How to avoid iatrogenic lingual nerve injury in the retromolar area: an anatomical study of retromolar pad and lingual nerve.

PURPOSE: This study aimed to investigate the relationship between the retromolar gland and pad, and the relationship between the LN and retromolar gland/pad to establish a new landmark for avoiding LN injury. METHODS: Sixty-two lingual nerves from fresh-frozen cadavers were used for this study. The age of the specimens at the time of death ranged from 57 to 98 with a mean of 76.5 years. The mucous incision was made into the medial border of the retromolar pad and the submucosal tissue depth of the initial incision was bluntly dissected to expose the lingual nerve. When the LN was identified, the mucosa overlying the retromolar pad was removed to expose the retromolar gland to confirm if the retromolar pad corresponds to the retromolar gland. RESULTS: On all sides, the lingual nerve was found to course medial to the retromolar pad and inferior to the inferior border of the superior pharyngeal constrictor muscle to enter the sublingual space via the pterygomandibular space. The retromolar pad corresponded to the retromolar gland on all sides. This demonstrated that the retromolar pad is an overlying mucosa of the retromolar gland. No LN was found to travel through the retromolar gland. CONCLUSION: We suggest that the retromolar pad can be used as a new landmark for avoiding iatrogenic LN injury.

Pigmented oral compound nevus of retromolar area - A rare case report.

Solitary pigmented melanocytic intraoral lesions of the oral cavity are rare. Oral nevus is a congenital or acquired benign neoplasm. Oral compound nevus constitutes 5.9%-16.5% of all oral melanocytic nevi. The oral compound nevus is commonly seen on hard palate and buccal mucosa and rarely on other intraoral sites. The objective of this article is to present a rare case report of oral compound nevus in the retromolar pad region along with a review of literature. A 22 year old female reported with a solitary black pigmented papule at retromolar pad region which was surgically removed and microscopic investigation confirmed the diagnosis of oral compound nevus.

Adenoid cystic carcinoma of the retromolar pad region: A case report.

INTRODUCTION: Adenoid cystic carcinoma (ACC) is one of the most common salivary gland malignancies, mostly occurs in the major and minor salivary glands in the oral and maxillofacial region. The development of ACC in the retromolar pad is extremely rare, which limits establishing proper diagnosis and management. PRESENTATION OF CASE: A patient described a 2-month history of finding a mass behind the lower left posterior teeth. Based on the physical examination and radiographic findings, we got an initial impression of a benign mucocele, the nature of which was to be investigated further. Pathological examination of the resected tissue resulted in a diagnosis of ACC. Follow-up visits showed no recurrence during the subsequent 54 months. DISCUSSION: In cases with an uncertain diagnosis based on medical history, clinical features and imaging examinations, it is important to proceed carefully with the possibility of a tumor in mind. CONCLUSION: ACC in the retromolar pad is rare and can be easily misdiagnosed. Clinical, radiographic, and pathological evidence confirm a definitive diagnosis. Long-term follow-up is important for the full analysis of ACC treatment.

Multilocular Radiolucent Pathology in the Body and Ramus of the Mandible: A Case Report.

Odontogenic keratocyst (OKC), a type of epithelial developmental cyst, is frequently found in the jaw region. It has invasive characteristics such as satellite cysts, rapid progression, and tissue expansion. The OKC often favors the mandibular angle and ascending ramus. OKC symptoms include pain, swelling, displacement or malpositioning of adjacent teeth, and erosion or thinning of the limited or no bucco-lingual cortical expansion. There is radiographic evidence of a distinct, often scalloped, radiolucent lesion with a characteristic "soap bubble" or "honeycomb" appearance. This article reports a female patient, aged 40 years, with the main concern of unilateral pain and swelling of the mandibular left side and the provisional diagnosis of ameloblastoma. After histopathological examination, the final diagnosis of the patient was OKC. This article also includes previously published literature on OKC with differential diagnosis and relevant clinical and radiologic findings of the case.

Three-dimensional morphometric study on the retromolar pad.

PURPOSE: The aim of this study was to classify the shapes of retromolar pads and assess their morphometric differences using a 3D model. MATERIALS AND METHODS: Two hundred fully edentulous or Kennedy Class I partially edentulous patients (400 retromolar pads) were enrolled. Scan data of the definitive mandibular casts produced through functional impressions were obtained using a 3D laser scanner. Seven parameters (transverse diameter, longitudinal diameter, transverse-contour length, longitudinal-contour length, longitudinal/transverse diameter ratio, longitudinal/transverse-contour length ratio, and angle of the retromolar pad line to the residual alveolar ridge line) were measured using image analysis software. Subsequently, the pads were classified according to the shape. Statistical analyses were performed using 95% confidence intervals. RESULTS: Classifying the retromolar pads into three shapes led to high intra-examiner reliability (Cronbach's alpha = 0.933). The pear shape was the most common (56.5%), followed by oval/round (27.7%) and triangular (15.8%) shapes. There were no significant differences between the left and right sides according to the shape and no significant differences in any parameter according to age. The transverse diameter and longitudinal/transverse diameter ratio differed between sexes (P < .05). The triangular shape had a significantly different transverse diameter, transverse-contour length, longitudinal/transverse diameter ratio, and longitudinal/transverse-contour length ratio compared with the pear and oval/round shapes (P < .05). CONCLUSION: From a clinical reliability standpoint, classifying retromolar pads into three shapes (oval/round, pear-shaped, and triangular) is effective. The differences in the sizes among the shapes were attributed to the transverse measurement values.

Surgery for Cystadenoma of the Retromolar Pad Area With Reconstruction Using a Buccal Fat Pad Flap: A Case Report.

Salivary gland tumors can also occur rarely in the retromolar area, though common near the junction of hard and soft palate, labial mucosa, and buccal mucosa. Most salivary gland tumors in the retromolar pad area are malignant and should be excised. The cystadenoma is a rare, benign, salivary gland tumor. Importantly, incomplete resection of this tumor can lead to recurrence or cervical lymph node metastasis. We reported herein a case of cystadenoma arising in the right retromolar pad area in a 63-year-old male patient who underwent reconstruction using a buccal fat pad flap (BFPF) after the surgical removal of the tumor with a 10-mm margin left a defect with bone exposure. No evidence of recurrence or complication was found at the postoperative, three-year follow-up.

Diagnostic Testing Using Pterygomaxillary Notches and Retromolar Pads on Casts to Check Horizontal Jaw Relation.

OBJECTIVE: To verify horizontal jaw relations using anatomical marks on a cast and evaluate the efficiency and accuracy of the test on checking the horizontal relation. METHODS: A total of 200 patients with a loss of posterior occlusion were recruited. After casts were made and the horizontal jaw relation was recorded, the pterygomaxillary notch and retromolar pad were identified bilaterally on the maxillary and mandibular casts. On each cast, a vertical line was drawn to bisect the anatomical landmarks and the distance between the two vertical lines was measured. Using the result of the wax try-in appointment and the corresponding measurements, a diagnostic test was conducted. A receiver operating curve was created and the maximum horizontal distance between bisecting points that still obtained correct jaw relations was determined to be a criterion. The accuracy of the test to verify horizontal jaw relations was evaluated. RESULTS: The area under the curve of the receiver operating curve was 0.833 (P < 0.05). With a maximum Youden index, the d value threshold was 1.0 mm. Using 1.0 mm as a criterion to check the horizontal relation, the sensitivity of the test was 0.76 and the specificity was 0.93. The kappa value for different researchers was calculated to be 0.79 (P < 0.05). The intraexaminer 1 reliability gave a kappa value of 0.76 (P < 0.05), and intraexaminer 2 gave a value of 0.81 (P < 0.05). CONCLUSION: The test for verifying the accuracy of horizontal jaw relations is reliable. If horizontal distance is measured as greater than 1.0 mm at the jaw relation record appointment, the recorded horizontal jaw relationship may be wrong and need to be reexamined.

Lower third molar region / Región del tercer molar inferior

The lower third molar region is an important region for the odontostomatological practice, since it presents a great amount of pathological processes related to the development and eruption of the third molar; thus having a considerable number of surgical interventions. Despite its importance, this region is not accounted for in anatomical terminology nor is it described in topographic anatomy; and in spite of the great number of studies that analyze the surgical anatomy of the region, it is necessary to systematize the description of its boundaries, planes, content, risk elements, anatomical repairs, etc.; therefore, the purpose of the present article is to review the modern concepts related to the surgical anatomy of the lower third molar region and to establish a description based on these concepts...

La región del tercer molar inferior es una región importante para la práctica odontoestomatológica, en ella se presenta una gran cantidad de procesos patológicos relacionados con el desarrollo y erupción del tercer molar, por lo que se practican un gran número de intervenciones quirúrgicas. No obstante su importancia, esta región no se encuentra considerada en la terminología anatómica ni descrita en la anatomía topográfica y a pesar de la gran cantidad de estudios que analizan la anatomía quirúrgica de la región, es necesario sistematizar la descripción de sus límites, planos, contenidos, elementos de riesgo, puntos de reparo, etc., es por ello que el propósito de este artículo es revisar los conceptos modernos relacionados con la anatomía quirúrgica de la región del tercer molar inferior y proponer una descripción basada en estos conceptos...