Detection of the Accessory Mental Foramina on Human Mandibles Using Cone-beam Computed Tomography: A Systematic Review and Meta-analysis

Prevalence of accessory mental foramen and lateral lingual foramen using cone beam computed tomography: A single-center cross-sectional study

PURPOSE

This study aimed to assess the prevalence, dimensions, and positions of accessory mental foramen (AMF) and lateral lingual foramen (LLF) in an Iranian population using cone beam computed tomography (CBCT).

METHODS AND MATERIALS

In this cross-sectional study, CBCT images of 2082 patients were retrospectively reviewed based on inclusion criteria, including images from the mandibular region taken in the past five years with accurate demographic data. Exclusion criteria included images with significant pathologies, fractures, or poor quality. CBCT images were captured, and AMF and LLF presence (primary outcome variable), dimensions, and positions (secondary outcome variables) were recorded relative to the mental foramen and adjacent teeth. Data analysis was performed using the Chi-square test with a 5% significance level.

RESULTS

A total of 2082 CBCT samples (46.54% females and 53.46% males) with a mean age of 48.30 ± 12.70 years were examined. Among these, 246 AMFs were observed in 222 individuals with a prevalence at the foramen level of 11.815%, with 24 having two AMFs. AMF was mostly observed unilaterally, with bilateral occurrence noted in 10.81% of patients with AMF. Additionally, 86 patients were found to have LLF with a prevalence at the foramen level of 5.907%. There were no significant differences between genders in AMF and LLF prevalence.

CONCLUSION

AMF and LLF were detectable using CBCT in the selected Iranian population. AMF was commonly situated posterior and superior to the mental foramen, while LLF was often found near the first premolar. This knowledge is crucial for preventing nerve injury during surgery and ensuring effective nerve block procedures.

Accessory lingual mental foramen: A case report of a rare anatomic variation

INTRODUCTION

The mandibular nerve and the mental foramen have occasionally shown variations in its anatomy. This report aims to present a case of lingual mental foramen recognised on three-dimensional cone beam computed tomographic imaging (CBCT).

CASE REPORT

Routine Orthopantomogram (OPG) and CBCT images were evaluated to assess the status of impact third molars in a 31-year-old female who had visited the dental clinics in our institution. The OPG image failed to reveal any anatomic variation in the position of the mental foramen. On tracing the course of the mandibular canal in CBCT images, two foramina were traced at the region of premolar. One opened towards the buccal cortical plate at the normal position of the mental foramen and an accessory lingual mental foramen had an opening on the lingual cortical bone at the same level as the mental foramen.

CONCLUSION

Understanding variations of the mental foramen is extremely essential in dentistry to carry out successful anaesthetic or surgical interventions and to avoid complications such as nerve damage or excessive bleeding.

Morphological Characteristics of the Double Mental Foramen and Its Relevance in Clinical Practice: An Observational Study

The mental foramen (MF) is an opening found bilaterally on the anterolateral aspect of the mandible; it can be round or oval and have different diameters. One of the anatomical variants of the jaw is the presence of an accessory mental foramen (AMF). These are usually smaller than the MF and can be located above, below, or to the sides of the main MF. The objective of this study was to recognize the presence of AMF in dry jaws of the Chilean population and collect information about its clinical relevance reported in the literature. In this descriptive observational study, we have collected dried jaws obtained from three higher education institutions in Santiago de Chile, from the Department of Morphology of the Andrés Bello University, the Normal Human Anatomy Unit of the University of Santiago, and the Human Anatomy pavilion from the Faculty of Medicine of the Finis Terrae University. The samples for this research were obtained by convenience, and the observation of the jaws was carried out in the human anatomy laboratories of each institution by three evaluators independently, and a fourth evaluator was included to validate that each evaluation was correct. The sample for this research came from 260 dry jaws, showing the following findings from the total jaws studied, and to classify as an accessory MF, it will be examined and measured so that it complies with what is declared in the literature as the presence of AMF, which is between 0.74 mm. and 0.89 mm. There were 17 studies included with a sample that fluctuated between 1 and 4000, with a cumulative total of 7946 and an average number of jaws analyzed from the studies of 467.4, showing statistically significant differences between the means with the sample analyzed in this study; p = 0.095. For the cumulative prevalence of the presence of AMF, this was 3.07 in this study, and in the compared studies, the average of AMF was 8.01%, which did not present a statistically significant difference; p = 0.158. Regarding the presence of variants of unilateral AMF, this occurred in five jaws, which is equivalent to 1.84% in the sample of this study, while in previous studies, it was 7.5%, being higher on the left side than on the right. The presence of AMF is a variant with high prevalence if we compare it with other variants of the jaw. Knowledge of the anatomy and position of the AMF is crucial to analyze different scenarios in the face of surgical procedures or conservative treatments of the lower anterior dental region.

Multiple Mental Foramina: A Rare Anatomical Variation Detected by Cone-Beam Computed Tomography (CBCT)

The mental foramen is a single anatomical structure that can be seen bilaterally in the body of the mandible and generally in the lower area of the premolars. Sometimes, the mental foramen can have accessory foramina that should be considered. Clinical evaluation of the accessory mental foramina is critical because of its neurovascular fibers. Identifying the secondary mental foramen reduces the possibility of paraesthesia and pain after surgery.

Bifid Mandibular Canal: A Proportional Meta-Analysis of Computed Tomography Studies

Introduction

Growing body of evidences showed different grades in prevalence of bifid mandibular canals. Because the previous reviews focused solely on patient-level occurrence, hemi-mandible-level prevalence, bilateral symmetry, length, and diameter of bifid mandibular canals were required to be estimated collectively. The research question of this meta-analysis was "What is the prevalence of bifid mandibular canal among patients seeking computed tomography examinations"?

Materials and Methods

In vivo, computed tomography, and cross-sectional studies were eligible. Studies, with less than 100 subjects or anatomic site restriction or controlled class of bifid mandibular canal, were excluded. Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies was used to assess methodological quality of all included studies. Random effect meta-analyses for proportion of bifid mandibular canal were done.

Results

40 studies met the inclusion criteria. All studies were selected for both systematic review and meta-analyses. Totally, 17714 patients and 31973 hemi-mandibles were included. All eligible studies showed moderate risk of bias on average. Resulting from the random effect model, more than 20% of patients seeking computed tomographic examinations had bifid mandibular canals (BMCs) which penetrated into slightly more than 14% of hemi-mandibles. Of the patients having bifid mandibular canals (BMCs), nearly 23% exhibited such anatomy on both sides of their mandibles. Estimated mean length and diameter of the accessory canals of bifid mandibular canals were 12.17 mm and 1.54 mm, respectively.

Conclusion

The geographical locations, classifications, reliability test, and voxel size of computed tomography were all implicated in the prevalence of bifid mandibular canals along with gender and laterality, although considerable heterogeneity and bias were detected.