A rare anatomic variation: Triple mental foramina.

Multiple mental foramina (MF) are rarely found in the human mandible. We report on the case, as documented using cone beam computed tomography (CBCT), of the triple MF that were identified on the right hemimandible of a 28-year-old female patient. The distal foramen was located on the mandible between the apices of the second premolar root and the first molar mesiovestibular root, being reached by a thin canal that left the mandibular canal. A pair of mesial foramina were identified between the apices of the premolar teeth. Thus, the three foramina corresponded to a surface area of 23.49mm2 of the mandible. On the opposite side, a single mental foramen had a surface area of just 13.25mm2. On each side, retromolar canals that opened into the retromolar fossae were also found. The anatomic possibility of multiple MF increases the surface area at risk during surgical procedures, increases the risk of neurovascular damage and obscures the common tooth-related location of the mental foramen. Practitioners should, therefore, consider a personalised and imaging-documented approach so as to avoid treatment failure.

Bilateral giant and unilateral duplicated sphenoidal tubercle.

The sphenoidal tubercle (SphT), also known as pyramidal tubercle or infratemporal spine projects from the anterior end of the infratemporal crest of the greater sphenoidal wing. As it masquerades the lateral entrance in the pterygopalatine fossa it could obstruct surgical corridors or the access for anaesthetic punctures. The SphT is, however, an overlooked structure in the anatomical literature. During a routine cone beam computed tomography study in an adult male patient we found bilateral giant SphTs transforming the infratemporal surfaces of the greater wing into veritable pterygoid foveae. Moreover, on one side the SphT appeared bifid, with a main giant partition, of 9.17 mm vertical length, and a secondary laminar one. The opposite SphT had 14.80 mm. In our knowledge, such giant and bifid SphTs were not reported previously and are major obstacles if surgical access towards the pterygopalatine fossa and the skull base is intended.