Introducing a novel intraoral mandibular nerve block technique for loco-regional analgesia in camels (Camelus dromedarius): a cadaveric study using computed tomography.

The aim of this study was to introduce a novel intraoral technique for performing mandibular nerve blocks in dromedary camels (Camelus dromedarius). In this study, 18 adult camel skulls of varying ages and breeds were examined to determine the position of the mandibular foramen. Using a Vernier caliper, three dimensions in millimeters were measured: (1) the distance between the mandibular foramen (MF) and the caudal edge of the third molar tooth at the occlusal surface level, (2) the distance between the MF and the rostral edge border of the mandible's ramus (RER) at the occlusal surface level, and (3) the distance between the MF and the ventral margin border of the mandible (VM). The technique was evaluated using five intact camel cadaver heads (n = 5), and a total of ten mandibular nerve blocks were described. An 18-gauge 80-mm Tuohy needle was inserted into the mouth commissure and advanced caudally while injecting a saline-methylene blue solution. The accuracy of the injection was confirmed through the infiltration of the contrast dye into the target area using computed tomography (CT) and post procedural dissection. Anatomical study of the mandibular nerve site was performed to aid the blind insertion of the needle. The findings contribute to the development of veterinary anesthesia techniques and provide anatomical considerations for clinicians performing oral surgeries in sedated camels. The results demonstrated the successful implementation of the intraoral technique, highlighting its efficacy and reliability in achieving local anesthesia for oral surgeries involving the lower jaw and teeth in sedated camels. Further research studies are needed to evaluate the long-term efficacy and safety of the technique and to compare it with existing approaches.

A rare case of the auriculotemporal and inferior alveolar nerves communication.

This case study describes anatomical variations in the branching pattern of the posterior division of the trigeminal nerve and its clinical implications for dental and craniofacial surgery. The study presents two uncommon variations observed in an elderly male cadaver. A communicating branch connecting one of three roots of the auriculotemporal nerve and inferior alveolar nerve just before entering the mandibular foramen on the right side, and three communicating branches between the IAN and lingual nerve on the left side. The presence of such variations may complicate anesthesia associated with oral surgery procedures.

Determining the position of the lingula and the mandibular foramen using the antilingula in orthognathic surgery.

BACKGROUND: The antilingula located on the lateral surface of the mandibular ramus has been served as a surgical landmark for the mandibular foramen on the medial surface for decades. However, whether the antilingula truly represents the lingula which is the bony prominence overlapping the mandibular foramen, or the foramen itself, is still unclear. This study thus aimed to examine the position of the antilingula in relation to three reference points: the lingula, the anterior and the posterior borders of the mandibular foramen, as well as to the reference plane used in the inferior alveolar nerve block, and to the posterior border of the mandible. METHODS: This observational study was performed in 113 Thai dry mandibles. The antilingula were identified followed by transferring the reference points to the lateral surface. The distances from the antilingula to the reference points, the reference plane and the posterior border of the ramus were then measured. Chi-square test was calculated for side-dependency of the antilingula. Paired t-test was calculated for difference in measurements in left and right sides. RESULTS: The antilingula could be identified in 92.48% of the mandibles with 86.67 - 90.00% accuracy and 86.67% reliability. There was no significant difference in the presence of the antilingula on left and right sides (p = 0.801). Only 2.5% and 0.83% of the antilingula correspond to the lingula and the anterior border of the mandibular foramen, respectively. However, 85% of the reference points were located within 11 mm radius. The antilingula was found located 2.80 mm inferior to the reference plane and 16.84 mm from the posterior border of the ramus. CONCLUSIONS: The antilingula does not concur with the reference points on the medial surface. Our study also suggests that the safe area for vertical osteotomy is 11 mm posterior to the antilingula or at 30% of the length from the posterior border parallel to the occlusal plane. The use of more accurate techniques in localizing the mandibular foramen combined with the antilingula is more recommended than using the antilingula as a sole surgical guide.

Morphological integration in inferior alveolar canal and mandibular shapes.

OBJECTIVE: During embryogenesis of mandible, the initial ossification centre begins at the bifurcation of the inferior alveolar (IA) and the mental nerves. Additionally, in congenital anomalies like craniofacial microsomia (CFM), the IA canal is completely absent on the microsomic side. These observations led us to hypothesise that there may be a morphological integration between these structures - the IA nerve and the mandibular shapes. Therefore, the primary objective of this study was to test for morphological integration between these structures and the secondary objective was to determine if there were shape variations in these structures among skeletal Classes I, II and III subjects. SETTING AND SAMPLE POPULATION: The sample size of the study is 80 full-head cone-beam computed tomography (CBCT) scans (age 16-56 years). METHODS: We retrieved CBCT scans from our archived database using specific inclusion/exclusion criteria. In the de-identified CBCT scans, traditional coordinate landmarks and sliding semi-landmarks were placed on the mandible and the IA canal (proxy for IA nerve). Using geometric morphometric analyses, we tested integration between the IA canal and the mandibular shapes. We used Procrustes ANOVA to test for overall shape variations among the three skeletal classes (Classes I, II and III). RESULTS: The IA canal and posterior/inferior border of mandible showed strong integration (r-PLS = .845, P = .001). Similar strong integration was also observed between the IA canal and the overall shape of the mandible (r-PLS = .866, P = .001). Additionally, there was a statistically significant variation in overall shape between skeletal Class I and Class II (P = .008) and Class II and Class III (P = .001). CONCLUSIONS: The strong integration between two structures suggests that the IA nerve may play a role in establishing mandibular shape early in development. We posit this may be important in driving mandibular defects seen in CFM, which warrants further investigation.

Characterization of the pterygomeningeal artery based on branching pattern and muscular distribution.

PURPOSE: The pterygomeningeal (accessory meningeal) artery arises from the middle meningeal or maxillary artery. Although there is the potential that this artery may be wounded by the surgery for the temporomandibular joint disorder, the current state of anatomical knowledge is insufficient. This study investigated the appearance and the branching pattern of this artery as a means to its characterization. METHODS: The pterygomeningeal artery was dissected in 14 cadavers and its branches and their distributions to the muscles inside the mandible were examined. RESULTS: The maxillary artery passed lateral to the lateral pterygoid muscle. The pterygomeningeal artery arose from the middle meningeal or maxillary artery. It ascended anteriorly and coursed medial or lateral to the mandibular nerve. It passed above the pterygospinous ligament and then descended. The ascending trunk gave some lateral branches to the lateral pterygoid muscle. The branches sometimes passed lateral to the mandibular nerve even if the pterygomeningeal artery coursed medial. The descending trunk was divided into middle and medial branches, which supplied the medial pterygoid muscle and the tensor veli palatini, respectively. The pterygomeningeal artery was sometimes equally bifurcate near the origin, and the counterparts passed lateral and medial to the mandibular nerve. The distributions of the medial and lateral counterparts were equivalent to those of the descending trunk and the lateral branches, respectively. CONCLUSION: The pterygomeningeal artery contains three groups of muscular branches, which sometimes appear in a bifurcate form. Their positions relative to the mandibular nerve and the pterygospinous ligament characterize the artery; this information may help to avoid iatrogenic injury.

Cadaveric Study of Topographic Anatomy of Temporal and Marginal Mandibular Branches of the Facial Nerve in Relation to Temporomandibular Joint Surgery.

PURPOSE: Detailed anatomy of the facial nerve, including the variations among different ethnic groups, is essential to prevent an iatrogenic injury. The purpose of the study was to document topographic anatomy of temporal and marginal mandibular (MM) branches of the facial nerve in relation to temporomandibular joint (TMJ) surgery. The specific aim was to demonstrate detailed course of temporal and MM nerves, their surgical implications, and to compare the results obtained with the previous studies. METHODS: The investigators implemented a prospective cadaveric study. A dissection was carried out on 52 facial halves. The facial nerve was dissected according to the instructions described in the Cunningham's dissection manual. Anatomic landmarks were selected as determined by Al-Kayat and Bramley, and results obtained were compared with previous published articles. RESULTS: The study sample was composed of 52 facial halves (males, n = 35; females, n = 17). The number of branches of temporal nerve varied in dissected facial halves from 3 (n = 37 [70%]), 2 (n = 14 [26%]), to 1 (n = 1 [2%]). The distance between the lowest concavity of the bony external auditory meatus to the point at which the facial nerve bifurcates (distance B) was considerably less in the study population (1.79 cm) when compared with the reported literature (2.3 cm). There was no significant influence of gender and cephalic index on distances measured. There was 1 branch in 15% of the dissected facial halves (1 in 52) and 2 branches in 85% (44 of 52). The MM nerve was seen coursing below the inferior border of the mandible, and in 44 (85%), the nerve was present above the inferior border of mandible all along the course. CONCLUSIONS: The topographic anatomy of the temporal and MM nerves is the same as reported in the literature. The only considerable difference was found in distance B; hence, surgical procedures involving the distance B require special consideration.

Key Anatomical Clarifications for the Marginal Mandibular Branch of the Facial Nerve: Clinical Significance for the Plastic Surgeon.

BACKGROUND: The marginal mandibular branch (MMBr) of the facial nerve is the least likely to recover from injury due to infrequent anastomosis with other branches. The MMBr has been described as coursing superior to the inferior border of the mandible. However, studies have reported variations in its location in embalmed and fresh specimens. It has been postulated that the embalming process may effect its anatomic position. OBJECTIVES: The aim of this study was to re-evalulate the location of the MMBr relative to the inferior border of the mandible in both fresh and embalmed cadavers, and investigate variation in its position with sex, side of the face, and age. METHODS: Superficial fascial planes were dissected to reveal the MMBr and its anatomic relations. Distance between the most inferior branch of the MMBr and the antegonial notch were measured bilaterally. The most inferior position of the MMBr between the antegonial notch and gonion was measured. Fresh heads were used as a comparison, with an additional measurement taken of the distance between the MMBr and the gonial angle. RESULTS: The MMBr was located inferior to the border of the mandible (90.3%) more often than above (9.6%). No significant differences were found between fresh and embalmed cadavers, sex, side of body, or age (P > 0.05). No significant difference was found between intact cadavers and fresh heads (P > 0.05). CONCLUSIONS: This study confirms and describes reliable landmarks for safety zones for the MMBr during plastic and reconstructive surgery of the lower face and upper neck. These data add reliability to studies that have investigated nerve locations in embalmed cadavers.

Anatomic Variations From 120 Mental Nerve Dissections: Lessons for Transoral Thyroidectomy.

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a promising technique for eliminating a neck incision. A new risk of TOETVA is the potential for injury to the mental nerves during placement of three oral endoscopic ports. A better understanding of the variations in mental nerve anatomy is needed to inform safer TOETVA technique. MATERIALS AND METHODS: We performed 120 dissections of mental nerve branches exiting the mental foramen in 60 human cadavers. Anatomic distances and relationships of the foramen to the midline were evaluated. Mental nerve branching patterns were studied and compared with previously reported classification systems to determine surgical safe zones free of nerve branches. RESULTS: The mean midline-to-mental foramen distance was 29.2 ± 3.3 mm, with high variability across individuals (18.8-36.8 mm). There were differences in this distance between the left and right foramina (29.8 ± 3.2 versus 28.8 ± 3.3 mm, P = 0.03). All mental nerve branches exiting the mental foramen distributed medially. The branching patterns were classified into eight distinct categories, three of which are previously undescribed. One of these novel patterns, occurring in 9.2% of cases, had a dense and wide clustering of branches traveling toward the midline. CONCLUSIONS: The location of the mental foramen and mental nerve branching patterns demonstrate high variability. To avoid mental nerve injury in TOETVA, we identify a safe zone for lateral port placement lateral to the plane of the mental foramen. Placement and extension of the middle port incision should proceed with caution, as clustering of mental nerve branches in this area can frequently be present.

Anatomical study of gasless transoral thyroidectomy and clinical application.

BACKGROUND: Transoral thyroidectomy is becoming a preferred technique because it has the advantage of not leaving a scar after surgery. However, it is not yet standard because of the anatomic nerve complexity of this oral cavity and difficulty of approach. The aim of this study was to determine the safety zone of a gasless transoral thyroidectomy approach using an anatomical study and to evaluate the efficacy of this approach on clinical application. METHODS: Phase 1, twenty unilateral specimens from fresh cadavers underwent staining by the modified Sihler's method to identify nerves around the oral vestibules. Then, the safety zone of the transoral thyroidectomy approach was proposed. Phase 2, a comparative analysis of the clinical outcomes of gasless transoral thyroidectomy through the safety zone versus transcutaneous thyroidectomy approach. RESULTS: In phase 1, numerous inferior labial branches diverged from the mental nerve and were distributed across the lower lip. In most cases, the most lateral branch reached almost to the corner of the mouth, whereas a nerve-free area was present at the medial region of the lower lip. The suggested safety zone was presented as a trapezoid shape. In phase 2, there were no significant differences in age, mass size, or complications between the two groups. However, the operation time in the transoral thyroidectomy group was longer than in the transcutaneous group (p = 0.001). CONCLUSIONS: Based on the anatomical study, we suggested a safety zone for the gasless transoral thyroidectomy. On application of this safety zone, gasless transoral thyroidectomy is a safe and feasible procedure.

Branching Patterns of Mental Nerve in Newborns.

In classical textbooks of Anatomy, the mental nerve is considered to be the terminal or main branch of the inferior alveolar nerve, especially trifurcate with no designated names as soon as it emerges from the mental foramen. The textbooks define the innervation area of the mental nerve regionally without naming its terminal branches. Nomina Anatomica designates 3 terminal branches of mental nerve as "labial, gingival, and mental branch" but offers no description about their distribution on the mandible. In the present study, bilateral dissections were performed on the lower lip specimens of 20 newborns for 40 mental nerves to determine the branching types of mental nerve. Although anatomy textbooks indicate that mental nerve divides into 3 branches, the authors noted that mental nerve branched into 1, 2, or 3 branches at or right after its exit from the mental foramen. Branching patterns were typed in 13 different subclasses under 3 main groups (Form I-II-III). Moreover, the branching patterns that could not be included in one of these 3 main groups were defined as "Complex Form." The most common type of branching that the authors observed was Form II, which had 2 terminal branches with an incidence of 41.9% (16 specimens). The next frequently encountered type was Form III, having 3 terminal branches, and it was detected in 32.0% of patients (12 specimens). The least common form was Form I, which had 1 terminal branch with a frequency of 15.8% (6 specimens). The unclassified group, Complex Form, was found 10.5% (4 specimens).

Surgical Anatomy of the Marginal Mandibular Nerve: A Systematic Review and Meta-Analysis.

The high number of marginal mandibular nerve (MMN) anatomical variants have a well-known clinical significance due to the risk of nerve injury in several surgical procedures. The aim of this study was to find and systematize the available anatomical data concerning this nerve. The PubMed and Scopus databases were investigated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All studies reporting extractable data on the origin, course, splitting, anastomosis and relationship of the MMN with the mandible or the facial vessels were included. We included 28 studies analyzing 1861 halves. The MMN had one (PP = 35% 95% CI:18-54%), two (PP =35% 95% CI:18-54%), three (PP = 18% 95% CI:0-35%), or four branches (PP = 2% 95% CI:0-8%). Anastomosis with the great auricular nerve, transverse cervical nerve, mental nerve, and other branches of the facial nerve were defined. The origin of the MMN in relation to the parotid and the mandible was variable. The MMN nearly always crossed the anterior facial vein laterally (PP = 38% 95% CI:9-72% if single, PP = 57% 95% CI:22-90% when multiple); its relation with other vessels was less constant. At least one branch of the MMN was found below the inferior border of the mandible (IBM), with a PP of 39% (95% CI:30-50%). The MMN has high anatomical variability and it is more often represented by one or two branches; its origin is frequently described at the parotid apex and above the IBM, although in its course at least one branch often runs below the IBM. Its most frequent anastomosis is with the buccal branch of the facial nerve. Clin. Anat., 33:739-750, 2020. © 2019 Wiley Periodicals, Inc.

Mandibular nerve block in juvenile Nile crocodile: a cadaveric study.

OBJECTIVE: To develop a technique for performing the mandibular nerve block in Nile crocodiles. STUDY DESIGN: Experimental cadaveric study. ANIMALS: A total of 16 juvenile Nile crocodile heads. METHODS: To study the course of the mandibular nerve, one head was dissected. Computed tomography (CT) examination was performed in two heads to identify useful landmarks. Thereafter, a hypodermic needle was inserted through the external mandibular fenestra of 17 hemimandibles (13 heads), and a mixture of methylene blue and iohexol was injected. Injection volumes were 0.5 (n = 7) and 1.0 mL (n = 10) for hemimandibles < 15 and ≥ 15 cm long, respectively. Iohexol spread and nerve staining with methylene blue were assessed with CT and anatomical dissection, respectively. Data were analysed with one-sample t test or Mann-Whitney U test. Significance was set at p < 0.05. RESULTS: Both anatomical dissection and imaging confirmed the external mandibular fenestra as a useful anatomical landmark for needle insertion. The CT images acquired after needle positioning confirmed that its tip was located on the medial bony mandibular surface formed by the fusion of the angular and coronoid bones in 100% cases. In all the hemimandibles, the rostrocaudal spread of contrast was > 23 mm. The length of the stained mandibular nerve in the temporal region and of the stained medial branch of the mandibular nerve, as well as the dorsoventral and mediolateral spread of iohexol, was greater in group 1.0 than in group 0.5 (p < 0.001). The caudal spread of iohexol was greater in group 1.0 than in group 0.5 (p = 0.01). CONCLUSIONS AND CLINICAL RELEVANCE: The technique developed in this study is feasible. Both injection volumes resulted in staining of the mandibular nerve. The spread of contrast in the anatomical region of interest may result in successful sensory block.

A new treatment for lingual nerve injury: an anatomical feasibility study for using a buccal nerve pedicle graft.

PURPOSE: Lingual nerve (LN) palsy is a serious complication in dentistry and repaired by direct suture or a free graft technique. To our knowledge, there has been no study using a (long) buccal nerve (BN) graft as a donor for LN repair. Therefore, we aimed to clarify the location of the BN and investigate if it is feasible to reroute the BN to the LN. METHODS: Twenty-four sides from 12 fresh-frozen Caucasian cadaveric heads were used in this study. The mean age at death was 73.9 ± 13.4 years. The LN was dissected on the floor of the oral cavity medial to the third molar tooth. Next, the mucosa with the buccinator muscle, pterygomandibular raphe, and superior pharyngeal constrictor muscle on the retromolar area was retracted anteriorly to widen the pathway of the LN. Finally, the BN was cut and transposed to the LN through this widened pathway to its feasibility. RESULTS: The mean diameter of the BN and vertical distance from the horizontal part of the retromolar trigone to the BN was 1.47 ± 0.32 mm and 18.53 ± 6.21 mm, respectively. On all sides, the BN was able to be transposed to the LN without tension. CONCLUSION: Such a technique might be used for the patients with LN injury and who have lost sensation of the tongue.

Surgical implications of the anatomic situation of the mandibular canal for mandibular osteotomies: a cone beam computed tomographic study.

PURPOSE: In bilateral sagittal split osteotomy (BSSO), the risk of lesion of the inferior alveolar nerve (IAN) is important. The aim of this study was to investigate the situation of the IAN in the area of the BSSO in preoperative 158 CBCT. METHODS: The situation of the mandibular canal (MC) has been studied in six coronal sections (one section each 4 mm) from the proximal root of the second mandibular molar. The height of the MC related to the height of the mandible, and the horizontal distance between the MC and the lateral cortical plate related to the mandibular width have been determined in each section. The cancellous bone width has been measured allowing to determine a cancellous bone ratio. RESULTS: The variability of the MC was high, depending mainly on the cancellous bone ratio which was higher when the IAN was deep. When a third molar was present, the MC was lower in the area of the third molar. CONCLUSIONS: To decrease the risk of injuring the IAN in BSSO, the evaluation of the cancellous bone ratio by a preoperative CBCT may be proposed to adapt the surgical technique to the anatomy.

Is the inferior occlusal plane a reliable anatomic landmark for inferior alveolar nerve block? A study on dry mandibles of Brazilian adults.

PURPOSE: To investigate the relationship between the mandibular foramen (MF) and the inferior occlusal plane (IOP) of anatomic specimens, in order to guide clinicians in the inferior alveolar nerve block (IANB). METHOD: Eighty-two dry mandibles (totally or partially toothed) of Brazilian adults were selected, totalizing 66 left and 66 right antimeres. A flat plate of rigid PVC plastic was placed on the occlusal surfaces of posterior teeth and pressure was then manually applied to simulate the IOP. Following, the perpendicular distance from the IOP to the lowest point of the MF was measured by the use of a digital caliper, adopting negative values inferiorly and positive values superiorly. RESULTS: Regarding the antimeres, the majority of the lowest limits of the MF was below the IOP (right: 86.4%, left: 81.8%) with a mean of -4.2mm (±4.8) in the right and -4.1mm (±4.8) in the left ones, without any statistical significance. Considering both sexes, no statistically significant difference was obtained between them. CONCLUSION: The IOP seems not to be a good anatomical landmark to localize the MF and, its turn, to guide clinicians during the IANB for Brazilian adults, given the marked topographic variations.

The unusually lower position of the mandibular foramen and the canal of the neck of mandible.

BACKGROUND: The inferior alveolar nerve (IAN) courses through the mandibular foramen (MF) to enter the first segment of the mandibular canal (MC) in the mandibular ramus, to further supply with trigeminal fibers the lower teeth of that hemimandible. As the IAN also supplies the mylohyoid nerve, it is a mixed nerve. METHODS: Unusual morphologies of the mandibular ramus were encountered during a retrospective study of archived CBCT files. RESULTS: A previously unreported anatomic variation was found bilaterally in an edentulous mandible, consisting of a lowered position of the MF, with seemingly compensatory lengthening and enlargement of the sulcus colli, thus shortened MCs. Also, a rare neurovascular canal of the neck of the mandible was incidentally found unilaterally in another case and is reported here. CONCLUSIONS: Such possibilities of variation could justify the individual effect of the IAN block.

Imaging study on relationship between the location of lingula and the Gonial angle in a Chinese population.

PURPOSE: The purpose of this study was to investigate the Gonial angle in relation to the position of the lingula using computerized image analysis to guide the oral surgeons to prevent injury to the inferior alveolar nerve and peripheral blood vessels during surgery. METHODS: We measured Gonial angle sizes of bilateral rami and the distances from the lingula tip to the mandibular notch (LN), the anterior (LA) and posterior (LP) margin of the mandibular ramus, the mandibular base (LB) and the occlusive plane (h) in 407 Chinese adults with CBCT. RESULTS: In males, the mean distance of LN was 17.64 mm in the low Gonial angle group while 16.76 mm in the high Gonial angle group, which was significantly different between two groups (P < 0.001). The distance of LA in LGA group was obviously longer than that in HGA group (P < 0.001). The mean distance LP of men was 17.94 mm in LGA group while 16.9 mm in HGA group (P < 0.001). In females, the mean distance of LB in LGA group was 33.32 mm and 32.37 mm in HGA group (P < 0.01). CONCLUSION: We discovered that the segment of the mandibular branch, between the mandibular lingula and the mandibular angle, was obviously smaller in the HGA group than that in the LGA group.

CBCT study on the relationship between lingula and antilingula position in a Chinese Han population.

OBJECTIVE: The purpose of this article was to assess the anatomical relationship between the lingula and the antilingula by measuring the projection of lingula on the lateral side of the ramus on CBCT. METHODS: This study collected CBCT images of 204 mandibular halves in 102 Chinese patients without any damage. We projected the lingula to the lateral side of the mandibular ramus and examined the distance and position relationship between the projection point and the antilingula using three-dimensional computed tomography (3DCT) created by image software. RESULTS: In 204 sides the antilingula appeared in 92 cases, 52 on right and 40 on left. The antilingula was used as a fixed point, in four cases the lingula projection in the anterior superior part, 38 cases in the posterior superior part, 45 cases in the posterior inferior part and zero case in the anterior inferior part. Scatter plots diagrammatic representation in four quadrants centered on the antilingula showed that 79% cases (73/92) lied in a 90° fan shape ranged in 5-10 mm radius in the posterior superior and inferior quadrant. CONCLUSION: The lingula mainly located in the posterior superior and inferior part from the antilingula in a 90° fan shape ranged in 5-10 mm radius. The osteotomy incision should be avoided in this area.

A DETAILED CBCT STUDY OF 'CORONOID FORAMINA' AND ACCESSORY FORAMINA OF THE MANDIBLE: A UNIQUE ANATOMIC VARIATION.

The aim of the study was to evaluate accessory foramina (AF) located on the medial aspect and to present a unique finding of 'coronoid foramina' (CF) along with AF on the mandible. The cone beam computed tomography images of the mandible in 979 patients were retrospectively evaluated for the presence of CF and AF. AF was found in 39 (3.98%) patients. AF located on the medial surface below and above mandibular foramen was found in 15.38% and 84.62% of patients, respectively. CF was confirmed in 20 (2.04%) patients. Mandibular AF is important for surgical procedures in the posterior region of the mandible and for mandibular nerve anesthesia. This study including CF will be useful for further studies due to the lack of literature on the issue.

[Topographic study of mandibular block landmarks]. / Sposob provedeniia mandibuliarnoi anestezii na osnovanii topografoanatomicheskikh orientirov.

The study samples included 12 anatomical specimens taken from the fixed corpses of various gender and age. Pterygomandibular space topography was assessed by macro - and micropreparation methods. The landmarks for the universal way of mandibular anesthesia were defined associated with low risk of medial pterygoid muscle, lingual nerve, inferior alveolar neurovascular bundle damage. The study results allow increasing the efficiency and safety of anesthesia of the lower jaw teeth.