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Jolly SS, Lata J, Sharma RK, Vashist R. Presence of antilingula and its relationship to mandibular foramen-An anatomical study. Natl J Maxillofac Surg 2024; 15:228-232. [PMID: 39234135 PMCID: PMC11371280 DOI: 10.4103/njms.njms_18_23] [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: 01/19/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 09/06/2024] Open
Abstract
Aim Aim of this study was to evaluate the presence of antilingula and its relationship with mandibular foramen. Materials and Methods In this study, a total of 50 specimens of dry human hemi-mandibles were studied to analyze the presence and relationship of antilingula to mandibular foramen. A 1-mm fissure bur was used to drill a hole perpendicular to bone from the deepest aspect of the concavity at the center of the mandibular foramen from the medial to lateral side, the drill perforated both the medial and lateral cortex of the mandible. The distance from the antilingula to hole was measured and recorded in both antero-posterior and supero-inferior planes. The data were collected and put to statistical analysis. Results From this study, it was concluded that the antilingula was present in 90% (n = 45) of mandibles and was absent in 10% (n = 5) of mandibles. Antero-posteriorly, the antilingula was present anterior to mandibular foramen in 22.2% (n = 10) of mandibles, posteriorly in 57.7% (n = 26) of mandibles, and there was complete concordance in 20% (n = 9) of mandibles. The supero-inferior relation shows that antilingula was present superior to mandibular foramen in 97.8% (n = 44) of mandibles, and it was present inferiorly in 2.20 (n = 1) of mandibles. Conclusion Although vertical ramus osteotomy is not a commonly used procedure in these days. From our study, it was concluded that antilingula was present as an elevation in 90% of cases on the lateral ramus border and the mandibular foramen is present inferior and anterior to the antilingula.
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Affiliation(s)
- Satnam S. Jolly
- Department of Oral and Maxillofacial Surgery, Oral Health Sciences Center, PGIMER, Chandigarh, India
| | - Jeevan Lata
- Department of Oral and Maxillofacial Surgery, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
| | - Ravi K. Sharma
- Department of Anatomy, Government Medical College and Hospital, Amritsar, Punjab, India
| | - Ruchi Vashist
- Department of Conservative Dentistry and Endodontics, Oral Health Sciences Center, PGIMER, Chandigarh, India
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Vorakulpipat C, Arayapisit T, Topothai P, Bhunyanaphakul V, Tiptimaphan K, Apilakkitakul N, Chantadul V. Determining the position of the lingula and the mandibular foramen using the antilingula in orthognathic surgery. BMC Oral Health 2024; 24:499. [PMID: 38678231 PMCID: PMC11055278 DOI: 10.1186/s12903-024-04286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The antilingula located on the lateral surface of the mandibular ramus has been served as a surgical landmark for the mandibular foramen on the medial surface for decades. However, whether the antilingula truly represents the lingula which is the bony prominence overlapping the mandibular foramen, or the foramen itself, is still unclear. This study thus aimed to examine the position of the antilingula in relation to three reference points: the lingula, the anterior and the posterior borders of the mandibular foramen, as well as to the reference plane used in the inferior alveolar nerve block, and to the posterior border of the mandible. METHODS This observational study was performed in 113 Thai dry mandibles. The antilingula were identified followed by transferring the reference points to the lateral surface. The distances from the antilingula to the reference points, the reference plane and the posterior border of the ramus were then measured. Chi-square test was calculated for side-dependency of the antilingula. Paired t-test was calculated for difference in measurements in left and right sides. RESULTS The antilingula could be identified in 92.48% of the mandibles with 86.67 - 90.00% accuracy and 86.67% reliability. There was no significant difference in the presence of the antilingula on left and right sides (p = 0.801). Only 2.5% and 0.83% of the antilingula correspond to the lingula and the anterior border of the mandibular foramen, respectively. However, 85% of the reference points were located within 11 mm radius. The antilingula was found located 2.80 mm inferior to the reference plane and 16.84 mm from the posterior border of the ramus. CONCLUSIONS The antilingula does not concur with the reference points on the medial surface. Our study also suggests that the safe area for vertical osteotomy is 11 mm posterior to the antilingula or at 30% of the length from the posterior border parallel to the occlusal plane. The use of more accurate techniques in localizing the mandibular foramen combined with the antilingula is more recommended than using the antilingula as a sole surgical guide.
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Affiliation(s)
- Chakorn Vorakulpipat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Tawepong Arayapisit
- Department of Anatomy, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Pee Topothai
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | | | | | - Varunya Chantadul
- Department of Anatomy, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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Sinanoglu A, Seki U, Tokuc B. A detailed radiomorphometric analysis of the mandibular foramen, lingula and anti-lingula with a special emphasis on mandibular prognathism. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101260. [PMID: 35948234 DOI: 10.1016/j.jormas.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/17/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate radiomorphometric differences of mandibular foramen (MF), lingula (Li), and anti-lingula (AL) between prognathic and non-prognathic patients, using cone-beam computed tomography (CBCT). METHODS A total of 228 3D CBCT images of 57 prognathic and 57 non-prognathic patients were retrospectively evaluated. The distances between MF or Li to occlusal plane (OP), anterior border of ramus (AR), posterior border of ramus (PR), sigmoid notch (SN), gonion (Go) and distances Li to MF were measured. The presence of AL, and the distances to Li were also assessed in both groups. RESULTS In prognathic patients the mean distances of MF-AR and Li-PR were lesser, and Li-OP was greater (p < 0.05). However, distances from MF or Li to the other ramal landmarks were similar in both groups (p > 0.05). Presence of AL was found at 53 sides in prognathic and 20 sides in non-prognathic groups (p < 0.05). The horizontal distance of Li-MF was greater in prognathic patients (p < 0.05). On the other hand, there was no difference between groups regarding the horizontal distance of Li-Al, and the vertical distances of Li-MF and Li-AL (p > 0.05). CONCLUSION The present study provided valuable data regarding morphological differences of MF-AR, Li-MF and Li-OP, which should be considered in the preoperative assessment of patients with mandibular prognathism. Presence of AL was more common in prognathic patients and mainly located above Li. 3D CBCT applications facilitated assessment of AL and its relationship with Li.
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Affiliation(s)
- A Sinanoglu
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey.
| | - U Seki
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - B Tokuc
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Morphological Study of the Mandibular Lingula and Antilingula by Cone-Beam Computed Tomography. Bioengineering (Basel) 2023; 10:bioengineering10020170. [PMID: 36829665 PMCID: PMC9952157 DOI: 10.3390/bioengineering10020170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023] Open
Abstract
The patterns of the lingula and antilingula are crucial surgical reference points for ramus osteotomy. Cone-beam computed tomography (CBCT) provides three-dimensional images, and patient radiation dose is significantly lower for CBCT than for medical CT. The morphology of the mandibular lingula and antilingula of ninety patients (180 sides) were investigated using CBCT. The lingula were classified as having triangular, truncated, nodular, and assimilated shapes. The antilingula were classified as having hill, ridge, plateau, and plain shapes. The patients' sex, skeletal patterns (Classes I, II, and III), and right and left sides were recorded. The most to least common lingula shapes were nodular (37.8%), followed by truncated (32.8%), triangular (24.4%), and assimilated (5%). The most to least common antilingulae were hill (62.8%), plain (18.9%), plateau (13.9%), and ridge (4.4%) patterns, respectively. The lingula and antilingula had identical patterns on both sides in 47 (52.2%) and 46 patients (51.1%), respectively. Sex and skeletal pattern were not significantly correlated to lingula and antilingula shapes. No significant correlation was observed between lingula and antilingula shapes.
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Asha K, Thejeshwari H, Jagadish AB, Alghamdi MA, Vidya H, Muguregowda HT. An Anatomical Study of Dry Mandibles to Determine the Important Surgical Reference Points in Ramus Osteotomy - An Evaluative Study. Ann Maxillofac Surg 2023; 13:9-12. [PMID: 37711537 PMCID: PMC10499277 DOI: 10.4103/ams.ams_19_23] [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: 01/28/2023] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction The variable relation and clinical significance of mandibular foramen (MF) and Lingula with inferior alveolar neurovascular bundle (IANB) is important for dental surgeons. Knowing the landmarks on the ramus of the mandible is of paramount importance to perform the surgery without causing damage to the neurovascular bundle. Materials and Methods This study was conducted on 85 dry adult mandibles of unknown sex and age. The distances were measured from the anatomical reference points (anti-Lingula, Lingula and MF) using digital callipers. Results The distance from the anti-Lingula to the anterior border of the ramus (A) was significantly longer on the right side (14.91 mm) than on the left side (14.5 mm). There was a significant difference in mean distances between the anti-Lingula and MF of both the sides (P ≤ 0.005). No significant difference was noted in the distances between the Lingula and the Anti-Lingula, observed for the posterior (B, P = 0.75) and the inferior margin of the mandible (D, P = 0.54). However we found correlation of vertical distances of anti-Lingula with Lingula and MF exhibited moderate positive correlation. Discussion The IANB is prone to damage during mandibular surgery. Using anti-Lingula alone as a reference point is not guaranteed, but it is still an important anatomical landmark for the surgeon to operate.
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Affiliation(s)
- K.R Asha
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
| | - H.G Thejeshwari
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
| | - Archana Belavadi Jagadish
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
| | - Mansour A. Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - H.K Vidya
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India
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Kini Y, Girotra C, Padhye M, Tomar G, Kankaria M, Nebhnani S, Maini A, Meswani S. Cross sectional analysis of mandibular anthropometric points using CBCT to derive biometric measurements for a safer approach to mandible osteotomies. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2022. [DOI: 10.1051/mbcb/2021047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: This study aims to derive a series of biometric measurements using cone-beam computed tomography (CBCT) from a cross sectional group of population to help the surgeon accurately locate the mandibular foramen and the mental foramen during mandibular osteotomies. Methods: CBCT images of 800 subjects were evaluated. Various measurements were noted and compared between the two sides of the mandible in and between the sexes. Result: Statistically significant values were noted between the right and left sides of Line X to Point A in female subjects, Line Z & Line B only in male subjects and Line X’ in both male and female subjects. However, Line Y was found to be significant when comparing both sides in both males and females and also on correlation between the genders. Conclusion: Although the identification of the mandibular lingula and anatomical landmarks is an important step during mandibular osteotomies, the position of one side, however, cannot be blindly extrapolated to the contra lateral side. Also, pre operative CBCT is a useful tool to derive measurements which when transferred clinically during the surgery gives an accurate and safe approach for localisation of lingula, thus reducing the incidence of post operative neurologic morbidities.
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Kapur M, Atul Shah R, Ferro A, Basyuni S, Brassett C, Santhanam V. Response to letter to the editor. Br J Oral Maxillofac Surg 2022; 60:370-371. [DOI: 10.1016/j.bjoms.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
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Ellis E. Letter To Editor Re: Sexual dimorphism and geographical variance: their impact on the reliability of the antilingula as a landmark in human mandibular surgery. Br J Oral Maxillofac Surg 2022; 60:369. [DOI: 10.1016/j.bjoms.2021.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
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Two-thirds anteroposterior ramus length is the preferred osteotomy point for intraoral vertical ramus osteotomy. Clin Oral Investig 2021; 26:1229-1239. [PMID: 34327588 DOI: 10.1007/s00784-021-04094-1] [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: 05/31/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aimed to investigate the mandibular canal of ramus and design a suitable osteotomy line for intraoral vertical ramus osteotomy (IVRO) using cone-beam computed tomography (CBCT). MATERIALS AND METHODS Ninety patients were classified into class I, II, and III skeletal pattern groups. When extended from the horizontal base plane (0 mm, mandibular foramen [MF]), with a 2-mm section interval, to 10 mm above and 10 mm below the MF, the following landmarks were identified: external oblique ridge (EOR), posterior border of the ramus (PBR), and posterior lateral cortex of ramus (PLC): IVRO osteotomy point. RESULTS In the base plane (0-mm plane), the EOR-PBR distance of class III (34.78 mm) and the IOR-PBR distance of class II (32.72 mm) were significantly higher than those of class I (32.95 mm and 30.03 mm). Compared to the EOR-PLC distance, the designed osteotomy point (two-thirds EOR-PBR length) has a 3.49-mm safe zone at the base plane and ranging from 0.89 mm (+ 10-mm plane) to 8.37 mm (- 10-mm plane). CONCLUSIONS The position at two-thirds EOR-PBR length (anteroposterior diameter of the ramus) can serve as a reference distance for the IVRO osteotomy position. CLINICAL RELEVANCE Mandibular setback operations for treating mandibular prognathism mainly include sagittal split ramus osteotomy (SSRO) and IVRO. IVRO has a markedly lower incidence of postoperative lower lip paraesthesia than SSRO. Our design presented a reference point for identification during IVRO, to prevent damage to the inferior alveolar neurovascular bundle.
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Antilingula as a Surgical Reference Point for Vertical Ramus Osteotomy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5585297. [PMID: 33997020 PMCID: PMC8081601 DOI: 10.1155/2021/5585297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022]
Abstract
Purpose This study investigated the antilingula and its related landmarks, the mandibular rami, by using cone-beam computed tomography (CBCT). Methods CBCT images of 37 patients (74 sides of the mandibular ramus) were collected. The landmarks of antilingula (AntiL), anterior ramus (A), posterior ramus (P), superior ramus (S), and inferior ramus (I) were identified. The distances (A-AntiL, P-AntiL, S-AntiL, and I-AntiL) were statistically evaluated according to gender, side (right and left), and skeletal patterns. Results The distance from the antilingula to the anterior (A-AntiL) border of the ramus was significantly longer on the right side (14.69 mm) than on the left side (13.97 mm). Male patients had longer AntiL-P, AntiL-I, and S-I distances (18.96, 40.07, and 54.94 mm, respectively) than did female patients (16.66, 35, and 47.54 mm, respectively). Regarding skeletal patterns, the classes can be ordered as follows in terms of the measurements: class III>class II>class I. However, the differences between the classes were nonsignificant. Pearson correlation analysis revealed that gender and S-I distance were strongly correlated (r = 0.667); specifically, male patients had a longer S-I distance. A-AntiL and A-P also exhibited a strong correlation (r = 0.796). Conclusion Antilingula-related distances did not differ between skeletal patterns. Among antilingula-related variables, A-AntiL could serve as a favorable measuring point during operation.
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Hsu HJ, Chen YS, Chen PH, Chen HS, Chen CM. The correlation between surgical reference points: antilingula, lingula, and mandibular foramen. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:535-538. [PMID: 33307209 DOI: 10.1016/j.jormas.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022]
Abstract
The purpose of the present study was to investigate and determine the anatomical relationship between the antilingula, lingula, and mandibular foramen using cone-beam computed tomography (CBCT). METHODS CBCT images of 90 participants (180 mandibular ramus) were collected. The locations of and distances between the antilingula, lingual, and mandibular foramen according to side (right and left) and skeletal patterns were measured and then evaluated by statistical analysis. RESULTS Only 27 participants (15%) had bilateral distinct antilingula, lingula, and mandibular foramen. The antilingula was located anteriorly (4.28 mm and 3.59 mm) and above (1.99 mm and 8.52 mm) the lingula and mandibular foramen. The lingula was behind (0.69 mm) and above (6.53 mm) the mandibular foramen. Skeletal Class III was anterior and inferior to Class II and Class I in the antilingula, lingula, and mandibular foramen. Considering the correlations of landmarks, we found that the lingula was strongly correlated with the mandibular foramen on the X axis (r = 0.757) and Y-axis (r = 0.878). CONCLUSION The antilingula is located anteriorly and above the lingula and mandibular foramen. The lingula is behind and above the mandibular foramen. The osteotomy line of orthognathic surgery can only be safely designed through actual measurement of the locations of the antilingula, lingula, and mandibular foramen.
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Affiliation(s)
- Han-Jen Hsu
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Sheng Chen
- Dental Department, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
| | - Ping-Ho Chen
- School of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Sheng Chen
- Dental Department, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.
| | - Chun-Ming Chen
- Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Hsiao SY, Hsu KJ, Liang SW, Tseng YC, Chen CM. The presence probability of mandibular lingla and antilingula. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:621-625. [PMID: 32222578 DOI: 10.1016/j.jormas.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The lingula and antilingula are crucial surgical landmarks for mandibular setback surgery. The purpose of study was to investigate the correlation of presence probability between lingual and antilingula. MATERIALS AND METHODS A total of 180 cone-beam computed tomography sides were collected from 90 patients. The probability of absence of the lingula and antilingula was recorded with respect to the gender, mandible (unilateral and bilateral), and skeletal patterns (Class I, II, III); in addition, the correlations between these variables were analysed. RESULTS Of the 180 sides, 9 sides showed the absence of the lingula (5%) and 34 sides showed the absence of the antilingula (18.9%). Pearson's test revealed that the presence of the lingula and antilingula differed nonsignificantly with respect to gender and skeletal patterns, respectively. The bilateral presence of the lingula was observed in 16 sides (91.1%), and that of the antilingula was observed in 122 sides (67.8%). Pearson's test verified a significant correlation between the presence of the left and right lingula (P<0.05). By contrast, gender and skeletal patterns were nonsignificantly correlated with the presence of the lingula and antilingula. The presence of the lingula was also nonsignificantly correlated with that of the antilingula. CONCLUSION Gender and skeletal patterns were nonsignificantly correlated with the presence of the lingula and antilingula, respectively. The presence of the lingula was also nonsignificantly correlated with that of the antilingula. Consequently, lingula and antilingula cannot serve as the absolute standards for mandibular setback surgery.
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Affiliation(s)
- S-Y Hsiao
- Department of dentistry for child and special needs, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - K-J Hsu
- Graduate institute of dental sciences, College of dental medicine, Kaohsiung medical university, Kaohsiung, Taiwan; Department of Dentistry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - S-W Liang
- Graduate institute of dental sciences, College of dental medicine, Kaohsiung medical university, Kaohsiung, Taiwan
| | - Y-C Tseng
- Graduate institute of dental sciences, College of dental medicine, Kaohsiung medical university, Kaohsiung, Taiwan; Department of Orthodontics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - C-M Chen
- Graduate institute of dental sciences, College of dental medicine, Kaohsiung medical university, Kaohsiung, Taiwan; Department of Oral and Maxillofacial Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Liu Z, Cao J, Qian Y, Sun H, Sun Y, Shen SG, Wang X. Course of the mandibular canal in hemifacial microsomia: a retrospective computed tomography study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:558-563. [DOI: 10.1016/j.oooo.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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CBCT study on the relationship between lingula and antilingula position in a Chinese Han population. Surg Radiol Anat 2019; 41:663-667. [PMID: 30903207 DOI: 10.1007/s00276-019-02224-9] [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: 01/21/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this article was to assess the anatomical relationship between the lingula and the antilingula by measuring the projection of lingula on the lateral side of the ramus on CBCT. METHODS This study collected CBCT images of 204 mandibular halves in 102 Chinese patients without any damage. We projected the lingula to the lateral side of the mandibular ramus and examined the distance and position relationship between the projection point and the antilingula using three-dimensional computed tomography (3DCT) created by image software. RESULTS In 204 sides the antilingula appeared in 92 cases, 52 on right and 40 on left. The antilingula was used as a fixed point, in four cases the lingula projection in the anterior superior part, 38 cases in the posterior superior part, 45 cases in the posterior inferior part and zero case in the anterior inferior part. Scatter plots diagrammatic representation in four quadrants centered on the antilingula showed that 79% cases (73/92) lied in a 90° fan shape ranged in 5-10 mm radius in the posterior superior and inferior quadrant. CONCLUSION The lingula mainly located in the posterior superior and inferior part from the antilingula in a 90° fan shape ranged in 5-10 mm radius. The osteotomy incision should be avoided in this area.
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Park JH, Jung HD, Kim HJ, Jung YS. Anatomical study of the location of the antilingula, lingula, and mandibular foramen for vertical ramus osteotomy. Maxillofac Plast Reconstr Surg 2018; 40:15. [PMID: 30094227 PMCID: PMC6057865 DOI: 10.1186/s40902-018-0155-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to identify the location of the antilingula, lingula, and mandibular foramen in Korean cadavers and to promote safe and accurate surgery without damage to the inferior alveolar neurovascular bundle (IANB) when performing a vertical ramus osteotomy (VRO). Methods This study was conducted on the dried mandibles of 20 adult cadavers. Digital calipers were used to measure the distances from the anatomical reference points (antilingula, lingula, and mandibular foramen). Result The antilingula was located at the anterior 44% and superior 31% in the ramus. The lingula was located at the anterior 55% and superior 30% in the ramus. The mandibular foramen was located at the anterior 58% and superior 46% in the ramus. Regarding the positional relationship with the antilingula, the lingula was located 0.54 mm superior and 4.19 mm posterior, and the mandibular foramen was located 6.95 mm inferior and 4.98 mm posterior. The results suggested that in order to prevent damage to the IANB, osteotomy should be performed in the posterior region of ramus at least 29% of the total horizontal length of the ramus. Conclusion Using only the antilingula as a reference point is not guaranteed to IANB injury. However, it is still important as a helpful reference point for the surgeon in the surgical field.
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Affiliation(s)
- Jin Hoo Park
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seodaemoon-Gu, Seoul, 120-752 South Korea
| | - Hwi-Dong Jung
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seodaemoon-Gu, Seoul, 120-752 South Korea
| | - Hyung Jun Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seodaemoon-Gu, Seoul, 120-752 South Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seodaemoon-Gu, Seoul, 120-752 South Korea
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He P, Iwanaga J, Matsushita Y, Adeeb N, Topale N, Tubbs RS, Kusukawa J. A Comparative Review of Mandibular Orthognathic Surgeries with a Focus on Intraoral Vertico-sagittal Ramus Osteotomy. Cureus 2017; 9:e1924. [PMID: 32760640 PMCID: PMC7394221 DOI: 10.7759/cureus.1924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Severe dentofacial deformities require both orthodontics and surgical management to repair. Modern mandibular orthognathic surgery commonly uses sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) methods to treat patients. However, complications like neurosensory disturbances and temporomandibular joint disorders are common following both procedures. In 1992, Choung introduced the intraoral vertico-sagittal ramus osteotomy (IVSRO) which led to a decrease in postoperative complications. The 'straight' IVSRO or Choung’s type II osteotomy has a 'condylotomy' effect that reduces iatrogenic temporomandibular joint symptoms and treats preoperative temporomandibular joint symptoms. This osteotomy type is especially applicable for prognathism with excessive flaring of the ramus and with temporomandibular joint dysfunction. The 'L-shaped' IVSRO or Choung’s type I osteotomy is indicated for patients with condylar hyperplasia and high condylar process fractures.
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Affiliation(s)
- Puhan He
- Harvard School of Dental Medicine, Harvard University, Cambridge, USA
| | - Joe Iwanaga
- Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, USA
| | - Yuki Matsushita
- Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, Ann Arbor, USA
| | - Nimer Adeeb
- Neurosurgery, Louisiana State University, Shreveport, USA
| | - Nitsa Topale
- Basic Sciences, St. George's University, True Blue, GRD
| | - R Shane Tubbs
- Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.,Anatomical Sciences, St. George's University, True Blue, GRD.,Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
| | - Jingo Kusukawa
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, JPN
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Wagner F, Strasz M, Traxler H, Schicho K, Seemann R. Evaluation of an experimental oblique plate for osteosynthesis of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:537-541. [PMID: 29056288 DOI: 10.1016/j.oooo.2017.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/04/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to test the bone thickness and potential screw length for osteosynthesis of condylar base fractures (according to the Loukota classification) with an experimental titanium plate, placed in an ideal position against 2 types of conventional plates. STUDY DESIGN After exclusion of completely edentulous mandibles, 28 dentate macerated mandibles available at the time of the study were included. Linear regression models 1 and 2 compared the sums of the 2 cranial bone thicknesses and the 3 caudal thicknesses among the 3 different plate designs, and linear models 3 and 4 tested the bone thickness in the 2 most cranial screw axes. RESULTS Linear models 1 and 2 revealed significantly higher potential screw lengths for the experimental oblique plate. Equally, linear models 3 and 4 indicated significantly higher bone thickness for the novel oblique plate. CONCLUSION The novel proposed oblique plate allows for favorable plate positioning in a biomechanically ideal location with sufficient amounts of local bone for stable plate fixation. When plates with 15-degree angulated screw holes are used, stable bicortical plate fixation can be achieved.
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Affiliation(s)
- Florian Wagner
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
| | - Martin Strasz
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Hannes Traxler
- Department for Systematic Anatomy, Medical University of Vienna, Vienna, Austria
| | - Kurt Schicho
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Rudolf Seemann
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
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Lima FJC, Oliveira Neto OB, Barbosa FT, Sousa-Rodrigues CF. Location, shape and anatomic relations of the mandibular foramen and the mandibular lingula: a contribution to surgical procedures in the ramus of the mandible. Oral Maxillofac Surg 2016; 20:177-182. [PMID: 26781719 DOI: 10.1007/s10006-016-0547-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 01/10/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to obtain morphological parameters of the mandibular foramen (MF) and the mandibular lingula (ML) as well as to use biometric data to locate these structures in the medial aspect of the mandibular ramus and to measure the angle that the inferior alveolar sulcus makes with the posterior margin of the ramus. METHODS The sample was composed of 30 dry human mandibles. The quantitative variables were the distances between the MF and the ML, as well as the distances between these structures and the margins of the mandibular ramus. The angle between the inferior alveolar sulcus and the posterior margin was also measured. The qualitative variables were the shape of the MF and the ML. All variables were analyzed using statistical softwares and the admitted level of statistical significance was 5 %. RESULTS The statistical analysis indicated a bilateral central positioning of the MF and the ML in relation to the medial surface of the mandibular ramus, however, with a more superior and posterior positioning when the relatives values-which also indicated an oval morphology of the MF and trapezoidal shape of the ML-were considered. The inferior alveolar sulcus was in an acute angle with the posterior margin of the ramus with a larger opening in the left side of the mandible-but equals, however, considering the margins of error. CONCLUSIONS With the data presented in this study, the surgeon will obtain quantitative and qualitative parameters that can be added to the surgical literature available, facilitating the identification and preservation of the anatomic structures in check, reducing, thus, the risk of iatrogenic injuries.
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Affiliation(s)
- F J C Lima
- Institute of Health and Biological Sciences, Federal University of Alagoas, Campus A.C. Simões - ICBS - UFAL. Av. Lourival Melo Mota, s/n Tabuleiro dos Martins, Maceió, AL, CEP 57072-900, Brazil.
| | - O B Oliveira Neto
- Institute of Health and Biological Sciences, Federal University of Alagoas, Campus A.C. Simões - ICBS - UFAL. Av. Lourival Melo Mota, s/n Tabuleiro dos Martins, Maceió, AL, CEP 57072-900, Brazil
| | - F T Barbosa
- Faculty of Medicine, Federal University of Alagoas, Campus A.C. Simões - FAMED - UFAL. Av. Lourival Melo Mota, s/n Tabuleiro dos Martins, Maceió, AL, CEP 57072-900, Brazil
| | - C F Sousa-Rodrigues
- Federal University of Alagoas, Campus A.C. Simões - ICBS - UFAL. Rua Jorge de Lima, 113, Trapiche da Barra, Maceió, AL, CEP 57010-300, Brazil
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Lee EM, Lee SH, Kim B. Guided cutting of bone for intraoral vertical ramus osteotomy with a freer marking technique. Br J Oral Maxillofac Surg 2015; 53:660-1. [DOI: 10.1016/j.bjoms.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
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Anatomic study to determine a safe surgical reference point for mandibular ramus osteotomy. J Craniomaxillofac Surg 2013; 42:22-7. [PMID: 23454267 DOI: 10.1016/j.jcms.2013.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/24/2012] [Accepted: 01/09/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify a surgical reference point on the mandibular ramus that can be used during ramus osteotomy to prevent injury to the inferior alveolar nerve. MATERIALS AND METHODS A total of 125 subjects' mandibles were analyzed and compared on a three-dimensional (3D) model constructed from computed tomography (CT). 25 volunteer subjects with normal class I occlusion (group I, control), 50 consecutive subjects (25 females and 25 males) diagnosed with mandibular retrognathism (group II), and 50 consecutive subjects (25 females and 25 males) with prognathism (group III) were included. This study created a landmark (the midwaist point) at the halfway point on a horizontal plane between the most concave points on the anterior and posterior borders of mandibular ramus, with the vertical plane bisecting the horizontal plane. The midwaist point was compared to other anatomic landmarks including antilingula, lingula, and mandibular foramen for correlation. RESULTS The distance from the midwaist point to lingula and mandibular foramen along the horizontal plane was not significantly different among three groups. Lingula and mandibular foramen were mostly located within 2 mm posterior of the midwaist point, whereas the locations of lingula and mandibular foramen along the vertical plane to the midwaist point were highly variable. CONCLUSION The midwaist point is an excellent intraoperative reference point that can help surgeons to identify the position of the lingual and the mandibular foramen, thus preventing inferior alveolar nerve injury.
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Kuroyanagi N, Miyachi H, Kanazawa T, Kamiya N, Nagao T, Shimozato K. Morphologic features of the mandibular ramus associated with increased surgical time and blood loss in sagittal split-ramus osteotomy. J Oral Maxillofac Surg 2013; 71:e31-41. [PMID: 23245774 DOI: 10.1016/j.joms.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/01/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine whether specific morphologic features of the mandibular ramus can predict increased surgical time and blood loss in sagittal split-ramus osteotomy (SSRO). MATERIALS AND METHODS The clinical and morphologic features of the mandibular ramus, obtained from computed tomographic images (n=50), were analyzed to predict the surgical time, the time required for ablation of the medial mandibular ramus, and the time required for sectioning of the mandible in performing a modified Obwegeser SSRO. RESULTS Significant factors associated with surgical time were an anterior border of the ramus at least 10.5 mm wide, a maximal length of the thickened ramus of at least 8.5 mm, and a distance from the mandibular incisor to the posterior border of the mandible of at least 97.5 mm. There were significant differences in blood loss between the 2 axial aspects of the medial ramus. CONCLUSIONS The greater protrusion of the medial oblique ridge, thickened ramus, and longer distance from the mandibular incisors to the posterior border of the mandible may increase the surgical time and blood loss in patients undergoing classic SSRO. When planning or performing an SSRO, the morphologic features obtained from computed tomographic images may help surgeons gain a better understanding of the potential difficulties when the surgical site involves the medial aspect of the ascending ramus of the mandible.
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Affiliation(s)
- Norio Kuroyanagi
- Department of Maxillofacial Surgery, Aichi-Gakuin University School of Dentistry, and Department of Oral and Maxillofacial Surgery and Stomatology, Okazaki City Hospital, Aichi, Japan.
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Anatomic study of the mandibular foramen, lingula and antilingula in dry mandibles, and its statistical relationship between the true lingula and the antilingula. Int J Oral Maxillofac Surg 2011; 41:74-8. [PMID: 21955366 DOI: 10.1016/j.ijom.2011.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 05/26/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
The authors verified the anatomical location of the mandibular foramen, lingula and antilingula in dry mandibles, aiming to obtain information that could be used when performing mandibular osteotomies. Forty-four mandibles (88 sides) were evaluated. The distances were measured using a sliding calliper, with the mandibles fixed in a reproducible position. Results showed that the mandibular foramen is on average 5.82 mm below the lingula. Regarding the statistical comparison between the mandibular foramen entrance and the antilingula position, there is no correlation between the position of those two structures in the studied sample. The mandibular foramen is slightly posterior in relation to the centre of the ramus. The lingula is an important anatomic landmark for ramus surgery, and for determining the distance to the mandibular foramen entrance. The use of the antilingula as a landmark for the position of the vertical ramus osteotomy is not recommended.
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Apinhasmit W, Chompoopong S, Jansisyanont P, Supachutikul K, Rattanathamsakul N, Ruangves S, Sangvichien S. The study of position of antilingula, midwaist of mandibular ramus and midpoint between coronoid process and gonion in relation to lingula of 92 Thai dried mandibles as potential surgical landmarks for vertical ramus osteotomy. Surg Radiol Anat 2010; 33:337-43. [PMID: 20635181 DOI: 10.1007/s00276-010-0700-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 07/01/2010] [Indexed: 11/26/2022]
Abstract
This study aims to investigate positions of the antilingula (AL), the midwaist of the mandibular ramus (MW) and the midpoint between the coronoid process and the gonion (MCG) in relation to the lingula of dried mandibles. Bilateral rami of 92 Thai dried mandibles were studied. The AL, the MW, the MCG and the corresponding position of the tip of lingula (L) were marked on the external aspect of the mandibular ramus. The distances from the AL, the MW and the MCG to the L were measured in the anterior-posterior and the superior-inferior planes using computerized image analysis. The results showed the AL was discernible in 80.4% of lateral mandibular rami studied. The most of the AL was found anterior-superior to the L with a maximum distance of 5.9 mm anteriorly and 8.2 mm superiorly. The MW was frequently located anterior-inferior to the L with a maximum distance of 9.3 mm anteriorly and 9.9 mm inferiorly. The majority of the MCG was found anterior-superior to the L with a maximum distance of 9.6 mm anteriorly and 8.9 mm superiorly. A 5 mm radius from the L included 84.5% of the AL, 81.5% of the MW and 79.4% of the MCG. Medians (interquartiles) of distances from the AL, the MW and the MCG to the L were 3.4 (2.3-5.0) mm, 3.8 (2.5-5.3) mm and 4.1 (2.8-5.3) mm, respectively. In conclusion, the AL was identified in 80.4% of lateral mandibular rami studied. The AL and the MCG were commonly found anterior-superior to the lingula, whereas the MW was mostly observed anterior-inferior to the lingula. Therefore, a cut made more than a 5 mm posterior or superior to these landmarks would be in 79% of cases, within a statistically safe area avoiding encroaching upon the inferior alveolar neurovascular bundle passing immediately lateral to the lingula. Although the MW and the MCG might be alternative surgical guides when the AL is absent, their use alone as surgical landmarks is not recommended.
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Affiliation(s)
- Wandee Apinhasmit
- Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330 Thailand.
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Pedroletti F, Johnson BS, McCain JP. Endoscopic Techniques in Oral and Maxillofacial Surgery. Oral Maxillofac Surg Clin North Am 2010; 22:169-82. [DOI: 10.1016/j.coms.2009.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yu IH, Wong YK. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images. Int J Oral Maxillofac Surg 2008; 37:521-8. [PMID: 18450425 DOI: 10.1016/j.ijom.2008.03.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 01/07/2008] [Accepted: 03/07/2008] [Indexed: 12/01/2022]
Affiliation(s)
- I H Yu
- Department of Dentistry, Taichung Veterans General Hospital College of Dentistry, Yang Ming Medical University, Taichung, Taiwan
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