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The variable position of the inferior alveolar nerve (IAN) in the mandibular ramus: a computed tomography (CT) study

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Abstract

Introduction

This study was designed to quantify the important anatomical landmarks and the path of the inferior alveolar nerve (IAN) within the human mandibular body and ramus, in particular with reference to the bilateral sagittal split osteotomy (BSSO).

Materials and methods

Four hundred and eleven CT scans were studied, 299 of these were involved in determining the position of lingula; and 230 were involved in determining the course of IAN in the mandibular molar region, namely from the mesial of the mandibular first molar to the distal of the mandibular second molar; 118 were involved with both measurements.

Results

On average, the lingula was located 17.0 ± 2.2 mm from the external oblique ridge; 11.6 ± 2.0 mm from the internal oblique ridge; 17.2 ± 2.7 mm from the sigmoid notch; and 15.6 ± 1.9 mm from the posterior border of the mandible. The course of the IAN in the mandibular molar region was found to descend vertically from the distal of the mandibular second molar (7) to reach its lowest point between the first and second molars (6 and 7), and then ascend towards the mesial of the first molar (6). Horizontally, the IAN was found to traverse medially between the distal of the 7 and the middle of the 7, and then changes its path laterally towards the mesial of the 6.

Conclusion

Precise knowledge of the individual’s position of the IAN will help surgical planning.

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Notes

  1. Due to the presence of IAN bifurcation loop in one of the male patient studied. For statistical purpose, this patient had the IAN-BB and TBC counted twice, while the IAN-IBM and TIBC only counted once—lower part of the loop.

Abbreviations

Ln:

Lingula

SN:

Deepest point of sigmoid/mandibular notch

EOR:

External oblique ridge (anterior border of mandibular ramus)

IOR:

Internal oblique ridge (anterior border of mandibular ramus)

PBMR:

Posterior border of mandibular ramus

SN–Ln:

Distance between SN and Ln

EOR–Ln:

Distance between EOR and Ln

IOR–Ln:

Distance between IOR and Ln

PBMR–Ln:

Distance between PBMR and Ln

(EOR–Ln) − (IOR–Ln):

Distance difference between EOR–Ln and IOR–Ln

Lingula ratio:

(EOR–Ln)/((EOR–Ln)+(PBMR–Ln))

Mes 6:

Mesial surface of the mandibular first molar

Mid 6:

Midpoint between the mesial and distal surfaces of the mandibular first molar

Int 6/7:

Interproximal area between the mandibular first and second molars

Mid 7:

Midpoint between the mesial and distal surfaces of the mandibular second molar

Dis 7:

Distal surface of the mandibular second molar

IAN:

Inferior alveolar nerve/neurovascular bundle

IBM:

Inferior border of mandible

TIBC:

Thickness of inferior border cortex

BB:

Buccal border of mandible

TBC:

Thickness of buccal cortex

IAN-IBM:

Distance between IAN and IBM

IAN-BB:

Distance between IAN and BB

(IAN-IBM)-TIBC ≤ 1mm:

Difference between (IAN-IBM) and TIBC ≤ 1 mm

(IAN-IBM) = TIBC:

(IAN-IBM) is equal to TIBC

(IAN-BB)-TBC ≤ 1mm:

Difference between (IAN-BB) and TBC ≤ 1 mm

(IAN-BB) = TBC:

(IAN-BB) is equal to TBC

References

  1. Afsar A, Haas DA, Rossouw PE, Wood RE (1998) Radiographic localization of mandibular anesthesia landmarks. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:234–241. https://doi.org/10.1016/S1079-2104(98)90131-7

    Article  PubMed  CAS  Google Scholar 

  2. Agbaje JO, Salem AS, Lambrichts I, Jacobs R, Politis C (2015) Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances. Int J Oral Maxillofac Surg 44:447–451. https://doi.org/10.1016/j.ijom.2014.11.010

    Article  PubMed  CAS  Google Scholar 

  3. Alves N, Deana NF (2015) Morphological Study of the Lingula in Adult Human Mandibles of Brazilians Individuals and Clinical Implications. BioMed Res Int. https://doi.org/10.1155/2015/873751

    Article  PubMed  PubMed Central  Google Scholar 

  4. Angel JS, Mincer HH, Chaudhry J, Scarbecz M (2011) Cone-beam computed tomography for analyzing variations in inferior alveolar canal location in adults in relation to age and sex. J Forensic Sci 56:216–219. https://doi.org/10.1111/j.1556-4029.2010.01508.x

    Article  PubMed  Google Scholar 

  5. Chenna D, Hosapatna M, d’Souza AS, Gadicherla S, Pentapati KC (2015) Lingula and antilingula as anatomic reference points for ramus osteotomies. Int J Dent Sci Res 3:1–3. https://doi.org/10.12691/ijdsr-3-1-1

    Article  Google Scholar 

  6. Fernandes AC, Cardoso PM, Fernandes IS, de Moraes M (2013) Anatomic study for the horizontal cut of the sagittal split ramus osteotomy. J Oral Maxillofac Surg 71:1239–1244. https://doi.org/10.1016/j.joms.2013.01.013

    Article  PubMed  Google Scholar 

  7. Findik Y, Yildirim D, Baykul T (2014) Three-dimensional anatomic analysis of the lingula and mandibular foramen: a cone beam computed tomography study. J Craniofac Surg 25:607–610. https://doi.org/10.1097/SCS.0b013e3182a30ec3

    Article  PubMed  Google Scholar 

  8. Gowgiel JM (1992) The position and course of the mandibular canal. J Oral Implantol 18:383–385

    PubMed  CAS  Google Scholar 

  9. Grover PS, Lorton L (1983) Bifid mandibular nerve as a possible cause of inadequate anaesthesia in the mandible. J Oral Maxillofac Surg 41:177–179. https://doi.org/10.1016/0278-2391(83)90076-9

    Article  PubMed  CAS  Google Scholar 

  10. Huang CS, Syu JJS, Ko EWC, Chen YR (2013) Quantitative evaluation of cortical bone thickness in mandibular prognathic patients with neurosensory disturbance after bilateral sagittal split osteotomy. J Oral Maxillofac Surg 71:2153.e2151–2153.e21102153. https://doi.org/10.1016/j.joms.2013.08.004

    Article  Google Scholar 

  11. Hwang K, Lee WJ, Song YB, Chung IH (2005) Vulnerability of the inferior alveolar nerve and mental nerve during genioplasty: an anatomic study. J Craniofac Surg 16:10–14. https://doi.org/10.1097/00001665-200501000-00004

    Article  PubMed  Google Scholar 

  12. Jansisyanont P, Apinhasmit W, Chompoopong S (2009) Shape, height and location of the lingula for sagittal ramus osteotomy in Thais. Clin Anat 22:787–793. https://doi.org/10.1002/ca.20849

    Article  PubMed  CAS  Google Scholar 

  13. Joo W, Yoshioka F, Funaki T, Mizokami K, Rhoton AL Jr (2014) Microsurgical anatomy of the trigeminal nerve. Clin Anat 27:61–88. https://doi.org/10.1002/ca.22330

    Article  PubMed  Google Scholar 

  14. Jung YH, Nah KS, Cho BH (2007) The location of the mandibular canal in prognathic patients compared to subjects with normal occlusion. Korean J Oral Maxillofac Radiol 37:217–220

    Google Scholar 

  15. Kane AA, Lo LJ, Chen YR, Hsu KH, Noordhoff MS (2000) The course of the inferior alveolar nerve in the normal human mandibular ramus and in patients presenting for cosmetic reduction of the mandibular angles. Plast Reconstr Surg 106:1162–1174

    Article  PubMed  CAS  Google Scholar 

  16. Kieser J, Kieser D, Hauman T (2005) The course and distribution of the inferior alveolar nerve in the edentulous mandible. J Craniofac Surg 16:6–9

    Article  PubMed  Google Scholar 

  17. Kilic C, Kamburoglu K, Ozen T, Balcioglu HA, Kurt B, Kutoglu T, Ozan H (2010) The position of the mandibular canal and histologic feature of the inferior alveolar nerve. Clin Anat 23:34–42. https://doi.org/10.1002/ca.20889

    Article  PubMed  CAS  Google Scholar 

  18. Kim ST, Hu KS, Song WC, Kang MK, Park HD, Kim HJ (2009) Location of the mandibular canal and the topography of its neurovascular structures. J Craniofac Surg 20:936–939. https://doi.org/10.1097/SCS.0b013e3181a14c79

    Article  PubMed  Google Scholar 

  19. Kuhlefelt M, Laine P, Supminen AL, Lindqvust C, horén H (2014) Nerve manipulation during bilateral sagittal split osteotomy increases neurosensory disturbance and decreases patient satisfaction. J Oral Maxillofac Surg 72:2052.e2051–2052e.2055. https://doi.org/10.1016/j.joms.2014.06.444

    Article  Google Scholar 

  20. Langlais RP, Broadus R, Glass BJ (1985) Bifid mandibular canals in panoramic radiographs. J Am Dent Assoc 110:923–926. https://doi.org/10.14219/jada.archive.1985.0033

    Article  PubMed  CAS  Google Scholar 

  21. Levine MH, Goddard AL, Dodson TB (2007) Inferior alveolar nerve canal position: a clinical and radiographic study. J Oral Maxillofac Surg 65:470–474. https://doi.org/10.1016/j.joms.2006.05.056

    Article  PubMed  Google Scholar 

  22. Massey ND, Galil KA, Wilson TD (2013) Determining position of the inferior alveolar nerve via anatomical dissection and micro-computed tomography in preparation for dental implants. J Can Dent Assoc 79:d39

    PubMed  Google Scholar 

  23. Mizbah K, Gerlach N, Maal TJ, Bergé SJ, Meijer GJ (2012) The clinical relevance of bifid and trifid mandibular canal canals. Oral Maxillofac Surg 16:147–151. https://doi.org/10.1007/s10006-011-0278-5

    Article  PubMed  CAS  Google Scholar 

  24. Monnazzi MS, Passeri LA, Gabrielli MFR, Bolini PDA, de Carvalho WRS, da Costa Machado H (2012) 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 41:74–78. https://doi.org/10.1016/j.ijom.2011.08.009

    Article  PubMed  CAS  Google Scholar 

  25. Nortjé CJ, Farman AG, de V Joubert JJ (1977) The radiographic appearance of the inferior dental canal: an additional variation. Br J Oral Surg 15:171–172. https://doi.org/10.1016/0007-117X(77)90050-6

    Article  PubMed  Google Scholar 

  26. Park KR, Kim SY, Kim GJ, Park HS, Jung YS (2014) Anatomic study to determine a safe surgical reference point for mandibular ramus osteotomy. J Cranio-Maxillofac Surg 42:22–27. https://doi.org/10.1016/j.jcms.2013.01.041

    Article  Google Scholar 

  27. Peacock ZS, Lee CCY, Klein KP, Kaban LB (2014) Orthognathic surgery in patients over 40 years of age: indications and special consideration. J Oral Maxillofac Surg 72:1995–2004. https://doi.org/10.1016/j.joms.2014.03.020

    Article  PubMed  Google Scholar 

  28. Poort LJ, van Neck JW, van der Wal KGH (2009) Sensory testing of inferior alveolar nerve injuries: a review of methods used in prospective studies. J Oral Maxillofac Surg 67:292–300. https://doi.org/10.1016/j.joms.2008.06.076

    Article  PubMed  Google Scholar 

  29. Pyun JH, Lim YJ, Kim MJ, Ahn SJ, Kim J (2013) Position of the mental foramen on panoramic radiographs and its relation to the horizontal course of the mandibular canal: a computed tomographic analysis. Clin Oral Impl Res 24:890–895. https://doi.org/10.1111/j.1600-0501.2011.02400.x

    Article  Google Scholar 

  30. Rouas P, Nancy J, Bar D (2007) Identification of double mandibular canal: literature review and three case report with CT scans and cone beam CT. Dentomaxillofac Radiol 36:34–38. https://doi.org/10.1259/dmfr/27374727

    Article  PubMed  CAS  Google Scholar 

  31. Samanta PR, Kharb P (2012) Morphological analysis of the lingula in dry adult human mandibles of north Indian population. J Cranio-Maxillary Dis 1:7–11. https://doi.org/10.4103/2278-9588.102467

    Article  Google Scholar 

  32. Sekerci AE, Sisman Y (2014) Cone-beam computed tomography analysis of the shape, height, and location of the mandibular lingula. Surg Radiol Anat 36:155–162. https://doi.org/10.1155/2014/945671

    Article  PubMed  Google Scholar 

  33. Tapas S (2013) Variation in the morphological appearance of lingula in dry adult human mandibles. Int J Cur Res Rev 5:41–45

    Google Scholar 

  34. Tuli A, Choudhry R, Choudhry S, Raheja S, Agarwal S (2000) Variation in shape of the lingula in the adult human mandible. J Anat 197:313–317

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tyndall DA, Price JB, Tetradis S, Ganz SD, Hildebolt C, Scarfe WC (2012) Position Statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 113:817–826. https://doi.org/10.1016/j.oooo.2012.03.005

    Article  PubMed  Google Scholar 

  36. Woo SS, Cho JY, Park WH, Yoo IH, Lee YS, Shim KS (2002) A study of mandibular anatomy for orthognathic surgery in Koreans. J Korean Assoc Oral Maxillofac Surg 28:126–131

    Google Scholar 

  37. Yang J, Cavalcanti MGP, Ruprecht A, Vannier MW (1992) 2-D and 3-D reconstructions of spiral computed tomography in localization of the inferior alveolar canal for dental implants. Oral Surg Oral MEd Oral PAthol Oral Radiol Endod 87:369–374. https://doi.org/10.1016/S1079-2104(99)70226-X

    Article  Google Scholar 

  38. Yashar N, Engeland CG, Rosenfeld AL, Walsh TP, Califano JV (2012) Radiographic considerations for the regional anatomy in the posterior mandible. J Periodontol 83:36–42. https://doi.org/10.1902/jop.2011.110076

    Article  PubMed  Google Scholar 

  39. Ylikontiola L, Moberg K, Huumonen S, Soikkonen K, Oikarinen K (2002) Comparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93:736–742. https://doi.org/10.1067/moe.2002.122639

    Article  PubMed  Google Scholar 

  40. Yu IH, Wong YK (2008) Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images. Int J Oral Maxillofac Surg 37:521–528. https://doi.org/10.1016/j.ijom.2008.03.003

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Woolloongabba Oral Health Centre, Metro South Oral Health Services, Queensland Health, Woolloongabba, QLD, 4102, Australia

    Andrew Y.E. Yeh

  2. Private Practice Oral and Maxillofacial Surgery, Cairns, QLD, 4870, Australia

    Brian P. Finn & Robert H. B. Jones

  3. Oral and Maxillofacial Surgery Unit, The University of Adelaide, Adelaide, SA, 5005, Australia

    Alastair N. Goss

Authors
  1. Andrew Y.E. Yeh
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  2. Brian P. Finn
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  4. Alastair N. Goss
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Contributions

All authors provided input for the manuscript writing and discussion. Yeh: Protocol development; Data collection and management; Data analysis; Manuscript writing and editing. Finn: Protocol development; Data collection; Manuscript editing. Jones: Manuscript editing. Goss: Manuscript editing.

Corresponding author

Correspondence to Andrew Y.E. Yeh.

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Ethical approval

This study has ethics approval by the Human Research Ethics Committee with reference number: HREC/17/QCH/13-1114LR.

Conflict of interest

The authors declare that they have no conflict of interest.

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Yeh, A.Y., Finn, B.P., Jones, R.H.B. et al. The variable position of the inferior alveolar nerve (IAN) in the mandibular ramus: a computed tomography (CT) study. Surg Radiol Anat 40, 653–665 (2018). https://doi.org/10.1007/s00276-018-1973-9

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  • DOI: https://doi.org/10.1007/s00276-018-1973-9

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