title: Variation in arterial supply to the floor of the mouth and assessment of relative hemorrhage risk in implant surgery.
abstract: OBJECTIVE
  Bleeding in the floor of the mouth during implant surgery is attributed to arterial injuries in the sublingual space: clinicians may injure the submental and sublingual arteries, which originate from the facial and lingual arteries, respectively. This study aimed to clarify the three-dimensional courses of submental and sublingual arteries and their topographic relation to the mandible.
  
  
  METHODS
  During the gross anatomy course at the Faculty of Dentistry and Graduate School, Niigata University (2009-2011), we investigated the relationship between the courses of submental and sublingual arteries and their dividing patterns of the mylohyoid muscle, sublingual gland, and mandible using 27 human cadavers.
  
  
  RESULTS
  The courses of submental and sublingual arteries were divided into four patterns: (1) the sublingual space was supplied by the sublingual artery (type I: 63%), (2) it was supplied by both the sublingual and submental arteries (type II: 5.6%), (3) it was supplied by the submental artery without the sublingual artery (type III: 29.6%), and (4) type III without the deep lingual artery originated from the lingual artery (type IV: 1.8%). In type II, III, and IV, the submental artery perforates the mylohyoid muscle or takes a roundabout route to travel near the surface of the mandible. The percentage occurrence of arteries traveling between the sublingual gland and mandible in type II, III, and IV (55%) is higher than that in type I (8.8%).
  
  
  CONCLUSIONS
  Susceptibility of the submental artery in type II, III, and IV to injury during implant surgery is suggested.
authors.affiliation: Division of Anatomy and Cell Biology of the Hard Tissue, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Katsumi
authors.forename: Ray
authors.initials: R
authors.lastname: Tanaka
authors.forename: Takafumi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Taketo
authors.initials: T
authors.lastname: Koga
authors.forename: Ritsuo
authors.initials: R
authors.lastname: Takagi
authors.forename: Hayato
authors.initials: H
authors.lastname: Ohshima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000033:anatomy & histology*; D002102:Cadaver; D003758:Dental Implantation, Endosseous; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply* / Q000293:injuries; D011183:Postoperative Complications / Q000209:etiology*; D012306:Risk