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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.

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.

50 corpses from adults aged 20 to 75 have been used in order to study the atherosclerotic lesions occurring in typical regions (bifurcation of the common carotid artery and the abdominal aorta) and their relationship to atherosclerotic changes in the inferior alveolar artery. Histological analysis revealed that atherosclerotic alterations of the inferior alveolar artery may appear sometimes earlier than it would be expected on the ground of age. Intima cell proliferation and thickening of elastic elements in the middle layer of the arterial wall, the first signs of atherosclerosis, were found already at the beginning of the third decade of life when the signs of this process in the typical regions were not yet evident. Atherosclerosis affects essentially the functional capacity of the inferior alveolar artery. The development of atherosclerosis in the wall of this artery favours an hypovascularization of the mandible, which must be of certain importance in every operative procedure in oral surgery, especially in those inducing a severe and long traumatism in bone and soft tissues, such as dental implantations., Cette étude, faite sur 50 cadavres (de 20 à 75 ans) concerne les altérations athéroscléreuses de l’artère dentaire inférieure et leurs rapports avec les altérations athéroscléreuses dans les territoires typiques (bifurcation carotidienne et aorte abdominale). L’examen histologique a fait apparaître que les altérations athéroscléreuses de l’artère dentaire inférieure peuvent être relativement plus évidentes et précoces que l’on ne s’y attendrait compte tenu de l’âge. Une prolifération cellulaire de l’intima et un épaississement de la lame élastique moyenne dans la paroi artérielle, premiers signes de l’athérosclérose, peuvent apparaître dès30 ans, alors que l’on ne trouve pas encore d’altérations de ce type dans les territoires typiques. L’athérosclérose a une influence cruciale sur la capacité fonctionnelle de l’artère dentaire inférieure puisque celle-ci chemine dans le canal osseux, qui empêche sa dilatation. Le développement de l’athérosclérose dans la paroi de cette artère favorise une hypovascularisation de la mandibule, ce qui a une importance certaine lors de toute intervention en chirurgie orale, surtout lorsqu’elle entraîne un traumatisme grave et prolongée de l’os et des parties molles, comme c’est le cas lors de l’insertion d’implants dentaires.

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

The wild boar is broadly distributed in several parts of the world by man, with the exception of Antarctica. It is known that the facial artery and its branches are responsible for maintaining the blood supply of structures related to chewing, swallowing, and the production of saliva. The aim of this study is to describe the origin and distribution of the right and left facial arteries of the boar in the context of foraging. The facial arteries of this boar species originated from the external carotid artery in all specimens and were distributed in the pharyngeal, glandular, and muscular branches as well as the branches to the mandibular lymph nodes. The anastomotic branches of the facial artery with the buccal and mylohyoid branch of the inferior alveolar artery were also identified. This feature shows that the region of allocation of the facial artery in these animals requires a large network for irrigation, which contributes to the functional efficacy as well as the modus viventis of this animal. O javali encontra-se amplamente distribuído pelo homem em diversas partes do mundo, com exceção da Antártica. É sabido que a artéria facial e seus ramos são responsáveis por manter o suprimento sanguíneo das estruturas relacionadas com a mastigação, deglutição e produção de saliva. Diante do exposto, objetivou-se descrever as origens e distribuições das artérias faciais direita e esquerda do javali. As artérias faciais deste suídeo originaram-se da artéria carótida externa em todos os espécimes e distribuíram-se em ramos faríngeo, glandulares, musculares e ramos para linfonodos mandibulares. Ramos anastomóticos da artéria facial com a bucal e com o ramo milo-hioideo da artéria alveolar inferior foram identificados. Essa característica demonstra que a região de alocação da artéria facial nesses animais necessita de um expressivo contingente para irrigação, colaborando muito com sua eficácia funcional, bem como com o modus viventis deste animal.

Considerable consistency in the arterial pattern of the head has been observed in species of Artiodactyla, but few studies have examined the order Perissodactyla. Here we describe arteries supplying the intermandibular, mental, masseteric, buccal, labial and nasal regions in eight perissodactylans, including representing of all families comprising this order. Observations were made on a total of 45 preparations of head arteries, obtained by injection of arteries with acetone-dissolved stained vinyl superchloride or stained latex LBS3060. In the Equidae species alone it was found that the facial artery descends from the linguofacial trunk. In tapirs and rhinos the facial artery branches off directly from the main arteries of the head. In tapirs alone it was found that the inferior alveolar artery gives off the buccal and sublingual arteries, and then extends into the mental artery. In the rhino a specific feature of the arterial pattern of the head was the exit of the occipital artery from the superficial temporal artery. In all equines studied, the transverse facial artery gave off a larger blood vessel to the masseter muscle and ran along the facial crest, while in tapirs and rhinos the transverse facial artery fanned out branches in the masseteric fossa. The variations observed can be considered in future studies on the origin of Perissodactyla. In this context, we note that the most similar patterns of exit and course of the facial, mental, transverse facial and infraorbital arteries exist in tapirs and rhinos (Ceratomorpha suborder), at least among the perissodactylans studied here. This article is protected by copyright. All rights reserved.

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.

WOS: 000302190500034, The aim of this study was to investigate the anatomy of the maxillary artery (MA) and its branches. Fourteen sides of Turkish adult cadavers were dissected. The specimens were classified according to the relation between MA and the lateral pterygoid. After the removal of the lateral pterygoid, parts and branches of MA were exposed. We classified the branching patterns of MA in the pterygopalatine fossa. The calibers and lengths of the arteries, and the distance between the zygomatic arch and MA, and between the infratemporal crest and MA were measured. The MA was found superficial to the lateral pterygoid in 57.2%. The inferior alveolar artery (IA) was arisen from MA before the middle meningeal artery (MM) in 35.7%, after MM in 35.7%. The IA and MM were arisen from the same area of MA in 14.3 %. In other two cases IA was arisen from the beginning of MA (14.3%). According to the contours of third portion of MA, we classified "Y" type (50%), "intermediate-T" type (14.3%), and "M" type (35.7%). This reinvestigation of the clinical anatomy of MA may provide useful information to the head and neck surgeons, dentists, neurosurgeons and radiologists related with this region.

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.