Widening of the inferior alveolar canal: a case report with atypical lymphocytic infiltration of the nerve

Structural and CBCT analysis of mandibular canal microvessels expressing neurotransmitters in human cadavers

PURPOSE

This study focused on the detailed structure of microvessels of the neurotransmitter-positive vasa nervorum of the inferior alveolar nerve, vein, and artery in the mandibular canal (MC) to obtain information for improved safety in dental treatments. We also observed the detailed structure of the MC from the mental foramen to the mandibular foramen using cone-beam computed tomography (CBCT).

METHODS

In this study, mandibles from 45 sides of 23 human cadavers aged 76-104 years were examined by microscopy, immunohistochemistry, and CBCT analysis. These data were further evaluated by principal component analysis (PCA).

RESULTS

The microvessels of the vasa nervorum with calcitonin gene-related peptide- and neuropeptide Y-positive reactions were classified into 5 types: large (4.19%, 28/667); irregular large (7.35%, 49/667), numerous intermediate (29.23%, 195/667), irregular intermediate (29.23%, 195/667), and scattered fine (30.0%, 200/667) microvessels. The MC showed various structures from the 3rd molar to the premolars and was also classified into three types, including complete (57.0%, 228/400), partial (33.8%, 135/400), and unclear (9.2%, 37/400), from the mandibular foramen to the mental foramen. PCA results revealed that developed capillaries were mainly localized in the molar region.

CONCLUSIONS

Fine microvessels of the vasa nervorum expressing neurotransmitters are present from the molar to premolar region, which is key information for mandibular dental treatments. The different microvessel structures also indicate differences in specific characteristics between dentulous and edentulous cadavers regarding oral surgical and implant treatments.

[Tumor involving the sciatic nerve: neurinoma or neurofibroma? Can MRI make the difference?]

The sciatic nerve is the terminal branch of the sacral plexus. Sciatalgia is a nerve root pain. In most cases, sciatica originates from degenerative disc disease. Tumor involving the sciatic nerve is extremely rare. We here report the case of a 33-year old patient with nerve tumor detected on MRI performed for drug-resistant sciatica. Tumor involving the sciatic nerve is rare and diagnosis is difficult. MRI data are crucial for establishing an effective surgical approach.

Common conditions associated with mandibular canal widening: A literature review

Purpose

The aim of this study was to review the common conditions associated with mandibular canal widening.

Materials and Methods

General search engines and specialized databases including Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus were used to find relevant studies by using the following keywords: “mandibular canal,” “alveolar canal,” “inferior alveolar nerve canal,” “inferior dental canal,” “inferior mandibular canal,” “widening,” “enlargement,” “distension,” “expansion,” and “dilation.”

Results

In total, 130 articles were found, of which 80 were broadly relevant to the topic. We ultimately included 38 articles that were closely related to the topic of interest. When the data were compiled, the following 7 lesions were found to have a relationship with mandibular canal widening: non-Hodgkin lymphoma, osteosarcoma, schwannoma, neurofibroma, vascular malformation/hemangioma, multiple endocrine neoplasia syndromes, and perineural spreading or invasion.

Conclusion

When clinicians encounter a lesion associated with mandibular canal widening, they should immediately consider these entities in the differential diagnosis. Doing so will help dentists make more accurate diagnoses and develop better treatment plans based on patients' radiographs.

Numb chin syndrome: an ominous sign of mandibular metastasis

A 51-year-old woman a known case of stage 2 breast carcinoma in 2006 and underwent left mastectomy performed in the same year presented with bilateral lower limb pain suggestive of spinal pathology, and left chin numbness, both of 2 weeks' duration. Examination revealed left mandibular hypoesthesia without any other sign or symptoms. Orthopantomogram was unremarkable apart from mild alveolar bone expansion at tooth 36 area, which was extracted 3 months earlier. Subsequently, a full-body positron emission tomography contrast enhanced computer tomography revealed hypermetabolic lesions of her axial (excluding skull) and appendicular skeleton. In the head and neck region, left mandibular foramen and oropharynx bilaterally showed increased metabolism suggestive of tumour metastasis. The diagnosis was numb chin syndrome secondary to mandibular metastasis. Apart from supportive treatment, she was started on palliative chemotherapy and radiotherapy. At the time of discharge, there were no active complaints other than the aforementioned hypoesthesia.

Mandibular Canal Enlargement: Clinical and Radiological Characteristics

Enlargement of the mandibular canal is a rare radiological finding. Clinically, it may or may not be associated with sensory deficits. We report four cases of widening of the mandibular canal observed with various methods of imaging with different clinical characteristics. We describe this unique radiological finding and elaborate the importance of quality assessment of the imaging that is vital for accurate diagnosis and treatment planning. Clinicians should be mindful when assessing the imaging whenever the size of the mandibular canal is implicated. The case ranged from a benign tumor to malignancy, radiological errors, and artifacts. A more superior imaging or treatment modality was necessary to ascertain the diagnosis.

Radiographic Enlargement of Mandibular Canal as an Extranodal Primary Non-Hodgkin's Lymphoma Early Sign in an Asymptomatic Patient

Non-Hodgkin's lymphoma (NHL) is a lymphoproliferative disorder, from a subgroup of heterogeneous hematologic malignancies; the term “extranodal” refers to malignant involvement of tissues other than lymph nodes, tonsils, spleen, pharyngeal lymphatic ring, or thymus. Only 0.6% of all NHL are at mandible alone, and it may involve the inferior alveolar canal. We describe a case of bilateral enlargement of the mandibular canal without symptomatology, which was shown in a panoramic radiograph and cone beam computed tomography in a rehabilitation routine exam, as an early sign of primary extranodal NHL.

Mandibular Canal Widening and Bell's Palsy: Sequelae of Perineural Invasion in Oral Cancer

Perineural invasion is an underrecognized route of metastatic spread along the nerve bundles within the nerve sheath into the surrounding tissues. It hinders the ability to establish local control as tumour cells can traverse along nerve tracts well beyond the extent of any local invasion rendering them inoperable and unresectable. Perineural invasion is a marker of poor prognosis. Oral submucous fibrosis with oral cancer constitutes a clinicopathologically distinct disease. Our case highlights an enigmatic presentation of oral submucous fibrosis and its coexistence with oral cancer presenting with unusual neurological disturbance of the inferior alveolar nerve and facial nerve and diffuse widening of the mandibular canal. The objective of this case report is to enumerate the significance of perineural invasion in determining the course of the disease and necessitate the need for future studies that can shed light on molecular mediators and pathogenesis of perineural spread.

Minimally Invasive Diagnosis of Secondary Intracranial Lymphoma

Diffuse large B cell lymphomas (DLBCL) are an aggressive group of non-Hodgkin lymphoid malignancies which have diverse presentation and can have high mortality. Central nervous system relapse is rare but has poor survival. We present the diagnosis of primary mandibular DLBCL and a unique minimally invasive diagnosis of secondary intracranial recurrence. This case highlights the manifold radiological contributions to the diagnosis and management of lymphoma.

An anatomical radiographic evaluation of the posterior portion of the mandible in relation to autologous bone harvest procedures

The purpose of the study was to evaluate the course of the mandibular canal and the thickness of the vestibular cortical plate in the posterior region of the mandible in relation to autologous bone harvest procedures. The study was performed on a cohort of 30 cone-beam computed tomography hemimandible images. For each hemimandible, the course of the mandibular canal and the thickness of the vestibular cortical plate have been evaluated in 4 regions: the retromolar region, the second molar region, the first molar region, and the second premolar region. The analyzed variables show a characteristic trend: the thickness of the cortical vestibular plate and the horizontal distance of the canal from the cortical vestibular plate are higher in the second molar region specifically in the area bordering on the retromolar region. In fact, the maximum thickness reaches the average value of 3.46 mm on 30 hemimandibles for slice (SD, 0.56 mm; range, 2.36-4.83 mm), and the horizontal distance reaches the average value of 6.06 mm on 30 hemimandibles for slice (SD, 1.34 mm; range, 3.65-9.27 mm); both variables decrease in more distal slices of the retromolar region. The vertical distance of the canal from the cortical crest shows the average value of 14.25 mm on 22 slices of the second molar and retromolar regions (SD of average values, 1.03 mm; range of average values, 12.92-16.25 mm; range of absolute values, 7.11-22.92 mm) exactly in regions potentially suitable for procedures of bone harvest (second molar and retromolar regions).