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Öçbe M, Borahan MO. Identifying the Anatomical Variations of the Inferior Alveolar Nerve with Magnetic Resonance Imaging. Niger J Clin Pract 2024; 27:136-142. [PMID: 38317047 DOI: 10.4103/njcp.njcp_641_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND The inferior alveolar nerve (IAN) is located in the mandibular canal (MC). It is critical to evaluate the position of the MC during treatment planning to prevent intra or postoperative complications. AIMS This retrospective study aimed to identify the anatomy and anatomical variations of the IAN using soft tissue imaging (pulse sequence magnetic resonance imaging [MRI]). MATERIALS AND METHODS This study was designed as a retrospective Consolidated Standards of Reporting Trials (CONSORT) study. In total, 220 MR images were obtained. Nutrient canals (NCs) were classified as intraosseous and dental NCs, while bifid MCs (BMCs) were classified as forward, retromolar, and buccolingual canals. IBM SPSS Statistics 22 was used. Kolmogorov-Smirnov and Shapiro-Wilk tests, descriptive statistical methods (means, standard deviations, and frequencies), and the Chi-square test were used. Statistical significance was set at P < 0.05. RESULTS In total, 220 patients (172 females and 48 males) were evaluated. NCs were present in 92.3% of all MCs and were significantly higher in patients aged <25 years. BMCs were observed in 106 patients (24.1%). The most common BMC of MC/IAN was in the forward canal (14.4%), followed by the retromolar canal (7.5%). CONCLUSION Although previously, the dental canal was considered as an anatomical variation, this study revisited the classification and suggested that dental canals are anatomical structures.
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Affiliation(s)
- M Öçbe
- Department of Oral and Maxillofacial Radiology, Institute of Health Sciences, Marmara University, Istanbul, Turkiye
| | - M O Borahan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkiye
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An evaluation of mandibular canal variations: a systematic review and meta-analysis. Anat Sci Int 2023; 98:176-184. [PMID: 36038792 DOI: 10.1007/s12565-022-00682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 02/07/2023]
Abstract
The inferior alveolar nerve and vessels are carried via the mandibular canal, which extends bilaterally from the inferior alveolar foramen to the mental foramen. Bifid and trifid mandibular canals result from abnormal fusions of nerve canals. The purpose of this study was to provide an up-to-date and comprehensive analysis of the prevalence of mandibular canal variations among healthy adults, and to identify any potential ethnic, sex, or laterality predilections. The prevalence of the bifid mandibular canal was 18.87% and that of the trifid canal 1.3%. Unilateral variants were three times commoner than bilateral. Each mandibular half had four canals emanating from separate openings on the lingual surface of the mandibular ramus. Retromolar and forward canals were the predominant subtypes, followed by dental; buccolingual were the least frequent. The mean length and diameter of the bifid mandibular canal were 13.62 mm and 1.63 mm, respectively. The possibility of a bifid mandibular canal is a crucial consideration in dental medicine. Because anatomical variations of the mandibular canal are fairly common, awareness of them is essential for anatomy teachers and for surgeons who operate in the oromaxillofacial region.
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Tumer H, Orhan K, Aksoy S, Berberoglu A. Cone-beam-computed tomography evaluation of mandibular nutrient canals in patients with periodontal diseases. Niger J Clin Pract 2023; 26:59-64. [PMID: 36751825 DOI: 10.4103/njcp.njcp_210_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and Aim The aim of this study was to evaluate radiographically the prevalence of mandibular nutrient canals (NCs) in patients with/without periodontal bone loss with aging and to correlate the number of NCs with the severity of bone loss using cone-beam-computed tomography (CBCT). Patients and Methods CBCT examinations of 208 patients were evaluated retrospectively of all patients, 114 had periodontal bone loss, whereas 94 patients were control subjects. Alveolar bone loss investigations were performed according to the Progressive Rate Index. Results NCs were observed in 55% of the control group and 86% of the periodontitis patients. NCs were more prevalent in the elderly age group with periodontal bone loss. In the study group, the NCs were statistically more frequent than in the control subjects (P > 0.05). Conclusion Statistical analysis showed a significant difference between the age groups and the prevalence of NCs increased in patients with periodontal alveolar bone loss with aging (P < 0.05).
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Affiliation(s)
- H Tumer
- Department of Periodontology, Final International University, Faculty of Dentistry, Mersin 10, Turkey
| | - K Orhan
- Department of Dentomaxillofacial Radiology, University of Ankara, Faculty of Dentistry, Ankara, Turkey
| | - S Aksoy
- Department of Dentomaxillofacial Radiology, Near East University, Faculty of Dentistry, Mersin 10, Turkey
| | - A Berberoglu
- Department of Periodontology, Ada Kent University, Faculty of Dentistry, Mersin 10, Turkey
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Koç A, Öner Talmaç AG, Keskin S. Variation of Mandibular Canal Branching Related to Anatomical Regions in Mandible: A Radiographic Study Without Contrast. J Oral Maxillofac Surg 2022; 80:1966-1977. [PMID: 36108711 DOI: 10.1016/j.joms.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Screening mandibular canal branches and awareness of these possible canal branches is vital for patient safety and surgical success. The aim of this study was to evaluate the prevalence and localization of mandibular canal branching (MCB). METHODS This is an institutional and retrospective cohort study of patients who presented for evaluation of cone beam computed tomography (CBCT) between 2019 and 2020. The prevalence of MCB and the related foramina was estimated according to anatomical regions. Predictor variables were gender, age, anatomical region, and side of branches. Outcome variable of the study was MCB. Thus, multiple correspondence analysis was performed to determine the relationships between the categories of the variables, as well as between variables. RESULTS CBCT images were obtained from 180 patients (n = 360 hemimandible; 90 males, 90 females). MCB was observed in 130 (72.2%) of 180 patients (mean age = 38.2 ± 11.8 years). MCB was observed in 63 (48.5%) males and 67 (51.5%) females, and the prevalence of MCB did not differ significantly according to gender (P = .618). MCB was mostly observed in the molar region (69 branches, 34.3%). Foramina were detected in 60 of 248 branches (24.19%) and were mostly observed in the retromolar region (28 foramina, 46.7%). "Quadrafid" branching was detected in 2 females (1.11%). Female patients aged 19-38 years were more prone to have MCB in molar and retromolar regions. MCB was more likely to occur bilaterally. There was also a high positive correlation among the MCB, side, and anatomical regions. CONCLUSIONS MCB is not a rare anatomical variation, and even quadrafid branching can be observed in the hemimandible. CBCT images should be examined carefully for possible MCB to minimize postoperative complications during dental surgery.
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Affiliation(s)
- Alaettin Koç
- Department Head, Associate professor, Van Yuzuncu Yil University, Faculty of Dentistry, Oral and Maxillofacial Radiology Department, Van, Turkey.
| | - Ayşe Gül Öner Talmaç
- Assistant Professor, Van Yuzuncu Yil University, Faculty of Dentistry, Oral and Maxillofacial Radiology Department, Van, Turkey
| | - Sıddık Keskin
- Department Head, Professor, Van Yuzuncu Yil University, Faculty of Medicine, Department of Biostatistics, Van, Turkey
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Detection Rate and Variability in Measurement of Mandibular Incisive Canal on Cone-Beam Computed Tomography: A Study of 220 Dentate Hemi-Mandibles from Italy. J Imaging 2022; 8:jimaging8060161. [PMID: 35735960 PMCID: PMC9225348 DOI: 10.3390/jimaging8060161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/29/2022] [Accepted: 06/04/2022] [Indexed: 12/10/2022] Open
Abstract
The mandibular incisive canal (MIC) is a small bony channel located in the interforaminal region; it represents the anterior continuation of the mandibular canal. Cone-beam computed tomography (CBCT) is the most commonly utilized radiological technique for assessing the MIC. The main purpose of this study was to evaluate the detectability and variability in measurements of the MIC on CBCT. A total of 220 dentate hemi-mandibles were retrospectively selected for this study. For each hemi-mandible, the detectability, diameter, and distance of the MIC from anatomical landmarks (cortical plates and tooth apices) were evaluated in consensus by two observers. The analysis was performed at four different levels (first premolar, canine, lateral incisor, and central incisor) and was repeated after one month. The variability of MIC measurements was expressed as the coefficient of repeatability (CR), obtained from the Bland-Altman analysis. The MIC detection rate reduced from the first premolar to the central incisor (from 82.3% to 0.5%). The CR of MIC measurements (diameter and distances from anatomical landmarks) was ≤0.74 mm. Although the MIC is difficult to detect in a non-negligible percentage of cases, the limited variability in measurements confirms that CBCT is an effective technique for the assessment of the MIC.
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Caughey JA, Do Q, Shen D, Ohyama H, He P, Tubbs RS, Iwanaga J. Comprehensive review of the incisive branch of the inferior alveolar nerve. Anat Cell Biol 2021; 54:409-416. [PMID: 34620736 PMCID: PMC8693131 DOI: 10.5115/acb.21.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
The incisive branch of the inferior alveolar nerve is a vital anatomical structure within the anterior mandible that has not been thoroughly defined and outlined in reports in the literature until recent years. Advances in radiological imaging, particularly the widespread use of cone-beam computed tomography has allowed for accurate visualization of the mandibular incisive canal (MIC) and its associated incisive branch of the inferior alveolar nerve. Surgical damage to the MIC, which could result in hemorrhage and sensory disturbance, may occur in commonly practiced oral and maxillofacial procedures, such as chin bone harvesting, implant placement, fracture repair and removal of pathologic entities of the anterior mandible. Knowledge of both the presence, dimensions and location of the incisive branch is a vital component to pre and peri-operative planning of oral and maxillofacial surgeries performed within the mandible, particularly within the interforaminal zone. In this article, the terminology, anatomy, imaging, surgical consideration, and pathology of the incisive branch will be discussed.
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Affiliation(s)
- Jennifer A Caughey
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, PA, USA
| | - Quang Do
- Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Daniel Shen
- Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Hiroe Ohyama
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Puhan He
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, PA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Is MRI a viable alternative to CT/CBCT to identify the course of the inferior alveolar nerve in relation to the roots of the third molars? Clin Oral Investig 2020; 25:3861-3871. [PMID: 33289048 PMCID: PMC8137481 DOI: 10.1007/s00784-020-03716-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/25/2020] [Indexed: 12/23/2022]
Abstract
Objectives To assess the reliability of judging the spatial relation between the inferior alveolar nerve (IAN) and mandibular third molar (MTM) based on MRI or CT/CBCT images. Methods Altogether, CT/CBCT and MRI images of 87 MTMs were examined twice by 3 examiners with different degrees of experience. The course of the IAN in relation to the MTM, the presence/absence of a direct contact between IAN and MTM, and the presence of accessory IAN were determined. Results The IAN was in > 40% of the cases judged as inferior, while an interradicular position was diagnosed in < 5% of the cases. The overall agreement was good (κ = 0.72) and any disagreement between the imaging modalities was primarily among the adjacent regions, i.e., buccal/lingual/interradicular vs. inferior. CT/CBCT judgements presented a very good agreement for the inter- and intrarater comparison (κ > 0.80), while MRI judgements showed a slightly lower, but good agreement (κ = 0.74). A direct contact between IAN and MTM was diagnosed in about 65%, but in almost 20% a disagreement between the judgements based on MRI and CT/CBCT was present resulting in a moderate overall agreement (κ = 0.60). The agreement between the judgements based on MRI and CT/CBCT appeared independent of the examiner’s experience and accessory IAN were described in 10 cases in MRI compared to 3 cases in CT/CBCT images. Conclusions A good inter- and intrarater agreement has been observed for the assessment of the spatial relation between the IAN and MTM based on MRI images. Further, MRI images might provide advantages in the detection of accessory IAN compared to CT/CBCT. Clinical relevance MRI appears as viable alternative to CT/CBCT for preoperative assessment of the IAN in relation to the MTM. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-020-03716-4.
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Stumpf K, Kaye E, Paul J, Wundrak S, Pauly JM, Rasche V. Two‐dimensional UTE overview imaging for dental application. Magn Reson Med 2020; 84:2616-2624. [DOI: 10.1002/mrm.28312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kilian Stumpf
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
| | - Elena Kaye
- Department of Medical Physics Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jan Paul
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
- Dental Imaging Dentsply Sirona Bensheim Germany
| | - Stefan Wundrak
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
- Dental Imaging Dentsply Sirona Bensheim Germany
| | - John M. Pauly
- Department of Electrical Engineering Stanford University Stanford California USA
| | - Volker Rasche
- Department of Internal Medicine II Ulm University Medical Center Ulm Germany
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Gomes LT, de Almeida Barros Mourão CF, Braga CL, de Almeida LFD, de Mello-Machado RC, Calasans-Maia MD. Anatomic evaluation of the incisive canal with cone beam computed tomography and its relevance to surgical procedures in the mental region: a retrospective study in a Brazilian population. Oral Maxillofac Surg 2018; 22:379-384. [PMID: 30178154 DOI: 10.1007/s10006-018-0716-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the prevalence, location, length, diameter, and distances related to the incisive canal (IC) and the need for cone beam computed tomography (CBCT) as a complementary exam prior to surgery in the mental region. MATERIALS AND METHODS One hundred CBCT images from patients of both genders aged 27 to 73 years were evaluated. At every 3 mm, the diameter (DIAM) of the right and left ICs and their location, their distance to base of the jaw (BIC), the buccal (BAIC) and lingual (LAIC) aspects, and their length were measured. RESULTS The 100 patients comprised 50 men (50%) and 50 women (50%). The IC was detected in 78 patients, more frequently in women (80%) than in men (76%). Measurements were taken in millimeters. The mean measurements for the two sides and for men and women combined were as follows: BIC = 10.0, BAIC = 4.0, LAIC = 6.2, ICL = 19.9, and DIAM = 1.4. CONCLUSIONS The measurements show the need for care from professionals when performing intraosseous surgical procedures in the mental region. The distances between the IC and the references studied must be observed. Thus, CBCT becomes essential for surgical planning in the mental region. CLINICAL RELEVANCE The mental region of the mandible is considered a safe area to perform surgical procedures such as the placement of osseointegrated implants, orthognathic surgery, and the removal of bone grafts. However, this region includes important neurovascular structures that must be considered or else hemorrhage and neurologic disorders can be experienced.
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de Castro MAA, Barra SG, Vich MOL, Abreu MHG, Mesquita RA. Mandibular canal branching assessed with cone beam computed tomography. Radiol Med 2018; 123:601-608. [DOI: 10.1007/s11547-018-0886-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
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Kong N, Hui M, Miao F, Yuan H, Du Y, Chen N. Mandibular incisive canal in Han Chinese using cone beam computed tomography. Int J Oral Maxillofac Surg 2016; 45:1142-6. [PMID: 27184354 DOI: 10.1016/j.ijom.2016.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 02/19/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
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12
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Histologic features and fascicular arrangement of the inferior alveolar nerve. Arch Oral Biol 2015; 60:1736-41. [DOI: 10.1016/j.archoralbio.2015.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/23/2015] [Accepted: 09/09/2015] [Indexed: 11/21/2022]
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Vu DD, Brockhoff HC, Yates DM, Finn R, Phillips C. Course of the mandibular incisive canal and its impact on harvesting symphysis bone grafts. J Oral Maxillofac Surg 2015; 73:258.e1-258.e12. [PMID: 25579015 DOI: 10.1016/j.joms.2014.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 09/30/2014] [Accepted: 10/04/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To characterize the anatomic course of the mandibular incisive canal to define parameters for harvesting autogenous bone from the symphysis of the mandible. MATERIALS AND METHODS A series of osteotomies were completed between the mental foramina in the anterior mandibles of 19 cadavers. Methylene blue dye was used to help identify the incisive canal. From the canal, distances to key adjacent landmarks were measured with a Boley gauge to 0.1 mm. Measurements included distances from the mandibular incisive canal to the buccal cortex, the lingual cortex, the inferior border of the mandible, the apices of the teeth, and the buccal cementoenamel junction (CEJ) of the teeth. RESULTS The canal decreased in diameter from lateral to medial. It tended to be closer to the buccal cortical bone than to the lingual cortex (P < .001) and was, at times, directly abutting the buccal cortex (average distance to buccal cortex, 3.5 mm). The canal maintained a relatively constant distance from the apices of the teeth (approximately 7 to 8 mm), coursing inferiorly under the longer canines bilaterally. The canal became increasingly difficult to identify toward the midline, likely dispersing into microscopic tributaries. CONCLUSIONS The authors suggest several modifications to the standard surgical approach to the symphysis area during the harvest of bone grafts. When the goal is to avoid the mandibular incisive canal, osteotomies should not exceed a depth of 4 mm, should be at least 5 mm anterior to the mental foramen, and 9 mm below the root apices (or 23 mm below the lowest facial CEJ) and should maintain the contour of the mandible's inferior border. Alternatively, some degree of canal compromise can be accepted and larger grafts can be obtained by increasing the depth of the harvest in the horizontal dimension or decreasing the distance from the osteotomy to the root apices (or the CEJ) in the vertical dimension.
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Affiliation(s)
- David D Vu
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Texas Southwestern Medical Center/Parkland, Dallas, TX.
| | - Hans C Brockhoff
- Fellow, Oral and Maxillofacial Head and Neck Oncology Surgery, University of Michigan, Ann Arbor, MI
| | - David M Yates
- Fellow, Cleft Lip/Palate and Craniofacial Surgery, Louisiana State University, Shreveport, LA
| | - Richard Finn
- Professor, Division of Oral and Maxillofacial Surgery, Department of Surgery, and Department of Cell Biology, University of Texas Southwestern Medical Center, Dallas; Chief, Oral and Maxillofacial Surgery, Veteran's Affairs North Texas Health Care System, Dallas, TX
| | - Ceib Phillips
- Assistant Dean, Advanced Education/Graduate Programs; Director, Curriculum in Oral Biology; Professor, Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
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Bertl K, Hirtler L, Dobsak T, Heimel P, Gahleitner A, Ulm C, Plenk H. Radiological assessment of the inferior alveolar artery course in human corpse mandibles. Eur Radiol 2014; 25:1148-53. [PMID: 25413966 DOI: 10.1007/s00330-014-3484-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 09/10/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES CT assessment of the entire course of the inferior alveolar artery (IAA) within the mandibular canal. METHODS After contrast medium injection (180 or 400 mg/ml iodine concentration) into the external carotid arteries of 15 fresh human cadaver heads, the main IAA's position in the canal (cranial, buccal, lingual or caudal) was assessed in dental CT images of partially edentulous mandibles. RESULTS The course of the main IAA could be followed at both iodine concentrations. The higher concentration gave the expected better contrast, without creating artefacts, and improved visibility of smaller arteries, such as anastomotic sections, dental branches and the incisive branch. The main IAA changed its position in the canal more often than so far known (mean 4.3 times, SD 1.24, range 2-7), but with a similar bilateral course. A cranial position was most often detected (42 %), followed by lingual (36 %), caudal (16 %) and buccal ( 6 %). CONCLUSIONS With this non-invasive radiologic method, the entire course of the main IAA in the mandibular canal could be followed simultaneously with other bone structures on both sides of human cadaver mandibles. This methodology allows one to amend existing anatomical and histological data, which are important for surgical interventions near the mandibular canal. KEY POINTS • Contrast medium injection displayed the inferior alveolar artery's course on mandibular CTs • An iodine concentration of 400 mg/ml enabled visibility until the chin • Frequent position changes of the artery in the mandibular canal were detected • Cranial and lingual positions were most often determined • Course similarities on the respective left and right sides were found.
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Affiliation(s)
- Kristina Bertl
- Division of Oral Surgery, Bernhard Gottlieb School of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria,
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Anatomic variations and lesions of the mandibular canal detected by cone beam computed tomography. Surg Radiol Anat 2013; 36:795-804. [DOI: 10.1007/s00276-013-1247-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
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Number of accessory or nutrient canals in the human mandible. Clin Oral Investig 2013; 18:671-6. [PMID: 23743519 DOI: 10.1007/s00784-013-1011-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of the study was to assess the presence, location and the number of accessory or nutrient canals in the body of the mandible by means of cone beam CT images, obtained with the Planmeca ProMax® 3D Max device. MATERIAL AND METHODS Seventy-four cone beam images of the mandible from adult patients (37 males and 37 females) who were imaged for dental implantology planning or third molar extraction were used to assess the number and location of accessory or nutrient canals. All images were taken with the same machine (Planmeca® ProMax 3D Max) at 200-, 400- or 600-μm resolution. Distinction was made between canals entering or exiting the mandible superior or inferior of the inferior alveolar canal and between similar canals superior or inferior of the genial tubercula. RESULTS The number of accessory canals varied between nil to 11. No statistical significant difference between males and females was found with regard to the number or location of accessory canals in the mandible. Only 5.4% of patients had no accessory canals. One to five accessory canals were found in 71.6%, and 23% of patients had more than five accessory canals. The majority (81%) of patients had between two and six accessory canals. CONCLUSION It seems that subjects showing no accessory canals whatsoever should be considered exceptional as more subjects with than without accessory canals in the body of the mandible were found. CLINICAL RELEVANCE These results are clinically relevant for mandibular surgery and mandibular local anaesthesia.
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Impact of the mandibular divergence on the position of the inferior alveolar nerve and mylohyoid nerve: a computed tomography study and its relevance to bilateral sagittal split osteotomy. Surg Radiol Anat 2012; 35:241-7. [PMID: 22926343 DOI: 10.1007/s00276-012-1010-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 08/13/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Bilateral sagittal split osteotomy (BSSO) is the most common procedure used to treat mandibular deformities. BSSO procedures include the Epker technique and the Dal Pont technique which are the most frequently used. Because of the intramandibular pathway of the inferior alveolar nerve (IAN), neurosensory disturbance of the lower lip and chin is the most common complication of BSSO. This study performed quantitative measurements from computed tomographic (CT) data obtained on dry human mandibles. The main aim of the study was to evaluate if mandibular divergence can predict the position of the IAN and the mylohyoid nerve (MHN) to prevent nerve injury. METHODS After CT and 3D reconstruction of 65 dry mandibles, 30 measurements were made on 3 planes for each hemi-mandible. This allowed analysis of the IAN and MHN pathways. Three groups of hemi-mandibles were created depending on their divergence, and a statistical analysis was performed. RESULTS Eight out of the 30 measurements showed a significant difference among the 3 groups. There was no significant difference for the remaining 22 measurements. CONCLUSIONS The IAN seems to have a more superior position in the groups of mandibular hypo- and hyper-divergence. Orthognathic surgeons should use a more superficial retromolar bone incision in these cases. Finally, the Epker technique would be safer for preserving the MHN in normo- and hypo-divergent patients.
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