases respectively.

CONCLUSIONS

Central AVMs in jaws exhibited variant patterns of angioarchitecture, which could be divided into five types. Elaboration of this classification was helpful for decision-making on choosing appropriate therapy.

Computed tomographic analysis of the position and course of the mandibular canal: relevance to the sagittal split ramus osteotomy

The aim of this study was to investigate the position and course of the mandibular canal through the mandibular ramus using computed tomographic (CT) imaging and to relate the findings to performing sagittal split ramus osteotomies. The mandibles of 35 patients with skeletal Class III prognathism with symmetry (12 males and 23 females) were observed on transaxial computed tomograms acquired with a slice thickness of 2 mm. The position and course of the mandibular canal from the mandibular foramen to the mandibular body at the level of the second molar were measured at four specific locations in the same plane. Among the 70 rami examined, lack of a bone marrow space on the buccal side, including a fusion type anatomy with no buccal side cortical bone of the mandibular canal, were observed at the CT location between the mandibular foramen and mandibular angle. Our results suggest that special care must be taken when sagittal splitting is performed, and the safest location for the buccal corticotomy is anterior to the mandibular angle.

Bifid mandibular canal: literature review and case report

OBJECTIVES

The objective is to call attention to and to review the literature of the anatomical variation: bifid mandibular canal.

METHODS

A review of the literature is summarized. Additionally, the clinical and radiographic findings of a patient who presented a unilateral bifid mandibular canal are recorded.

RESULTS

Bifid mandibular canals can be detected on a panoramic radiograph. More precise information about the course of the canal can be revealed on cross sectional CT images perpendicular to the alveolar ridge.

CONCLUSIONS

Bifid mandibular canals are often unrecognized. The detection of these anatomical variations is important because of its clinical implications. Special attention has to be paid in surgical procedures involving the lower jaw.

Bilateral mandibular distraction in adult dogs with an epiperiosteal distractor

We tested the function and efficiency of a new intraoral, bone-borne distraction device for mandibular lengthening, and the effect of bilateral transsection of the inferior alveolar arteries on osteogenesis in adult dogs. Nine adult Beagles had bilateral complete mandibular osteotomies and epiperiosteal placement of the distractor. After 7 days, the mandibles were distracted at 1 x 1mm/day, 1 x 0.5 mm/day or 2 x 0.25 mm/day for 15 or 30 days, respectively. Hemimandibles were harvested after 1, 14, or 42 days consolidation and evaluated clinically, radiographically and histologically. The mean distraction achieved was 11 mm (range 4-16 mm). New bone formation and clinical stability increased with increasing consolidation time and was independent of the distraction protocol used. Osteogenesis at the distal and proximal mandibular fragments did not differ. In 10/18 distraction sites, wound dehiscences compromised osteogenesis. The new epiperiosteal distractor permitted successful distraction osteogenesis despite complete bilateral osteotomy with section of the medullary vessels in adult dogs.

[Application of near-infrared spectroscopy to postoperative monitoring of flap in plastic surgery]

As a non-invasive technique for the measurement of blood and oxygen in tissue, the near-infrared spectroscopy (NIRS) has an increasing application to the postoperative monitoring of plastic surgery. In authorial research, a set of NIRS oximeter has been used in 6 successful flap-transplantation operations to monitor and contrast the oxygen saturation in the free flap side and in the normal opposite side. It was found in the research that there is a notable difference in the oxygen saturation between those two sides. Another research has been done in an unsuccessful operation. In this experiment, several points in the mandible were measured and the result shows that the oxygen saturation is at an obviously lower level in the anoxic position than in the normal ones. In the above several researches, near infrared spectroscopy showed a high sensitivity to detect the dynamic changes in flaps induced by inhalation of pure oxygen. Therefore, NIRS can be a valuable aid in the post-operative monitoring of free flap after the operation, and must have a great practical future in this field.

Cerebellopontomandibular vascular malformation: a rare type of cerebrofacial arteriovenous metameric syndrome. Case report

The concept of a cerebrofacial arteriovenous metameric syndrome (CAMS) recently has been posited. A 22-year-old woman presented with gait ataxia. She had unilateral angiomatous lesions involving the lower face, the auricle, and the retromastoid area, as well as the tongue on the right side. Angiography revealed the presence of extensive arteriovenous malformations (AVMs) in the ipsilateral cerebellum and pons, in addition to those located in the facial region. The authors report a case of multiple AVMs of the face, cerebellum, and pons, corresponding to CAMS Type 3, and include a review of the literature.

Interactive web-based programs to teach functional anatomy: the pterygopalatine fossa

Certain areas of the body contain structures that are difficult to envision in their proper spatial orientations and whose functions are complex and difficult to grasp. This is especially true in the head, where many structures are relatively small and inaccessible. To address this problem, we are designing Web-based programs that consist of high-resolution interactive bitmap illustrations, prepared using Adobe Photoshop, and vector-based animations, prepared via Macromedia Flash. Flash action script language is used for the animations. We have used this approach to prepare a program on the pterygopalatine fossa, an important neurovascular junction in the deep face that is especially difficult to approach by dissection and to depict in static images in an atlas. The program can be viewed online at http://cds.osr.columbia.edu/anatomy/ppfossa/. A table of contents simplifies navigation through the program and a menu enables the user to identify each of the vascular and neuronal components and either to insert or to remove each from its position in the fossa. The functional anatomy of the nerves in the fossa is animated. For example, users can activate and subsequently follow action potentials as they course along axons to their targets. This high degree of interactivity helps promote learning.

Submental Perforating Artery: A Culprit of Bleeding During Facelift

The aim of the study was to elucidate the precise anatomical detail of the submental perforating artery (SPA) and avoid bleeding during the facelift operation or submental procedures. Latex-injected heads of eight fresh Korean cadavers (6 male, 2 female) were used. After the facial artery was found, the dissection was continued anteriorly, following the submental artery (SMA). When the SMA ran anteriorly about 15.5 mm (15.5 +/- 2.2 mm) from the facial artery and reached about halfway from the gonion to the menton, it gave off one or two perforating branches (SPA, mean number 1.6). The SPA ran upward and forward until it reached the skin. Diameter of the SPA at its beginning was 1.25 +/- 0.36 mm. The point of emergence of the SPA from the SMA was about halfway (49% +/- 14%) from the gonion to the menton, about 6 mm (6.1 +/- 1.9 mm) inferior to the lower border of mandible. The high risk of injuring the vessels during the facelift can be explained by the close vicinity of the SPA to the mandibular inferior border.

Ultrasound measurement of mandibular arterial blood supply: Techniques for defining ischemia in the pathogenesis of alveolar ridge atrophy and tooth loss in the elderly?

PURPOSE

To adapt ultrasound methods used to measure blood flow in the extremities to quantify mandible blood flow in order to determine the role of ischemia in the pathogenesis of mandible atrophy and tooth loss in the elderly.

PATIENTS AND METHODS

Doppler and duplex ultrasound techniques as used in measurement of arterial pulse in the extremities were adapted for recording the intraoral pulse profile at 7 sites in 57 patients of varying ages.

RESULTS

After omitting the large number (26 patients) with signals of indeterminate strength, the mental artery pulse was strong in 11 of 12 (92%) in those younger than 65 versus 9 of 19 (47% in those older than 65 years; P = .02). The equivalent figures for the sublingual artery were 15 of 15 strong for those younger than 65 and 11 of 17 (65%) for those older than 65 years ( P = .02). The varying depth of soft tissue overlying the inferior alveolar artery made its signal difficult to evaluate, but there was no statistically significant age-related difference in the inferior alveolar artery signals. In 4 elderly patients (2 with established carotid artery disease), Doppler and duplex scanning showed reversal of mental artery flow, indicating collateral flow to the mandible.

CONCLUSIONS

Ultrasound Doppler techniques used for measuring peripheral arterial flow can be adapted to quantify mandible alveolar ridge perfusion. This provides means to evaluate the role of arterial obstruction in mandible alveolar ridge atrophy and tooth loss in the elderly. The mental artery is the best site for this purpose. Preliminary data suggest an age-related reduction in mental artery flow.

Mandibular lesions of vasoocclusive origin in sickle cell hemoglobinopathy

Sickle cell hemoglobinopathy is an inherited disorder characterized by vasoocclusive crises. Involvement of the maxillofacial skeleton leading to radiopaque lesions that correspond to bone infarcts has rarely been reported in the literature. Forty-two adult patients suffering from sickle cell anemia were examined radiographically for radiopaque lesions situated in the course of a known vessel or in the apical region of the teeth. In 6 cases, such lesions were combined with facial pain during sickle cell crisis and absence of dental pathology and were considered to be of possible vasoocclusive origin. In conclusion, vasoocclusive involvement should be taken into consideration when assessing painful episodes or neurological symptoms in the maxillofacial region in this patient population.

Lingual vascular canals of the interforaminal region of the mandible: evaluation with conventional tomography

The presence of lingual vascular foramina and canals in the interforaminal region may increase the risk of surgical complications during implant placement, bone grafting procedures and osteodistraction. Oral and maxillofacial radiologists should recognize this anatomical variant and include a description in their interpretative report to inform the referring clinician of the potential for surgical complications.