title: Assessment of variations of the mandibular canal through cone beam computed tomography.
abstract: The neurovascular bundle may be vulnerable during surgical procedures involving the mandible, especially when anatomical variations are present. Increased demand of implant surgeries, wider availability of three-dimensional exams, and lack of clear definitions in the literature indicate that features of anatomical variations should be revisited. The objective of the study was to evaluate features of anatomical variations related to mandibular canal (MC), such as bifid canals, anterior loop of mental nerve, and corticalization of MC. Additionally, bone trabeculation at the submandibular gland fossa region (SGF) was assessed and related to visibility of MC. Cone beam computed tomography exams from 100 patients (200 hemimandibles) were analyzed and the following parameters were registered: diameter and corticalization of MC; trabeculation in SGF region; presence of bifid MC, position of bifurcations, diameter, and direction of bifid canals; and measurement of anterior loops by two methods. Corticalization of the MC was observed in 59% of hemimandibles. In 23%, MC could be identified despite absence of corticalization. Diameter of MC was between 2.1 and 4 mm for nearly three quarters of the sample. In 80% of the sample trabeculation at the SGF was either decreased or not visible, and such cases showed correlation with absence of MC corticalization. Bifid MC affected 19% of the patients, mostly associated with additional mental foramina. Clinically significant anterior loop (>2 mm of anterior extension) was observed in 22-28%, depending on the method. Our findings, together with previously reported limitations of conventional exams, draw attention to the unpredictability related to anatomical variations in neurovascularization, showing the contribution of individual assessment through different views of three-dimensional imaging prior to surgical procedures in the mandible.
authors: Oral Imaging Center and Department of Periodontology, Katholieke Universiteit, Leuven, Belgium. oliveirachristiano@hotmail.com
authors: Christiano
authors: C
authors: de Oliveira-Santos
authors: Paulo Henrique Couto
authors: PH
authors: Souza
authors: Soraya
authors: S
authors: de Azambuja Berti-Couto
authors: Lien
authors: L
authors: Stinkens
authors: Kristin
authors: K
authors: Moyaert
authors: Izabel Regina Fischer
authors: IR
authors: Rubira-Bullen
authors: Reinhilde
authors: R
authors: Jacobs
mesh_terms: D000328:Adult; D019412:Anatomy, Cross-Sectional; D002680:Chin / Q000294:innervation; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003724:Dental Arch / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008334:Mandible / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000294:innervation; D008336:Mandibular Diseases / Q000000981:diagnostic imaging; D008340:Mandibular Nerve / Q000000981:diagnostic imaging; D008875:Middle Aged; D008963:Molar / Q000000981:diagnostic imaging; D011862:Radiography, Panoramic / Q000379:methods; D013363:Submandibular Gland / Q000000981:diagnostic imaging; D055815:Young Adult