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Pseudoaneurysms in the external carotid artery system are rare, mostly reported in the superficial temporal and facial arteries. The bilateral sagittal split osteotomy has a low incidence of complications requiring emergency interventions. We report the case of a patient with acute bleeding from a pseudoaneurysm of the inferior alveolar artery diagnosed by angiography and treated successfully by super-selective embolization.

Background The aim of this study was to clarify the morphology of the mylohyoid branch of the inferior alveolar artery and the main blood supply to the mylohyoid muscle. Methods: The maxillary artery (MA) and inferior alveolar artery (IAA) within the infratemporal fossa, the facial and submental arteries within the submandibular triangle, and the nerve to the mylohyoid muscle and related artery were dissected in twelve sides from embalmed cadaveric heads. The main blood supply to the extraoral (inferior) surface of the mylohyoid muscle was recorded. Results: The mylohyoid branch of the inferior alveolar artery was an anastomosis of the descending branch of either the inferior alveolar or maxillary artery and the ascending branch of either the submental or facial artery. The anastomosis was classified into four types according to the origins of the arteries. The main blood supply to the extraoral surface of the mylohyoid muscle was the submental artery. Conclusions: The results of this study indicate that the mylohyoid branch of the IAA in human adults is an anastomosis of branches of the maxillary and facial arteries.

Pseudoaneurysm resulting from the external carotid artery or its branches after trauma to the maxillofacial region is unlikely, even more so, in a patient with von Willebrand disease. This study aimed to report a challenging case of pseudoaneurysm of the buccal artery and inferior alveolar artery due to a mandible fracture in a traumatized patient with undiagnosed von Willebrand disease. This reported case was conducted by a multidisciplinary team, covering the departments of maxillofacial surgery, interventional neuroradiology, neurosurgery, and hematology. From a fracture of the lower jaw and the appropriate course of action, bleeding episodes followed until intervention with embolization therapy. To our knowledge, this is the first case reported in the literature of a patient with those conditions.

The mental artery is a terminal branch of the inferior alveolar artery arising from the maxillary artery. It often communicates with the submental and inferior labial arteries branching off the facial artery. To our knowledge, few reports have described its anatomy and clinical significance in detail. The aim of this paper was to clarify the anatomy of the mental artery. Ten sides from five embalmed Caucasian cadaveric heads were used. The facial artery was identified at the point passing through a notch for the facial vessels and was traced medially. The mental artery and its anastomoses with other arteries were observed in detail. It was detected on all sides. Fourteen anastomoses were found, eight with the inferior labial artery and six with the submental artery. On one side, the mental artery directly supplied the lower lip with no anastomosis. The inferior labial artery tended to anastomose with the mental artery superior to the mental foramen and was likely to anastomose with the submental artery anterior to the mental foramen. We clarified the detailed anatomy of the mental artery. Our results could provide dentists with information that will help them to make oral surgery safer and more successful.

Introduction The anatomical position of the inferior alveolar artery (IAA) within the mandibular canal and in relation to the substructures of the neurovascular mandibular bundle has been sparsely described to date. More detailed information on the exact IAA position would be beneficial for both dental and maxillofacial surgical procedures to minimize complications such as bleeding, nerve compression hematoma, and sensory deficiency. Material and methods In 31 Thiel-preserved and fresh-frozen cadaver hemimandibles the position of the IAA in relation to the structures of the inferior alveolar neurovascular bundle and the mandible borders was analyzed anatomically and histologically. Results In 77.4% of the cases, rotation of the IAA around the mental nerve was apparent, resulting in a typical site-dependent IAA position. While the IAA was situated buccally within the pterygomandibular space, buccal-inferior in the mandibular foramen, superior in the molar region, and lingually in the premolar region. In 12.9% of the cases, a persistent lingual position of the IAA was observed for the entire mandibular canal. In one case, an additional mandibular canal and an accessory IAA were identified. Discussion This study provides new and encompassing information on the complete course and position of the IAA. This course is of practical use for oral implantology and various surgical procedures in dental- and maxillofacial surgery. Variations in the typical IAA course and site-dependent positional changes may be referred to as mandible growth and functional adaption to occlusion anomalies. This report helps enhance the morphological and functional understanding of IAA relationship during mandible development.

Simple Summary Nowadays, cats are one of the most common companion animals. They differ from dogs in some important aspects. However, most of the veterinary clinics are oriented towards the care and treatment of dogs, where the cat patient is clinically treated like a small dog. The cat mandible and related structures have some particularities that should be taken into account, when treating a cat, to avoid any unintended medical (iatrogenic) damage. The feline mandible has fewer teeth than a dog’s one, but tooth roots and the neurovascular supply account for up 70% of the volume of the mandibular body. This fact makes mandibular fracture repair challenging. In addition, the cat mandible has a prominent angular process that, when the cat is under anesthesia and his mouth is wide open (during oral or transoral manipulation), compresses the maxillary artery (that supplies blood to the brain) inducing temporal or permanent blindness and/or deafness. Other particularities of the cat jaw are also addressed to get a comprehensive knowledge of its functional anatomy, essential to an effective feline clinical practice. Abstract Cats are one of our favourite pets in the home. They differ considerably from dogs but are usually treated clinically as small dogs, despite some anatomical and physiological dissimilarities. Their mandible is small and has some peculiarities relative to the dentition (only three incisors, a prominent canine, two premolars and one molar); a conical and horizontally oriented condyle, and a protudent angular process in its ventrocaudal part. Most of the body of the mandible is occupied by the mandibular dental roots and the mandibular canal that protects the neurovascular supply: the inferior alveolar artery and vein, and the inferior alveolar nerve that exits the mandible rostrally as the mental nerves. They irrigate and innervate all the teeth and associated structures such as the lips and gingiva. Tooth roots and the mandibular canal account for up to 70% of the volume of the mandibular body. Consequently, when fractured it is difficult to repair without invading the dental roots or vascular structures. Gaining a comprehensive anatomical knowledge and good clinical practice (such as image diagnosis before and post-surgery) will help in the awareness and avoidance of iatrogenic complications in day-to-day feline clinical practice.

We report a case of left inferior alveolar nerve dysfunction following management of left inferior alveolar artery pseudoaneurysm in a 32-year old female following third molar extractions. After failing to manage the bleeding with conservative methods, embolization of the left inferior alveolar artery and the anastomosing branches of the facial artery was performed by interventional neuroradiology utilizing a fibered coil and N-butyl cyanoacrylate. Immediate hemostasis was achieved without major complications. The patient suffered transient anesthesia of left inferior alveolar nerve but recovered fully after two months.

Background and Objectives: The mandibular canal is a canal inside the mandible that contains the inferior alveolar artery, the inferior alveolar nerve and the inferior alveolar vein. The anatomy and variations of the human mandible are very important for planning various surgical measures such as extraction of the third molar, dental implants and mandibular reconstruction. This study was conducted to determine the frequency of the different courses of the mandibular canal and to investigate the visibility of the mandibular canal by panoramic radiography, among a sample of Yemeni adults. Subjects and Methods: A retrospective cross-sectional study was conducted in Sana'a city on a sample of Yemeni adults. The study consisted of panoramic radiographs of 928 patients; the number of males was 340 (36.6%) and 588 females (63.4%). The mandibular canal course, as shown in the panoramic radiographs, was classified into four types: elliptical, linear, turning curves and spoon-shaped. The visibility of this canal from the first to the third molar region was assessed through visual determination of whether the lower canal was clearly visible, possibly visible, or invisible. Results: Elliptical curves were the most observed along the mandibular canal course at 62.2% of the total, followed by the linear curve (24.8%) while the lower rate curve spoon (7.9%) and the turning curve (5.2%). There were no statistically considerable differences between the distribution of the mandibular canal courses between males and females except in the spoon curve where the ratio was 10.8% in males versus 6.1% in females (p

Background The knowledge of nerves and vessels in the maxillofacial region, particularly the anatomical structures in the maxilla, mandible, tongue muscles, and salivary glands, is essential for dental surgeons. In addition, the structures in the mandibular canal, palate, and maxillary sinus should be understood well. Highlight The arteries and nerves in the maxillofacial region were observed in this study. Some variations in the origin of the inferior alveolar artery were found. Notably, the variations in the origin of the inferior alveolar artery from that of the external carotid artery and a double origin of the inferior alveolar artery were observed. Thus, the maxillary artery may originate from the external carotid and stapedial arteries. The following points are important. (1)The greater palatine artery is always located deeper than the greater palatine nerve. (2)The posterior superior alveolar artery often runs through the compact bone of the maxilla. Using CT scans, the canal of the artery can be observed. (3)Variations in origins of the inferior alveolar artery have been observed. The origin of the inferior alveolar nerve may differ depending on the course of the maxillary artery. Conclusions Dental practitioners should, therefore, have a comprehensive knowledge of the anatomy of the maxillofacial region and its variations. Without this knowledge, they should not operate on patients.

Background Despite substantial displacements, fractures of the mandibular condyle rarely lead to necrosis. This illustrates the negligible role of the inferior alveolar artery in intraosseous supply to the condyle, and led to this systematization of its arterial vascularization. Methods Forty-two temporomandibular joints from nonembalmed cadaveric specimens were studied following injection of latex (n = 32) or India ink (n = 10). Results The intraosseous branches of the inferior alveolar artery that lead to the condyle were inconstant and often rudimentary. In this study, the arteries that consistently led to the condyle were the superficial temporal artery, the deep posterior temporal artery, and arterial branches leading to the lateral pterygoid muscle emanating directly from the maxillary artery. These arteries, along with the transverse facial artery and the masseteric artery (when they participated in condoyle vascularization), formed a quadrangle around the mandibular condyle. After India ink injection, the pterygoid muscle was the most strongly colored muscle, thus indicating substantial vascularization. Conclusions Although there is a lack of consensus in the literature regarding the constancy and proportions of the arteries participating in vascularization of the condyle, the superficial temporal artery, the maxillary arterial branches leading to the lateral pterygoid muscle, and the deep posterior temporal artery were constant in this study. This study shows the important role of the lateral pterygoid in the vascularization of the condyle. In case of a fracture with substantial displacement, the vascularization emanating from the superficial temporal artery and the lower alveolar artery is ruptured or compromised.

Background: The occurrence of bifid mandibular canals is unusual but not rare. Previous reviews and case studies have described numerous types of bifid canals based on location, anatomy, and contents. Developmentally, ossification of the mandible begins at the region of the mental foramen and continues posteriorly, forming the mandibular canal around the neurovascular bundle within. This process explains the creation of multiple mandibular canals and the diversity of canal types previously recorded in the literature. However, the presence of two distinct mandibular canals, each originating from its own mandibular foramen, is even more unusual. Materials and methods: This case report describes a unilateral variant discovered during the dissection of a 92-year-old African American female. Results: On the left side, the cadaver presents two distinct mandibular canals, each containing a branch of the inferior alveolar artery and mandibular nerve, the third division of the trigeminal. The nerves within the two canals were distinct from each other at the level of the posterior division of the mandibular nerve, within 1 cm of foramen ovale. Conclusion: This is the first description of such an occurrence and emphasizes the need for identification of the contents of a bifid or accessory mandibular canal prior to invasive procedures. Keywords: Mandibular canal, Inferior alveolar nerve, Mental nerve, Mental foramen, Maxillary artery

А^ - the development of ultrasound method of the study of inferior alveolar arteries and their normal data of blood circulation. Materials and methods. In 20 men the apparatus «Vivid E9» the study of the bipolar bloodstream in the inferior alveolar arteries was performed. Results. In the study of the facial arteries the following results were obtained: PS - 55,7+0,9 cm/s, ED - 10,15+0,3 cm/s, TAMX - 52,0+1,1 cm/s, PI - 1,32+0,06, RI - 0,77+0,03, PS/ED - 2,30+0,1, HR - 35,36+1,9 bpm. In the study of the inferior alveolar arteries the following results were determined: PS bloodstream 57,96+0,7 cm/s; ED bloodstream 5,47+0,1 cm/s; TAMX 17,22+0,5 cm/s; PI 3,05+0,1; RI 0,91+0,05; PS/ ED 10,60+0,2; HR 69,48+0,4 Ьрм. Conclusion. The methodology of ultrasound study of the inferior alveolar arteries and bloodstream parameters in them was developed.

Understanding anatomical variations of the facial artery and its branches is important for dental and medical practitioners. Routine cadaveric dissection of the head and neck was performed to demonstrate the origin and branches of the facial artery. Facial artery emerged from a common linguofacial trunk off the external carotid artery. On the face, the facial artery first gave off a pre-masseteric branch. Immediately after, an aberrant artery emerged from the facial artery that coursed along the ramus of the mandible, which upon further dissection and examination was found to anastomose with inferior alveolar artery within the ramus of the mandible. We report a unique anastomosis between facial and inferior alveolar arteries, vessels that have not been previously shown to communicate. This case report may provide useful information for oral and maxillofacial surgeons as well as dentists performing inferior alveolar nerve blocks.

This study assessed the arterial blood supply to the mandible of edentulous patients treated for mandibular fractures using colour Doppler ultrasound. The blood supply of edentulous patients surgically treated for mandibular fractures (group A) and edentulous fracture-free individuals (group B) was assessed. Only the fractured sides were evaluated in the first group (N = 17), whereas each side was evaluated in the second group (N = 20). The arterial flow of six sites was assessed. The systolic-peak maximum velocity (SPV), final diastolic velocity (FDV), resistive index (RI), pulsatility index (PI), acceleration and flow direction of each artery were obtained. Additionally, the presence of local vascular obstructive factors was evaluated. The differences between groups were analysed using the Kruskal-Wallis test, which was complemented by the Mann-Whitney test, for correlations between the degree of alveolar atrophy and the study factors (p

PURPOSE: In the mandible, the condylar neck vascularization is commonly described as mainly periosteal; while the endosteal contribution is still debated, with very limited anatomical studies. Previous works have shown the contribution of nutrient vessels through accessory foramina and their contribution in the blood supply of other parts of the mandible. Our aim was to study the condylar neck's blood supply from nutrient foramina. METHODS: Six latex-injected heads were dissected and two hundred mandibular condyles were observed on dry mandibles searching for accessory bone foramina. RESULTS: Latex-injected dissections showed a direct condylar medular arterial supply through foramina. On dry mandibles, these foramina were most frequently observed in the pterygoid fovea in 91% of cases. However, two other accessory foramina areas were identified on the lateral and medial sides of the mandibular condylar process, confirming the vascular contribution of transverse facial and maxillary arteries. CONCLUSIONS: The maxillary artery indeed provided both endosteal and periosteal blood supply to the condylar neck, with three different branches: an intramedullary ascending artery (arising from the inferior alveolar artery), a direct nutrient branch and some pterygoid osteomuscular branches.

The purpose of this retrospective study is to describe in detail a novel ventral approach for mandibulectomy and the results in 19 dogs. The medical records of 19 dogs that received a partial or total unilateral mandibulectomy with the new ventral approach were reviewed. Information obtained included signalment, tumour type, extent of mandibulectomy, removal of regional lymph nodes, intrasurgical complications, immediate postoperative complications, histopathological diagnosis and study of margins. Intrasurgical complication occurred in one dog (haemorrhage) and required a blood transfusion. Postoperative morbidity was minor and included transient ventral cervical swelling and self-limiting sublingual swelling (two dogs). All 19 animals were discharged between 24 and 48 hours of the procedure, and appetite was considered normal at discharge. Some perceived advantages of this procedure include easy identification of all the important anatomic structures in the area, including the inferior alveolar artery and temporo-mandibular joint, and the fact that osteotomy of the zygomatic arch is not necessary (in case of caudal mandibulectomy). In addition, dissection of both mandibular and retropharyngeal lymph nodes is easily achieved by caudal extension of the same skin incision.

Intravascular papillary endothelial hyperplasia (IPEH) is unusual, benign lesion of vascular origin caused by exuberation of endothelial cell proliferation. It is rarely seen in the oral region. Previous studies on oral IPEH revealed that the lower lip is the most frequent site, followed by tongue, upper lip, buccal mucosa and mandibular vestibule. We report a case of IPEH associated with hemangioma of the mandible of a 75-year-old male. Embolization of the inferior alveolar artery was performed in this case and the lesion was removed under general anesthesia the day after embolization. Histopathologically, intravascular proliferation of papillary processes within hemangioma was found. Immunohistochemically, the endothelial cells were positive for CD34. In this case, IPEH was observed in preexisting varices, hemangiomas, pyogenic granulomas, or lymphangiomas, known as a secondary (mixed) form. Continuous and careful observation is needed, because recurrence of the mixed form has been mostly reported due to incomplete excision or regrowth of the underlying lesion.

Pseudoaneurysm of the Inferior Alveolar Artery after Surgical C urettage for Keratocystic Odontogenic Tumor: A Case Report Sang-Chang Lee, Jong-Bae Kim 1 , Byung-Rho Chin 2 , Jin-Wook Kim, Chin-Soo Kim, Tae-Geon Kwon Department of Oral and Maxillofacial Surgery, Kyungpook Nationa l University School of Dentistry, 1 Department of Dentistry, Keimyung University College of Medicine, 2 Department of Dentistry, Yeungnam University College of MedicinePseudoaneurysms are rare complications of orgthognathic surgery , trauma or other surgical procedures in the head and neck regions. Surgical approach is a routine procedure of bleeding c ontrol. However, bleeding control using angiography and emboliz a-tion can also be an excellent method. We experienced pseudoaneu rysm of the inferior alveolar artery occurring after surgical curettage of cystic lesion. The 33-year-old man who underwent s urgical curettage of keratocystic odontogenic tumor was present ed with severe bleeding in the right mandible ramal inner surface 14 days after the surgical curettage. After hemostasis with vaseline gauze packing and pressure, bleeding temporarily stopp ed. However, bleeding started after 14 days and soon it has been continued. Finally, the patient was diagnosed as pseudoane urysm of the inferior alveolar artery from the enhanced-compute d tomography images, and angiographic embolization was performed successfully. We report a rare case of pseudoaneurysm of the inferior alveolar artery after benign tumor curettage and review of the previewer’s literature.Key words:False aneurysm, Inferior alveolar artery, Angiography, Therapeu tic embolization, Keratocystic odontogenic tumor

Purpose: Approximately 5% of irradiated head and neck cancer patients develop osteoradionecrosis of the mandible. The current non-surgical treatment options for osteoradionecrosis have limited effects and are based on a small number of studies. Therefore, we aimed to enhance the understanding of the pathophysiology of osteoradionecrosis by investigating changes induced by external irradiation in minipigs.Methods: Sixteen Gottingen mini-pigs were divided into four groups for the application in two fractions with total equivalent radiation dosages of 25, 50, 70 Gray, and one group served as control. Thirteen weeks after irradiation, the left lateral teeth the mandible were removed and implants were placed. The pigs were sacrificed twenty-six weeks after irradiation, and the bone samples were stained with Masson's trichrome.Results: The amount of fibrosis, resorption lacunae, necrosis, and the woven/lamellar bone ratios were increased after higher radiation dosages. The diameter of the lumen of the inferior alveolar artery was reduced depending on the irradiation dosages. The rate of bone remodeling decreased after irradiation.Conclusion: Both surgery and increasing irradiation dosages cause architectural bone changes and damage the vascularization. This might result in a chronic hypoxic state of the mandibular bone. In general, the bone formation rate was markedly decreased after radiotherapy. (C) 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A 34-year-old female patient required surgical removal of lower left third molar under local anesthesia. Two percent lignocaine with 1:80000 adrenaline was used for administrating inferior alveolar nerve block at dental clinic. Twenty five minutes after the surgical removal, patient developed diplopia on the left eye. This transient diplopia could be due to retro flow of local anesthetic agent through the inferior alveolar artery and indirectly to the ophthalmic artery paralyzing the lateral rectus muscle. Patient recovered after 60 minutes. This article discusses the possible etiologies of diplopia, the mechanism behind this ophthalmic complication, and the review of various reported literature.

The inferior alveolar artery (IAA), accompanied by the inferior alveolar nerve, runs through the mandibular canal. The mandibular canal can be observed by conventional radiography and computed tomography, although it is sometimes difficult to identify on these images. This study examined visualization of the IAA with phase-contrast magnetic resonance angiography (PC-MRA). Phase-contrast magnetic resonance angiography images were obtained in the double oblique sagittal plane by using a two-dimensional, fast, low-angle shot (2D FLASH) sequence in five healthy volunteers. A flow-encoding gradient was applied from anterior to posterior, with velocity-encoding numbers (VENCs) of 10, 8, 6, 4, 2, and 1 cm/s. Two observers subjectively evaluated the detectability of the IAA in three mandibular regions on all PC-MRA images. The IAA appeared as a line of high signal intensity on the PC-MRA images. In the mandibular ramus region, the rating scores at VENCs of 1 and 2 cm/s were significantly higher than those at VENCs of 8 and 10 cm/s (p

The inferior alveolar nerve is the one of the large branches of the mandibular division of the trigeminal nerve. It is vulnerable during surgical procedures of the mandible. Despite its importance, no anatomical and histological examination has been conducted to provide a detailed cross-sectional morphology of the mandibular canal according to dental status. Therefore, the present study aimed to identify the position of the mandibular canal through direct measurement and to determine the branches of the inferior alveolar nerve through histologic examination. The area between the anterior margin of the third molar and the anterior margin of the second premolar of dentulous, partially dentulous, and edentulous hemimandible specimens (n = 49) from 26 human cadavers was serially sectioned into seven segments, and specific distances were measured using digital calipers. Following this, 5-microm cross-sections were prepared along the mandibular canal and mental foramen, and examined by fluorescence microscopy. The mandibular canal was located at a mean distance of 10.52 mm above the inferior margin of the mandible. The mean maximum diameters of the mandibular canal, inferior alveolar nerve, inferior alveolar artery, and inferior alveolar vein were 2.52, 1.84, 0.42, and 0.58 mm, respectively. This study found that the inferior alveolar nerve often gives rise to several branches at each level (range 0-3). To minimize the risk of injury, knowledge of the small branches of the nerve and of the detailed findings regarding the position of the mandibular canal reported here should be considered when planning mandibular surgery, especially during implant placement.

The major complication in dental implant surgery is loss of sensation due to damage to the inferior alveolar nerve resulting from poor characterization of the location of the mandibular canal and the traveling course of the inferior alveolar nerve, artery, and vein therein. The purposes of this study were to determine the buccolingual location of the mandibular canal and to verify the topography of the inferior alveolar nerve, artery, and vein therein by three-dimensional reconstruction of these structures. Sixty-two mandible sides were used for this study. The buccolingual location of the mandibular canal was classified into 3 types: type 1 (70%), where the canal follows the lingual cortical plate at the mandibular ramus and body; type 2 (15%), where the canal follows the middle of the ramus behind the second molar and the lingual plate passing through the second and first molars; and type 3 (15%), where the canal follows the middle or the lingual one third of the mandible from the ramus to the body. Three-dimensional reconstruction of the mandibular canal revealed that the inferior alveolar vessel traveled above the inferior alveolar nerve in 8 cases (80%), with the inferior alveolar artery being lingual to the inferior alveolar vein, and in 2 cases (20%) where the inferior alveolar vessel was buccal to the nerve.

Background The literature describes different local complications derived from a local anesthetic. The authors present a report of a case of such a complication—a complication of which they have identified only one other similar case in the literature. Case Description A 10-year-old girl received an inferior alveolar nerve block injection for a dental restoration on the right side. After the procedure, she developed pallor of the right side of the lower lip and chin that subsequently evolved into a surface ulceration. The lesion suddenly healed 15 days later. The authors ruled out self-inflicted injury, intra-operative injury and skin infection as causes. Conclusions and Clinical Implications On the basis of the clinical manifestations and affected anatomical structures, the authors postulated skin necrosis secondary to vascular spasm of the terminal branches of the inferior alveolar artery. Even when clinicians use the utmost care, this kind of complication can occur as a result of an inferior alveolar nerve block injection. The practitioner should diagnose the problem appropriately and reassure the patient.

Objectives Knowledge of the various possible morphologies and courses of the inferior alveolar nerve and artery is important for successful and safe surgical procedures in the mandibular region. The purpose of this study was to verify the histologic features and fascicular arrangement of the inferior alveolar nerve and artery relative to tooth region. Materials and methods Twenty embalmed dentulous hemimandibles were examined (eight males and two females; mean age, 58.2 years). The hemimandibles were prepared for routine histology and stained with hematoxylin–eosin and Masson’s trichrome. The histologic features, fascicular arrangement, courses, and areas of the inferior alveolar nerve and artery were investigated with the aid of a light microscope. Results The inferior alveolar neurovascular bundle comprised the inferior alveolar nerve, which appeared as a large trunk comprising two major nerves (the mental and dental nerves), and the inferior alveolar artery, which occupied a relatively small portion of the bundle. The mental nerve was located inferolingually in the third molar region and turned to the buccal side in the first molar region, separating from the dental nerve before reaching the mental foramen. The mandibular incisive canal with a bony wall was not found in the lateral incisor region; instead, small dental nerve fascicles and arteries presented consistently in the intertrabecular spaces. The inferior alveolar artery traveled above the inferior alveolar nerve over the entire mandibular canal. Conclusions These results provide data that are relevant to treatment planning for operative procedures such as implant placement, endodontic treatment, and osteotomy in the mandibular region.

The lingual canal with foramen displays different appearances on the internal surfaces of mandible as confirmed by macroscopic observation and computerized tomography (CT). The lingual canal was observed in the inside of mental region run to the outside of lingual foramen, which is extend internally from mandibular canal in right and left sides of the mandible in cadavers (13 sides out of 88 sides) and in dry skulls (43 out of 94 sides) examined. The spinal foramen connected with mental canal occurred at the midline of mandible in 6 cases (6 out of 47 cases) in dry skulls. In this small foramen, the inferior alveolar artery give some branches to the inside of mental region at the anterior mandible and which may be run pass through the lingual canal to the lingual foramen, where they emerge to enter the mylohyoid or anterior belly of digastric muscles. The observations of these are important considerations for surgical placement of dental implants in the region in the mandible.

Transcatheter arterial embolization (TAE) is an effective and minimally invasive treatment againstuncontrolled arterial bleeding. We report a traumatic aneurysm that occurred after tooth extraction and was treatedby TAE. A 48-year-old woman was referred to our hospital because of uncontrolled intraoral arterial bleeding 4days after third molar extraction. In her medical history, she had been treated for liver cirrhosis and hepatocellularcarcinoma. A pseudoaneurysm of the inferior alveolar artery was found on selective carotid angiography. Massive arterial bleeding from the aneurysm was successfully treated by TAE. TAE and selective carotid angiographywere useful for the management of hemorrhage probably caused by a traumatic aneurysm after toothextraction.

To adapt ultrasound methods used to measure blood flow in the extremities to quantify mandible blood flow in order to determine the role of ischemia in the pathogenesis of mandible atrophy and tooth loss in the elderly. Doppler and duplex ultrasound techniques as used in measurement of arterial pulse in the extremities were adapted for recording the intraoral pulse profile at 7 sites in 57 patients of varying ages. After omitting the large number (26 patients) with signals of indeterminate strength, the mental artery pulse was strong in 11 of 12 (92%) in those younger than 65 versus 9 of 19 (47% in those older than 65 years; P =. 02). The equivalent figures for the sublingual artery were 15 of 15 strong for those younger than 65 and 11 of 17 (65%) for those older than 65 years (P =. 02). The varying depth of soft tissue overlying the inferior alveolar artery made its signal difficult to evaluate, but there was no statistically significant age-related difference in the inferior alveolar artery signals. In 4 elderly patients (2 with established carotid artery disease), Doppler and duplex scanning showed reversal of mental artery flow, indicating collateral flow to the mandible. Ultrasound Doppler techniques used for measuring peripheral arterial flow can be adapted to quantify mandible alveolar ridge perfusion. This provides means to evaluate the role of arterial obstruction in mandible alveolar ridge atrophy and tooth loss in the elderly. The mental artery is the best site for this purpose. Preliminary data suggest an age-related reduction in mental artery flow.

Penetration of the mandibular cortex during dental implant surgery may damage 3 important arteries and could lead to life-threatening circumstances. To lessen the likelihood of lateral angulations and cortical perforations, dental implants of less than 14 mm may be considered for the mandible. The courses of the inferior alveolar, facial, and lingual arteries and their branches are reviewed. Management of hemorrhage from a branch of the lingual or facial arteries may require an extraoral approach for ligation, because the mylohyoid, sublingual, and submental arteries can anastomose and be anatomically variable as well. A violation of 1 of these may be difficult to manage and lead to a compromise of the airway. A cortical perforation may be avoided by studying the anatomy of the ridge being treated. This article discusses what procedures to perform to obtund bleeding from 1 of these arteries and the technique of performing an emergency tracheotomy.

The mandibular canal is usually a single canal that begins with mandibular foramen on the medial surface of the ascending mandibular ramus. It transmits the inferior alveolar artery, vein, and the inferior alveolar nerve. The identification of the mandibular canal and its anatomic variations is of great importance in many branches of dentistry, especially in implant dentistry. Sometimes, there may be variations in the normal anatomic structures; one of the rarest among them is double mandibular canal. The clinician should be aware of such variations to avoid complications during the treatment. In the present case report, we have discussed about a case with double mandibular canal and the complications that can arise during the treatment.

La arteria maxilar (AM) es una rama terminal de la arteria carotida externa (ACE), y se ubica en la region infratemporal (RI). Algunas de sus ramas en esta region son la arteria alveolar inferior (AAI) y la arteria bucal (AB), ambas ramas descendentes. En este trabajo informamos de un inusual origen unilateral de la AAI y de la AB a partir de un tronco comun desde la ACE. Se realizo una diseccion de rutina de ambas regiones infratemporales en un cadaver de 54 anos, sexo masculino, caucasico. Fijado con solucion conservadora Universidad de los Andes® y replecion vascular con latex rojo. A cada lado, se observa la AM en ubicacion superficial sobre el musculo pterigoideo lateral. Al lado derecho, la AAI y la AB se originan de un tronco comun desde la ACE aproximadamente 5 mm antes de la bifurcacion en sus ramas terminales. Al lado izquierdo la AAI se origina de la AM inmediato a su origen, formando un tronco comun con los ramos pterigoideos. El conocimiento de la morfologia de la AM y de sus ramas en la RI es de importancia en procedimientos odontologicos, de cirugia oral y maxilofacial. Por lo que cualquier variacion en el origen o trayecto de estas arterias puede predisponer a un paciente a una mayor morbilidad durante algun procedimiento invasivo en la zona.

In this chapter, authors present composite hemiface/mandible/tongue allotransplantation model in rat based on the common carotid artery and the external jugular vein. The unique property of this model is the presence of vascularized bone marrow within the mandibular component which has an independent vascular supply based on the inferior alveolar artery. Thus, this is first and new model of more complex craniofacial composite tissue allotransplantation including vascularized skin, hemimandible, tongue, teeth, oral mucosa and masseter muscle. Authors also present long-term allograft survival up to 385 days without signs of rejection or graft loss correlated with development and maintanence of donor-spesific chimerism in lymphoid organs and bone marrow components of the recipients.

CT assessment of the entire course of the inferior alveolar artery (IAA) within the mandibular canal.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.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 %).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.• 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.

To evaluate prognostic factors affecting surgically treated osteoradionecrosis (ORN) of the mandible, 13 patients with mandibular bone necrosis caused by irradiation for head and neck cancer were examined clinicopathologically. The subjects were included 12 men and 1 woman, with a mean age of 65.3 years at surgery. The mean total dose of irradiation was 61.6Gy. The clinical stage according to Epstein et al.(1987) was II B in 1 patient, III A in 4, and III B in 8. The mandible was resected 10mm or more from the lesion. Delayed healing was found in two patients, and three had recurrence of necrosis of the remaining bone. Patients whose mandibular periosteum had been resected previously who received mandibular reconstruction had a poor outcome. Pathological changes, such as stenosis of the inferior alveolar artery, fibrosis of bone marrow, and low osteocyte density in cortical bone, were found in all resected mandibles. Among them, mandibles lacking sequestra and bone remodeling had poor viability. Therefore, the periosteal blood supply should be conserved and surgical interventions, particularly heat, must be minimized to avoid recurrence of ORN.

Angiography is often used to investigate age-related changes in the inferior alveolar artery, the major nutrient artery of the mandible. Although histological examinations have been made from several viewpoints, e.g. age change, pathogenesis of osteoradionecrosis, and relation to tooth extraction, these studies have used a limited number of samples and simple histometric methods. The purpose here was to describe histopathological and histomorphometric age-related changes, and to investigate the relation between dentate status and the histomorphometry of the artery. Inferior alveolar arteries from 162 autopsy cases (age range 3–86 years) were examined histometrically with a mathematically standardized method. Histologically, there was diffuse fibrous intimal thickening, but no atheroma formation. Histometric analyses revealed a very gradual increase in both the radius of the artery and the thickness of the media with age, but the luminal radius did not correlate with age. Intimal thickness increased exponentially with age with very different features from those of the increase in the media. The relative radius of the lumen decreased with age after the sixth decade; this is thought to be an index for senile changes in the artery. Among the variables of arterial architecture examined, no particular difference was found between the dentate and non-dentate cases in the molar region.

We have identified an artery which is a sub-branch of the inferior alveolar artery, and propose to call it the temporomandibular branch. Mandibular bones of 36 autopsy cases (ages 23-85; 20 males and 16 females) were examined. Contrast media were injected into the inferior alveolar artery, decalcification was conducted, and photographs were taken using soft X-ray equipment (Softex: Nippon Softex, co. CSM type). Then, an examination was conducted concerning sclerosis of these arteries. Next, H.E., Azan, and Pap silver stains were used for microscopic specimens to examine arteriosclerosis of the temporomandibular joint. The artery that sub-branches toward the temporomandibular branch, branches out immediately after the inferior alveolar artery and enters the mandibular foramen, becoming the artery that supplies the temporomandibular joint. This temporomandibular branch travels slightly downward, forward of the inferior alveolar artery, and turns back toward the mandibular base. It advances to the mandibular joint almost directly. The route taken was classified into three types. Toward the head of the mandible, the temporomandibular branch, after passing over the neck of the mandible, divides into two sub-branches, anterior and posterior. In our pathological study of the temporomandibular branch, there were a small number of cases with slight intimal thickening and mild elastosis. As regards sclerotic changes, particularly in cases more than 50 years old. There were very few cases showing intimal changes. Sclerotic changes of the artery supplying the head of the mandible increase with age. The same can be said of the about the constriction rate. These findings correlated with subject age.

In this study we evaluated the role of Doppler sonography in the assessment of central mandibular blood flow. We assessed the characteristics of blood flow in the mental artery, the larger terminal branch of the inferior alveolar artery, in 30 healthy volunteers equally distributed in the age groups 20-39, 40-59 and over 60 years. We used a DWL Multi-Dop X4(R) Doppler sonography machine (DWL GmbH) with an 8 MHz probe applied intraorally. The variables analysed were patency, time averaged maximum velocity (TAMV), pulsatility index (PI), discomfort and the duration of the procedure. All the arteries analysed were patent. The TAMV and PI decreased as age increased and there were significant differences between the age groups: TAMV (P = 0.01), PI (P = 0.006). Pair-wise comparisons also showed significant differences (P0.05) between the 20-39 and the over 60 age group, 40-59 and the over 60 age group for TAMV, and between the 20-39 and over 60 age group for PI. The difference in measurements between the right and left sides in individual patients was not significant. The assessment took about 20 minutes and caused little discomfort. The technique is simple and could potentially be used to influence clinical decisions.

Purpose The arrangement of the structures within the inferior alveolar neurovascular bundle has not been clearly defined. Because this could be of importance in surgery involving the inferior alveolar canal, a study was undertaken. Materials and Methods The inferior alveolar neurovascular bundle was dissected from 8 cadaveric mandibles and examined for the arrangement of the inferior alveolar artery, vein, and nerve. Histologic sections were taken for examination, and simultaneously, the bundle was exposed as part of a clinical surgical procedure for a marginal resection of the mandible. Results All 3 studies confirm that the inferior alveolar vein lies superior to the nerve and that there are often multiple veins. The artery appears to be solitary and lies on the lingual side of the nerve, slightly above the horizontal position. This position appeared to be consistent in all cases. Conclusions Knowledge of the arrangement of the inferior alveolar artery vein and nerve within the inferior alveolar canal can be of importance in surgical procedures that may involve these structures. Dentoalveolar surgery, implant-related surgery, and surgery for trauma or pathology could involve these structures.

The mandibular canal transmits the inferior alveolar artery, vein and the inferior alveolar nerve. From an embryological perspective, there might be three inferior dental nerves innervating three groups of mandibular teeth. During rapid prenatal growth and remodeling in the ramus region there is spread of intramembranous ossification that eventually forms the mandibular canal. Occurrence of bifid/trifid mandibular canals in some patients is secondary to incomplete fusion of these three nerves. Various types of bifid mandibular canals have been classified according to anatomical location and configuration. This case report highlights an unusual variant of the mandibular canal.

Unfavorable fractures and blood vessel injuries encountered during 196 operations on 185 patients who underwent surgical correction of jaw deformities were studied to analyze the causes. There were 12 unfavorable fractures (6.1%) and 9 blood vessel injuries (4.6%). All complications occurred in two-jaw surgery and sagittal splitting ramus osteotomy (SSRO). Blood loss and operation time were significantly higher in cases with complications than in those without complication in SSRO.SSRO. With the exception of one case, all fractures were encountered during SSRO. Most of them were minor fractures occurring along the osteotomy line, but relatively large segments of the proximal segment were fractured in 3 cases, 2 of which were not repositioned. Blood vessel injury of the descending palatine artery was encountered in 2 cases of Le Fort I osteotomy. In SSRO, injuries of the inferior alveolar artery, facial artery, and unidentified artery occurred in 3, 1, and 3 cases, respectively. Ligation of the arteries was required to stop bleeding in 2 cases, whereas in the other cases, bleeding was controlled by packing of gauze or oxidized regenerated cellulose.Insufficient bony cut, forcible splitting, and careless handling of surgical instruments were the main causes of the complications. It is thought that the complications can be avoided by precise analysis of structures at the operation site by computed tomography, sufficient bony cut, and careful handling of surgical instruments.

Comprehensive reports concerning selective embolization for arterial bleeding from third molar removal have not been published. We analyzed cases of arterial bleeding from third molar extraction that required transarterial embolization, and we demonstrate representative cases. Five consecutive patients (three men and two women, aged 24 to 37 years) who underwent transarterial embolization at our institution were included in this study. Four of them showed postoperative bleeding after lower third molar removal, and one suffered bleeding after upper third molar extraction. The period of time from extraction to embolization varied from 5 h to 5 weeks. Angiography revealed pseudoaneurysms at the inferior alveolar artery in four cases and at the superior alveolar artery in one case. The pseudoaneurysms were selectively embolized using 25–33 % n-butyl-2-cyanoacrylate (NBCA)–lipiodol. All of the cases showed good results angiographically and clinically. Transit hypoesthesia at the region of the mental nerve was observed in one patient. Selective transarterial embolization is an effective technique for arterial bleeding from third molar removal when it is difficult to obtain hemostasis by dental procedures. Injection of NBCA can be useful when the alveolar artery is too small to embolize with coils.

Chronic mandibular osteomyelitis (CMO) is an inflammatory disease that is resistant to treatment. This paper describes 16 cases of CMO that were treated in our hospital between 1986 and 1992. The discussion includes various methods of treatment. An insufficient inferior alveolar artery (IAA) blood supply as determined by angiography also played a role in CMO. In the above cases, CMO was caused by several different dental diseases.1. Ten cases were diagnosed histopathologically as supprative osteomyelitis; the remaining 6 cases were determined to be sclerosing osteomyelitis. Female patients in their fourth decade accounted for the biggest subgroup. The most frequent tooth involved was the mandibular molar.2. Patients with supprative osteomyelitis showed characteristic symptoms: a) short duration of disease, b) local infection, c) pus discharge, and d) fistula formation. Sequestrectomy was most frequently used as a corrective procedure. Decortication combined with sequestrectomy was used in all cases with sclerotic changes of bone cortex.3. Sclerosing osteomyelitis was clinically characterized by a long duration of disease, diffuse sclerotic changes on X-ray, and associated trismus. Among 4 cases of sclerosing osteomyelitis that underwent angiography of the IAA, 3 cases showed deformities. Therefore, angiography seemed to be a useful procedure to forecast the prognosis because it evaluates the blood supply into the mandible. Consequently, a decreased blood supply might indicate a poor response to antibiotic therapy. In cases without IAA deformity, decorticotomy alone was sufficient for treatment. On the other hand, in the cases of IAA deformity, treatment included a combination of intra-arterial antibiotic infusion and decorticotomy or saucerization.The above procedures resulted in cure in all but 1 case of CMO.

The inferior alveolar nerve (IAN), a branch of the mandibular division of the trigeminal nerve, is a major component of the neurovascular bundle along with the inferior alveolar artery and vein. In rats, when exposed using an external oral approach while remaining intact, it can serve as an important tool to study the different effects of neuromediators and assess the role of different groups of nerve fibers. This paper describes a new technique to expose this nerve giving some experimental results to support its usefulness.

Summary The first known use of Onyx delivered via a dual lumen balloon catheter is reported. A mandibular arteriovenous malformation was successfully embolized with Onyx via an Ascent balloon catheter. Case presentation A teenage girl presented with facial deformity and episodes of oral bleeding. Angiogram showed an extensive left mandibular arteriovenous malformation with ectatic intraosseous venous pouches. A dual lumen Ascent balloon catheter was placed in the inferior alveolar artery. With balloon inflation, Onyx was injected transarterially with excellent penetration into the venous puches. There was closure of over 80% of the lesion with reduction in arteriovenous shunting. Conclusion Onyx embolization via a dual lumen balloon catheter allows for great penetration without the necessity of the long plug creation process for the usual ‘plug and push technique’ or the use of detachable tip microcatheters. The technique is limited by the deliverability of the balloon catheter, and is safest in the external carotid circulation.

Many authors have studied variation in the maxillary artery but there have been inconsistencies between reported observations. The present research aimed to examine the courses and branching patterns of the trunk and branches of the maxillary artery in a large sample of Japanese adult cadavers. The course of the maxillary artery should be reclassified into seven groups as a clear relationship was found between the origin of the middle meningeal artery and the course of the maxillary artery. This indicates that conventional theory about the formation of the maxillary artery, which was considered to be a direct derivative of the stapedial artery, might be inaccurate. Many variations in the origin of the inferior alveolar artery were found. Notably, the inferior alveolar artery origin from the external carotid artery and a double origin of the inferior alveolar artery was also observed. Thus, the maxillary artery might be derived from a combination of both the external carotid and stapedial arteries.

In this study, the relationship between osseous hiealing and microvascular changes was investigated utilizing an osseous-microvascular corrosion casting specimen of mandibular segmental defects (5×3mm) made using an ultrasonic blade in the rabbit. Specimens were prepared at 1, 2, 3 and 4 weeks postoperatively, and studied under light and scanning electron microscopes. At 1 week, neovascularization arose from preexisting vessels of inferior alveolar artery and mandibular periosteum. New bone formation was first seen at the fundus of the defect, and newly-formed trabeculae spread richly between new sinusoidal capillaries. At 2 weeks, there were increased signs of vascularization at the fundus of the defect, and the sinusoidal capillaries gave rise to new capillarise that had independent lumina and formed an interconnected network. Newly formed trabeculae developed to establish a bridge between the cut ends of the defect. At 3 weeks, the new bone formation or deposition observed previously increased in thickness. At 4 weeks, the defects were filled with the newly-formed bone, which rose to the level of the mandibular border. The periosteal vascular network was gradually remodeled to a normal pattern.It is concluded that microvasculature formed during all stages of osseous healing after mandibular segmental resection contributes to new bone formation and development. It is therefor beneficial to maintain the existing vessels of the inferior alveolar artery using an ultrasonic blade.

Introduction Embolia cutis medicamentosa (Nicolau syndrome) is a rare iatrogenic event of tissue necrosis after intramuscular or intraarticular application of cristalloid suspensions. Clinically, it presents as a livid discoloration of the skin, local pain, and signs of inflammation. Methods This article presents the first case of Nicolau syndrome after the endodontic application of calcium hydroxide paste into the distal root canal of tooth 18. The patient presented to the Department for Maxillofacial Surgery and hospitalized for several days. Results The application of calcium hydroxide paste led to a thrombosis of the inferior alveolar artery and various branches of the maxillary artery. A definite necrosis of the left-side infraorbital skin area and concomitant hypaesthesia of the infraorbital nerve and of the mental nerve were observed. Conclusions Calcium hydroxide paste is appropriate for the medicamentous treatment of root canals, but is not suitable to stanch bleeding from periapical arteries.

We have studied a patient with osteolysis, considered to be the initial stage of massive osteolysis suggesting a mandibular cyst, is whom an iliac bone graft was performed.The patient was a 33-year-old male referred to our hospital for spontaneous pain on the left side of the mandible. Radiographic examination revealed that the affected site of the mandible included a mandibular canal and exhibited an oval cyst-like radiolucent image with an unclear boundary. Surgery was performed under systemic anesthesia and included extirpation and curretting of the affected region as well as an iliac bone graft. Pathologically, cortical bone and bone marrow of the mandible were completely replaced by dense and irregular collagen fibers, and abundant iron pigment was deposited in fibrous tissues. The inferior alveolar nerve was normal, but the inferior alveolar artery was extremely narrow.At present, 2 years and 4 months postoperatively the bone graft site shows almost complete osseous concrescence both clinically and radiologically.

Background Causes of mandibular condylar (condylar) head necrosis as a consequence of intracapsular mandibular fractures are still a subject of controversy. Objectives To investigate why in some cases of intracapsular fractures condylar head necrosis occurs. Material 58 human heads from the collection of Head and Neck Clinical Anatomy Laboratory, from the Institute of Physiology and Pathology of Hearing, Warsaw, Poland, constituted the material. Study Head arterial tree injections, anatomical preparation with the use of standard set of microsurgical equipment and an operating microscope. Results The main source of condylar head vascularization is the inferior alveolar artery, supplying bone marrow of the whole mandible as well as its cortical layer. Additional arterial blood supplying comes from a various number (2–7) of branches supplying the temporomandibular joint capsule. They originate directly from the maxillary artery or from its primary branches: masseteric artery, external pterygoid artery or superficial temporal artery. Two rare variants of accessory mandibular head vascularization were encountered. The first (2 cases) was an arterial branch from the maxillary artery and the second (1 case) was a branch from the external pterygoid artery. In these cases the arterial supply of lateral part of temporomandibular joint capsule from other sources was reduced. Conclusion Fractures resulting in the lateral part of the condylar head in isolation could be potentially threatened by necrosis because of poor vascularization.