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SUMMARY: The mandibular foramen and its canal are one of the most important structures in the skull, as they solely supply the mandible through their associated nerves and vessels. Many anatomical variations have been reported in the literature until now, and this case report represents a clear-cut appearance of its shape in a panoramic radiograph, which is not mostly seen in normal panoramic radiographs. These factors are of utmost importance when it comes to performing various surgeries and preventing complications due to their varied anatomy, which will allow dentists to create a better treatment plan and provide better treatments without any complications.

El foramen mandibular y su canal son algunas de las estructuras más importantes del cráneo y cara, ya que a través de ellos la mandíbula es inervada por nervios e irrigada por vasos. Hasta ahora, en la literatura consultada, se han informado de numerosas variaciones anatómicas. En este trabajo reportamos la forma y trayecto del foramen y canal mandibular, obtenidos en una radiografía panorámica, que no es observada normalmente en este tipo de radiografía. Los factores anatómicos son de importancia a la hora de realizar las cirugías para prevenir complicaciones debido a su variada anatomía, permitiendo a los odontólogos crear un mejor plan de tratamiento sin ningún tipo de complicaciones.

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A local anaesthetic block performed in cranial and mandibular foramina contributes towards analgesia and the reduction of systemic anaesthesia in procedures in the oral cavity. However, anatomical differences between in wild animals may require adaptations to the anaesthetic and surgical manoeuvres of the head used in domestic animals. With that in mind, we aimed to describe the topography and morphometry of the infraorbital and mandibular foramina in Bradypus variegatus, to support perineural anaesthetic approaches in the cranio-mandibular region of this species. We demonstrated that in B. variegatus there is no significant variability in the morphometric data, allowing access to the studied foramina to occur in a similar way in adult individuals. Finally, we understand that the techniques for the infraorbital and mandibular foramen needed to be adapted due to the anatomical singularities of the species, which culminated in new reference points for more assertive needle positioning.

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OBJECTIVE: To report radiographic characteristics of a case of a patient with neurofibromatosis involving the maxillomandibular complex and to point out other dental radiographic characteristics that are found in the scientific literature to help the dentist when faced with a case of neurofibromatosis. SHORT COMMUNICATION: Male, 31 years old, referred for radiographic examination. During anamnesis and physical examination, lesions were noted, which were papules and café-au-lait patches larger than 1 cm on the trunk and upper limbs, further to Lisch nodules (brown spots on the iris) and axillary and inguinal ephelides. When investigating the history of the disease, the patient reported the presence of such skin atlterations since birth and mentioned that his mother had been diagnosed with neurofibromatosis. During radiographic evaluation, a significant increase in the caliber of the mandibular canal and mental foramen was observed, bilaterally. CONCLUSION: Completing the combination of skin characteristics present in the patient, anamnesis data and current history of the disease with interpretation of radiographic alterations, it was possible to arrive at the diagnostic hypothesis of Neurofibromatosis type 1 and correct clinical management. Therefore, it is extremely important for the dentist to be aware of the clinical, physical and radiographic characteristics that this condition presents for the correct management and success of dental treatment.

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SUMMARY: The inferior alveolar nerve block (IANB) technique is a common technique performed on patients in dental surgery, placement of mandibular implants and other procedures involving the mandible. Precise identification of the mandibular foramen (MF) is essential for dental surgeons to accurately administer local anesthetics. Inaccurate localization of the mandibular foramen may result in IANB failure and injury to neurovascular tissues. Therefore, this study aimed at investigating the precise location of the MF from various anatomical land marks in dry adult human mandibles of Malawian population. The study was conducted on 29 dry adult human mandibles of unknown sex of Malawian origin from the Anatomy Division collection of human skeletons housed in the Biomedical Sciences Department, College of Medicine, University of Malawi. To determine the position of the mandibular foramen, distances from mandibular foramen to anterior margin, posterior margin, mandibular notch, gonial angle and mandibular base using a Vernier caliper were measured. The mean distance of the MF from posterior margin of mandibular ramus was 11.26±1.22 mm (right side) and 11.47±1.35 mm (left side), from the anterior margin 20.85±3.12 mm (right side) and 20.85±3.22 mm (left side) mandibles. The mean distance between mandibular notch (MN) and MF was 23.87±2.61 mm (right side) and 23.53 ± 2.65 mm (left side). The mean distance between mandibular base (MB) and MF for the right and left were 28.47 ± 2.90 mm and 27.85 ± 2.99 mm respectively. The inferior limit of the mandibular foramen was located at 24.69 ± 3.65 mm (right side) and 24.25 ± 2.77 mm (left side) to the angle (AG) of the mandible. The findings of this study show that the anterior margin mean distance from the MF for both right and left mandibles seem to be bilateral symmetrical suggesting the interpretation that the needle for IANB could be inserted at about 21 mm from the anterior margin to the MF in an adult of Malawian origin during surgery.

RESUMEN: La técnica de bloqueo del nervio alveolar inferior (IANB) es una técnica común que se realiza en pacientes en cirugía dental, colocación de implantes mandibulares y otros procedimientos que involucran la mandíbula. La identificación precisa del foramen mandibular (MF) es esencial para que los cirujanos dentistas administren con precisión anestésicos locales. La localización inexacta del foramen mandibular puede resultar en una falla de la IANB y lesión de los tejidos neurovasculares. Por lo tanto, este estudio tuvo como objetivo investigar la ubicación precisa de la MF de varias marcas anatómicas en las mandíbulas humanas adultas secas de la población de Malawi. El estudio se llevó a cabo en 29 mandíbulas humanas adultas secas de sexo desconocido de origen malauí de la colección de esqueletos humanos de la División de Anatomía del Departamento de Ciencias Biomédicas de la Facultad de Medicina de la Universidad de Malawi. Para determinar la posición del foramen mandibular, se midieron las distancias desde el foramen mandibular hasta el margen anterior, margen posterior, incisura mandibular, ángulo gonial y base mandibular utilizando un calibre Vernier. La distancia media del MF desde el margen posterior de la rama mandibular fue de 11,26 ± 1,22 mm (lado derecho) y 11,47 ± 1,35 mm (lado izquierdo), desde el margen anterior 20,85 ± 3,12 mm (lado derecho) y 20,85 ± 3,22 mm (lado izquierdo) lado) mandíbulas. La distancia media entre la muesca mandibular (MN) y MF fue de 23,87 ± 2,61 mm (lado derecho) y 23,53 ± 2,65 mm (lado izquierdo). La distancia media entre la base mandibular (MB) y MF para la derecha y la izquierda fue de 28,47 ± 2,90 mm y 27,85 ± 2,99 mm, respectiva- mente. El límite inferior del foramen mandibular se ubicó a 24,69 ± 3,65 mm (lado derecho) y 24,25 ± 2,77 mm (lado izquierdo) del ángulo (AG) de la mandíbula. Los resultados de este estudio mues- tran que la distancia media del margen anterior desde el MF para las mandíbulas derecha e izquierda parece ser simétrica bilateral, lo que sugiere la interpretación de que la aguja para IANB podría insertarse a unos 21 mm del margen anterior al MF en una adulto de origen malauí durante la cirugía.

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The morphological variations of the mental foramen (MF) and mandibular foramen (MBF) have been studied for several years, and the prevalence and morphometric characteristics of double and triple foramina have been reported. The objective of this study was to establish the prevalence of variations in the MF and MBF, and to carry out a morphometric analysis of a Chilean population using digital panoramic radiographs. The study included 927 radiographs; the observed prevalence of double MF was 2.58 %, while the prevalence of double MBF was 1.51 %. No cases of triple foramina were found. In men, double MF was found more frequently in the left hemiarch (64.28 % of cases), while in women it was more frequent in the right hemiarch (80 %). Double MBF was found more frequently in the right hemiarch in women (80 % of cases), while the distribution between left and right in men was even. The mean area, width and height of the double MF were 5.46 mm2, 2.77 mm and 2.57 mm respectively. The means of the same morphometric measurements in double MBF were 6.37 mm2, 2.27 mm and 3.19 mm respectively. In both foramina, statistically significant differences were only found between the height of the foramen and the age of the subjects, with the observation that the greater the subject's age, the smaller the height. Dental surgeons must take these anatomical variants into consideration in clinical and surgical actions; timely diagnosis by radiograph is important to avoid possible complications.

Las variaciones morfológicas del foramen mental (FM) y mandibular (FMB) han sido estudiadas durante varios años, reportándose su prevalencia y las características morfométricas de forámenes dobles y triples. El objetivo de este estudio fue establecer la prevalencia de variaciones de los FM y FMB y realizar un análisis morfométrico a través de radiografías panorámicas digitales de una muestra de población chilena. En el estudio se incluyeron 927 radiografías y se observó una prevalencia de FM doble de 2,58 %, mientras que la prevalencia de FMB doble fue de 1,51 %. No se encontraron casos de forámenes triples. En hombres, el FM doble se encontró mayoritariamente en la hemiarcada izquierda (64,28 % de los casos), mientras que en mujeres fue en la hemiarcada derecha (80% de los casos). Para el caso de los FMB dobles, en mujeres se presentó mayoritariamente en la hemiarcada derecha (80 % de los casos), mientras que en hombres fue equitativo en ambos lados. El promedio del área, ancho y alto de los FM dobles fue de 5,46 mm2, 2,77 mm y 2,57 mm, respectivamente. Asimismo, los promedios de estas medidas morfométricas para el FMB doble fueron 6,37 mm2, 2,27 mm y 3,19 mm, respectivamente. Para ambos forámenes sólo se encontraron diferencias estadísticamente significativas entre el alto y la edad de los sujetos, observando que, a mayor edad menor era el alto del foramen. Los cirujanos dentistas deben tener en consideración estas variantes anatómicas para la realización de distintas acciones clínicas y quirúrgicas, su diagnóstico radiográfico oportuno es importante para prevenir posibles complicaciones.

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Great part of the veterinary care in wild carnivores is intended to treat the dental disorders, and oral cavity disorders may generally affect the animal health as a whole. It is factual that knowing the location of the mandibular foramen is vital for local anesthetic block of the inferior alveolar nerve, however, there is still no data on the morphometry of the hoary fox mandibular foramen. The aim was describing morphometry of the mandibular foramen of this species and associating its position with anatomic reference points in the mandible, thus providing support for more effective local anesthetic block of the inferior alveolar nerve in such species. Four adult jaws of Lycalopex vetulus were used. Radiography and biometrics of the hemimandibulas were performed. The rostral third of the jaw body in a lateral view presented three mental foramens, being a rostral, a medium and a caudal. Each hemimandibula presented I3/C1/PM4/M3. The angle of the mandible was marked by the masseteric fossa, the angular incisure, the angular process and the mandibular foramen, and this last one located perpendicularly to the dorsal edge of the angular incisures in medial view. In this view, the crevice to the milohyoid nerve, projected in the caudodorso rostral direction, was also evidenced. The ramus of the mandible was characterized by the presence of the condylar and coronoid processes, and by the dorsal and ventral mandibular incisions. Statistical analyzes did not present significant differences between the antimeres of the studied animals, and the penetration of the needle perpendicularly to the dorsal end of the angular incision on average 8.79mm, overlapped to the medial face of the angle of the mandible could be indicated. Alternatively, the access may also be achieved by inserting the needle in an average of 17.69mm perpendicular to the dorsal end of the angular process, in contact with the medial aspect of the angle of the mandible, and in caudo-rostral projection, also allowing a better anesthetic blockade of the inferior alveolar nerve in L. vetulus. It can also be concluded that the masseteric fossa, the dorsal and ventral mandibular angles, the crevice to the milohyoid nerve, the ramus of the mandible and the mandibular foramen presented differences in their topographic descriptions when compared to the other canids.(AU)

A maior parte dos atendimentos veterinários em carnívoros silvestres destina-se ao tratamento das afecções dentárias, sendo que doenças de cavidade oral podem afetar a saúde do animal como um todo. É factível que o conhecimento da localização do forame mandibular é essencial para o bloqueio anestésico local do nervo alveolar inferior, entretanto, ainda são inexistentes dados sobre a morfometria do forame mandibular de raposa-do-campo. Objetivou-se descrever a morfometria do forame mandibular desta espécie, e correlacionar sua posição com pontos de referência anatômica na mandíbula, oferecendo subsídio para um bloqueio anestésico local mais efetivo do nervo alveolar inferior nesta espécie. Foram utilizadas quatro mandíbulas de cadáveres adultos de Lycalopex vetulus. Realizou-se a radiografia e as biometrias das hemimandíbulas. O terço rostral do corpo da mandíbula em uma vista lateral apresentou três forames mentuais, sendo um rostral, um médio e um caudal. Cada hemimandíbula apresentou I3/C1/PM4/M3. O ângulo da mandíbula foi marcado pela fossa massetérica, pela incisura angular, pelo processo angular e pelo forame mandibular, e este último localizado perpendicularmente ao extremo dorsal da incisura angular em vista medial. Nesta vista, também se evidenciou o sulco para o nervo milohióideo, projetado em sentido caudodorsorostral. O ramo da mandíbula foi caracterizado pela presença dos processos condilar e coronóide, e pelas incisuras mandibulares dorsal e ventral. As análises estatísticas não apresentaram diferenças significantes entre os antímeros dos animais estudados, podendo-se indicar a penetração da agulha perpendicularmente ao extremo dorsal da incisura angular em média 8,79mm, justaposto à face medial do ângulo da mandíbula. Alternativamente, o acesso também poderá ser realizado introduzindo a agulha em média 17,69mm de forma perpendicular ao extremo dorsal do processo angular, em contato com a face medial do ângulo da mandíbula, e em projeção caudorostral, permitindo também um melhor bloqueio anestésico do nervo alveolar inferior na L. vetulus. Também se pode concluir que a fossa massetérica, as incisuras angular, mandibulares dorsal e ventral, o sulco para o nervo milohióideo, o ramo da mandíbula e o forame mandibular apresentaram diferenças em suas descrições topográficas quando comparados aos demais canídeos.(AU)

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Great part of the veterinary care in wild carnivores is intended to treat the dental disorders, and oral cavity disorders may generally affect the animal health as a whole. It is factual that knowing the location of the mandibular foramen is vital for local anesthetic block of the inferior alveolar nerve, however, there is still no data on the morphometry of the hoary fox mandibular foramen. The aim was describing morphometry of the mandibular foramen of this species and associating its position with anatomic reference points in the mandible, thus providing support for more effective local anesthetic block of the inferior alveolar nerve in such species. Four adult jaws of Lycalopex vetulus were used. Radiography and biometrics of the hemimandibulas were performed. The rostral third of the jaw body in a lateral view presented three mental foramens, being a rostral, a medium and a caudal. Each hemimandibula presented I3/C1/PM4/M3. The angle of the mandible was marked by the masseteric fossa, the angular incisure, the angular process and the mandibular foramen, and this last one located perpendicularly to the dorsal edge of the angular incisures in medial view. In this view, the crevice to the milohyoid nerve, projected in the caudodorso rostral direction, was also evidenced. The ramus of the mandible was characterized by the presence of the condylar and coronoid processes, and by the dorsal and ventral mandibular incisions. Statistical analyzes did not present significant differences between the antimeres of the studied animals, and the penetration of the needle perpendicularly to the dorsal end of the angular incision on average 8.79mm, overlapped to the medial face of the angle of the mandible could be indicated...(AU)

A maior parte dos atendimentos veterinários em carnívoros silvestres destina-se ao tratamento das afecções dentárias, sendo que doenças de cavidade oral podem afetar a saúde do animal como um todo. É factível que o conhecimento da localização do forame mandibular é essencial para o bloqueio anestésico local do nervo alveolar inferior, entretanto, ainda são inexistentes dados sobre a morfometria do forame mandibular de raposa-do-campo. Objetivou-se descrever a morfometria do forame mandibular desta espécie, e correlacionar sua posição com pontos de referência anatômica na mandíbula, oferecendo subsídio para um bloqueio anestésico local mais efetivo do nervo alveolar inferior nesta espécie. Foram utilizadas quatro mandíbulas de cadáveres adultos de Lycalopex vetulus. Realizou-se a radiografia e as biometrias das hemimandíbulas. O terço rostral do corpo da mandíbula em uma vista lateral apresentou três forames mentuais, sendo um rostral, um médio e um caudal. Cada hemimandíbula apresentou I3/C1/PM4/M3. O ângulo da mandíbula foi marcado pela fossa massetérica, pela incisura angular, pelo processo angular e pelo forame mandibular, e este último localizado perpendicularmente ao extremo dorsal da incisura angular em vista medial. Nesta vista, também se evidenciou o sulco para o nervo milohióideo, projetado em sentido caudodorsorostral. O ramo da mandíbula foi caracterizado pela presença dos processos condilar e coronóide, e pelas incisuras mandibulares dorsal e ventral. As análises estatísticas não apresentaram diferenças significantes entre os antímeros dos animais estudados, podendo-se indicar a penetração da agulha perpendicularmente ao extremo dorsal da incisura angular em média 8,79mm, justaposto à face medial do ângulo da mandíbula...(AU)

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Objetivo: analisar a topografia e biometria do forame mandibular e da lingula mandibular em crânios secos para verificar sua variabilidade e determinar suas posições topográficas. Material e Método: Para analisar as distâncias, foram realizadas medições utilizando um paquímetro digital Mitutoyo® devidamente calibrado para coletar a distância em milímetros, do centro do forame até as quatro margens (anterior, posterior, superior e inferior) do ramo mandibular (N = 176). Realizamos as medidas do forame mandibular em milímetros para determinar sua geometria externa. A lingula mandibular (N = 76) foi estudada quanto à sua localização topográfica e forma quando sua estrutura é preservada. Todos os dados foram documentados em um protocolo de coleta de dados com o objetivo de desenhar diagramas esquemáticos e arquivar as fotografias dos casos e a análise dos resultados. Resultados: em relação à frequência, o forame estava presente em todos os casos (100%), em ambos os lados da superfície medial do nervo mandibular. O número de forames de cada lado é único: foram observados 175 casos (99,5%). Apenas um forame (0,5%) era o dobro do lado direito. Em relação à sua posição em relação às margens da mandíbula, na maioria delas, está localizada próxima à margem inferior, variando entre 9,6 mm e 39,1 mm, com média de 26,0 mm. A margem posterior da mandíbula variou entre 6,8 mm e 24,0 mm, com média de 12,30 mm. A lingula mandibular dos maxilares foi analisada em 32 maxilares (64 casos), com formato triangular (55%), presente na maioria dos casos (86%) e posição ântero-superior em 43% deles. Conclusões: o forame mandibular é um elemento anatômico importante para o sucesso da técnica de bloqueio do nervo alveolar inferior. Sua estrutura acessória, a lingula mandibular, é uma posição de referência em cirurgia ortognática; devido à sua localização e aspecto, serve como um escudo protetor para o feixe neurovascular alveolar inferior

Objective: to analyze the topography and biometrics of the mandibular foramen and mandibular lingula in dry skulls to verify their variability and to determine their topographic positions. Material and method: to analyze the distances, measurements were made using a properly calibrated Mitutoyo® digital caliper to collect the distance in millimeters, from the center of the foramen to the four margins (anterior, posterior, superior and inferior) of the mandibular ramus (N=176). We performed the measurements of the mandibular foramen in millimeters to determine its external geometry. The mandibular lingula (N=76) was studied regarding its topographical location and shape when its structure was preserved. All data were documented in a data collection protocol aimed at drawing schematic diagrams and archiving the photographs of the cases and the analysis of the results. Results: in relation to the frequency, the foramen was present in all cases (100%), on both sides on the medial surface of the mandibular ramus. The number of foramen on each side is unique: 175 cases (99.5%) were observed. Only one foramen (0.5%) was double on the right side. Regarding its position in relation to the margins of the jaw, in most of them, it is located near the inferior margin, having varied between 9.6mm and 39.1mm, with an average of 26.0mm. The posterior margin of the jaw varied between 6.8mm and 24.0mm, with an average of 12.30mm. The mandibular lingula of the jaws were analyzed in 32 jaws (64 cases), having triangular shape (55%), present in most cases (86%) and in anterosuperior position in 43% of them. Conclusions: the mandibular foramen is an important anatomical element for the success of the inferior alveolar nerve block technique. Its accessory structure, the mandibular lingula, is a reference position in orthognathic surgery; due to its location and aspect, it serves as a protective shield for the inferior alveolar neurovascular bundle

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Objetivos: Determinar a prevalência das foraminas mandibulares acessórias (FMAs) e seus possíveis canais acessórios (CAs), bem como a direção e comprimento destes, por meio de análise macroscópica de mandíbulas maceradas e seus exames tomográficos. Métodos: Foram avaliados 200 exames de tomografia computadorizada de feixe cônico (TCFC), realizados a partir de 50 mandíbulas maceradas selecionadas aleatoriamente. As mandíbulas foram submetidas a exames no aparelho i-Cat® e Accuitomo®, em uma das aquisições em cada aparelho foi introduzido um fio metálico de 0,25mm na FMA para determinar comprimento e direção dos canais acessórios que algumas davam origem, foram realizados 100 exames em cada tomógrafo. Resultados: Foram observados macroscopicamente 134 FMA e 109 CA. A maioria dos CAs apresentaram comprimento entre 10 mm e 20 mm, 72/109 dos canais acessórios foram em direção a cortical lingual. Na análise estatística os exames realizados em ambos tomógrafos apresentaram alto índice de sensibilidade, baixo índice de especificidade, alto índice de acurácia na identificação das foraminas e médio índice de acurácia na identificação dos canais acessórios. Conclusões: A TCFC é um exame de imagem ideal na identificação da FMA e seus canais, visto que seja de extrema importância para o planejamento de procedimentos odontológicos, dada sua elevada incidência na população brasileira. (AU)

Objectives: To determine the prevalence of accessory mandibular foramina (AMF) and their possible accessory canals, as well as their direction and length, through macroscopic analysis of macerated mandibles and their tomographic examinations. Methods: were evaluated 200 CBCT exams performed from 50 randomly selected macerated mandibles. The mandibles were examined in the i-Cat® and Accuitomo® apparatus, in one of the acquisitions in each apparatus was introduced a 0,25mm metal wire in the AMF to determine length and direction of the accessory canals that some gave origin, 100 examinations were performed on each tomograph. Results: We observed macroscopically 134 AMF and 109 accessory canals. The majority of the AC had length between 10 mm and 20 mm, 72/109 of the accessory canals were towards the lingual cortical. In the statistical analysis, the examinations carried out in both tomographs had a high index of sensitivity, low specificity index, high accuracy index in the identification of foraminas and a average index of accuracy in the identification of accessory canals. Conclusions: The CBCT is an ideal imaging exam to identify AMF and its canals, seeing that it is extremely important for the planning of dental procedures, given its high incidence in the Brazilian population. (AU)

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The mandibular foramen and its lingula is a major landmark when administering anesthetic or performing surgical procedures. The objective of this study was to determine whether the topological features of the mandibular foramen (MF) and lingula varied in mandibles from skulls of different cephalic indexes. The location of the mandibular foramen referred to the longitudinal borders of the mandibular ramus (MR), height of the foramen (Hf) referred to the occlusal line of the second molar, and the height of the lingula (Hl) were determined in a total of one hundred and five dry mandibles from skulls identified as dolicho- meso- and brachycephalic. On average MF in brachycephalic mandibles was closest to the anterior border of MR. Hf in brachy-, meso- and dolichocephalic mandibles were -0.22 mm, -4.04 mm and -4,01mm, respectively. The lingula in brachycephalic specimens was considerably shorter (0.78 mm) than in dolichocephalic ones (1.84 mm). Inferior alveolar nerve block should be carried out using shorter needles, inserting it 4mm above the occlusion level of the molar teeth. The ramus of brachicephalic mandibles were significantly less wide those of dolicho- and mesocephalic ones. If the height of the lingula is to be used as a reference to judge the level of the medial horizontal cut to carry out sagittal split ramus osteotomy, special attention should be given to the patient's cephalic index.

El foramen mandibular y la língula son los puntos anatómicos más importantes a considerar en la administración de anestesia troncular o la realización de procedimientos quirúrgicos en la mandíbula. El objeivo fue determinar si las características topológicas del foramen mandibular (FM) y la língula mandibular presentan variaciones en las mandíbulas de cráneos con diferentes índices cefálicos. Fueron utilizados 105 mandíbulas secas, pertenecientes a cráneos identificados como dolico, meso y braquicéfalos. En cada caso, se relacionaron la ubicación del FM con los márgenes longitudinales de la rama mandibular (RM) y la altura del foramen (Af) con la línea oclusal del segundo molar. Además, se determinó la altura de la língula (Al). En promedio, el FM de mandíbulas braquicefálicas se encontró más cerca del margen anterior de la RM. La Af en mandíbulas braqui, meso y dolicocéfalas fue de -0,22 mm, -4,04 mm y -4,01 mm, respectivamente. La língula mandibular en muestras braquicefálicas, fue considerablemente más corta (0,78 mm) que en las dolicocéfalas (1,84 mm). El bloqueo del nervio alveolar inferior debe llevarse a cabo usando agujas cortas, insertándolas 4 mm por encima del nivel de oclusión de los dientes molares. La rama de las mandíbulas braquicefálicas fueron significativamente menos anchas que en cráneos dolico y mesocefálicos. Si la altura de la língula mandibular se utilizará como referencia para determinar el nivel del corte medial horizontal para realizar la osteotomía sagital de la rama mandibular, se debe dar especial atención al índice cefálico del paciente.

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Objective: Mandibular foramen (MF) is located on the internal surface of the ramus through which blood vessels and nerves pass. Determination of the anatomic position of the MF is very important in inferior alveolar nerve block anesthesia (IANBA), ramus osteotomy and surgical procedures of the posterior angle of mandibular ramus. The aim of this study was to determine anatomic position of the MF using anatomic landmarks on the three dimensional CBCT images. Material and Methods: A total of 103 CBCT images was evaluated. The NNT Viewer software program was used to measure the distances between the lines tangent on the MF periphery and the anterior border of the ramus, the posterior border of the ramus, the inferior border of the mandible, and the coronoid notch in mm by to age and gender. Results: The results showed a slight difference in anatomic dimensions between the right and left sides, with no significant differences. The anatomic dimensions of the MF on both sides were a little bigger in males than in females. There were no significant differences in the anatomic dimensions of superior inferior and anterior-posterior dimensions of the left and right sides in different age groups. Conclusion: No significant changes occur in the position of the MF with age. The anatomic differences between males and females should be taken into account during IANBA procedures. Males have bigger jaws than females; therefore, there is a longer distance between the MF and the anatomic landmarks evaluated...

Objetivo: O forame mandibular (FM) localiza-se na superfície interna do ramo mandíbula, onde passam vasos sanguíneos e nervos. A determinação da posição anatômica do FM é muito importante para anestesia por bloqueio do nervo alveolar inferior (ABNAI), durante osteotomiano ramo da mandíbula e para procedimentos cirúrgicos do ângulo posterior do ramo mandibular. O objetivo deste estudo foi determinar a posição anatômica do FM utilizando referências anatômicas em imagens tridimensionais de CBCT. Material e Métodos: Um total de 103 imagens de CBCTforam avaliadas. O programa de software NNT Viewer foi utilizado para medir as distâncias em milímetros entre as linhas tangentes na periferia do FM e borda anterior do ramo, borda posterior do ramo, borda inferior da mandíbula e processo coronóide, em relação à idade e o gênero. Resultados: Os resultados mostraram uma ligeira diferença de dimensões anatômicas entre os lados direito e esquerdo, sem diferenças significativas. As dimensões anatômicas do FM em ambos os lados foram um pouco maior no sexo masculino do que no feminino. Não houve diferenças significativas nas dimensões anatômicas superior-inferior e ânteroposterior, tanto do lado direito quanto esquerdo,em diferentes faixas etárias. Conclusão: Mudanças significativas na posição do FM não são observadas em função da faixa etária. As diferenças anatômicas entre homens e mulheres devem ser levadas em consideração durante procedimento ABNAI. Mandíbulas maiores são encontradas no gênero masculino, portanto, há uma maior distância entre o FM e as referências anatômicas avaliadas...

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The aim of this study was to analyze the anatomotopographic location of the mandibular foramen in the right and left ramus, and to verify the influence of the amount of dental alveoli on the foramen position. Thirty-five adult dry human mandibles of Araraquara Dental School, UNESP - São Paulo State University were assessed, with or without dental alveoli. Measurements were obtained, using a ruler and a digital caliper. The following distances were measured: FI - distance between the lowest point of the mandibular incisure and the mandibular foramen (F point); FB - distance between the mandibular base and F point; FP - distance between the posterior margin of the ramus and F point; FA - distance between the anterior margin of the ramus and F point; FT - distance between the apex of the retromolar trigone and F point. The Mann-Whitney test was used to compare each measurement according to hemi-arch, and the Kruskal-Wallis test was used to analyze the influence of the presence of alveoli on the measures. For multiple comparison, Dunn's method was used. There was no statistically significant difference in the location of the mandibular foramen when compared to the right and left hemi-arches. The amount of dental alveoli influenced, significantly, only on FA and FP distances. Thus, it was concluded that the right and left mandibular ramus showed symmetry in the location of the mandibular foramen, and the amount of alveoli influenced on the distances of the anterior and posterior margins of the mandibular ramus, in relation to the mandibular foramen.

El objetivo de este trabajo fue evaluar la posición anátomo-topográfica del foramen mandibular en ambas ramas de la mandíbula y verificar la influencia de la cantidad de alvéolos dentales en la posición del foramen. Se evaluaron 35 mandíbulas humanas secas de individuos adultos de la Facultad de Odontología de Araraquara, Universidade Estadual Paulista - UNESP, con o sin alvéolos dentales. Se utilizó regla y calibrador digital para realizar las mediciones de las distancias entre: el punto más profundo de la incisura de la mandíbula y el foramen mandibular (FI); base de la mandíbula y el foramen (FB); margen posterior de la rama mandibular y el foramen mandibular (FP); margen anterior de la rama mandibular y el foramen (FA) y la distancia entre el vértice del trígono retromolar y el foramen mandibular (FT). Para la comparación de cada medida según hemiarcada se realizó el test de Mann-Whitney y para la influencia de la presencia de alvéolos en las medidas se utilizó el test de Kruskal-Wallis y para comparación múltiple el método de Dunn. No hubo diferencia estadística significativa en la localización del foramen mandibular al comparar el hemiarco mandibular derecho con el izquierdo. La cantidad de alvéolos dentales interfirió, de manera significativa, sólo en las distancias FA y FP. Se concluyó que las ramas mandibulares derecha e izquierda presentan simetría en el posicionamiento del foramen mandibular y la cantidad de alvéolos interfirió en las distancias de las márgenes anterior y posterior de la rama mandibular en relación con el foramen de la mandíbula.

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Introducción: los procedimientos quirúrgicos que se realizan en la mandíbula requieren conocimiento detallado de la posición y trayectoria del conducto alveolar inferior (CAI) que contiene en su interior al nervio alveolar inferior (NAI). La tomografía volumétrica computarizada (TCCB) es un medio diagnóstico subutilizado en nuestro medio principalmente por los costos, sin embargo es un medio sensible y preciso para la evaluación del CAI por encima de otros medios diagnósticos. Métodos: se evaluaron 50 tomografías volumétricas computarizadas de última generación con tecnología Cone Beam (TCCB) de las mandíbulas de pacientes mayores de dieciocho años, con premolares y molares mandibulares en boca, sin anomalías evidentes de los maxilares, patologías mandibulares y patologías que comprometieran la calidad ósea, se realizaron cortes transeccionales e imágenes panorámicas. Resultados: el promedio de distancia del CAI a la cresta alveolar fue 17,9 mm en mujeres y 19,8 en hombres, hacia la tabla vestibular el promedio fue 3,8 mm para ambos sexos; hacia la tabla lingual de 3,2 mm en mujeres y en hombres de 2,8; el promedio del CAI al borde basilar fue 6,5 mm para mujeres y 6,2 en hombres y del borde anterior de rama al foramen mandibular el promedio fue 12,3 mm para mujeres y 13,2 en hombres. Conclusiones: la TCCB es una ayuda diagnóstica altamente sensible para la ubicación de la posición y trayectoria del CAI, no hubo diferencias significativas en cuanto a edad y lados, de las medidas tomadas en los tres sectores del cuerpo mandibular.

Introduction: surgical procedures involving the mandible require a deep understanding of the position and course of the inferior alveolar conduct (IAC) that encloses the inferior alveolar nerve. Computerized volumetric tomography (CVT) is an under used diagnostic tool in our context, mostly because of the costs it compels, nevertheless it’s a sensitive and precise method for the evaluation of IAC above other diagnostic current tools. Method: 50 last generation computerized volumetric tomographies, using Cone Beam technology, were evaluated in 18 years old patients or older, with premolars and molars present, without any evident maxillary anomalies, mandibular pathology or alteration that decrease bone quality. Panoramic and transectional cuts were performed. Results: the average distance from IAC to alveolar crest was 17.9 mm for women and 19.8 mm for men. The average distance from IAC to the vestibular plate was 3.8 mm for both genders towards the lingual plate, the distances from IAC was 3,2mm for women and 2.8 mm for men. The average distance from basilar border to IAC was 6.5 mm for women and 6.2 mmfor men. From the mandibular foramen to anterior border of mandibular ramus, the average distance for men was 13.2 mm and 12.3 mm for women. Conclusion: CVT is a highly sensitive diagnostic tool for the assessment of IAC position and course. Therewere no differences regarding age or between both sides of the mandible among the three measured points on the mandibular body.

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Morphological and topographic knowledge of the mandibular canal is of paramount importance during dental procedures in the jaw, as structures that go through this canal must be preserved. The aim of this study was to make a morphologic and morphometrical analysis of the course and relations of the mandibular canal of adult men and women, in two different age groups. The sample was composed of 300 panoramic radiographs divided into 4 groups: Groups F1 and F2: women (ranging between 18-40 years, and over 40 years of age, respectively); Groups M1 and M2:men (ranging between 18-40 years and over 40 years of age, respectively). Seven linear vertical measurements were performed in the radiographs to describe the course of the mandibular canal, and its and relations with the anatomic structures of jaw. The horizontal position of the mental foramen and relation of proximity between the mandibular canal and the roots of the mandibular teeth were also evaluated. Statistically significant differences were observed in four of the measurements between genders. There was, however, no difference between age groups for any of the measurements. The most frequent position of the mental foramen was between the roots of the mandibular pre-molars; and the mandibular canal shows a relation of proximity to the roots of the mandibular third molar, moving gradually away from the roots of the other teeth. The results suggest that the measurements related to the mandibular canal performed in this study can be influenced by the gender but are independent of age.

El conocimiento morfológico y topográfico del canal mandibular es de suma importancia durante la realización de procedimientos odontológicos en la mandíbula, pués las estructuras que lo recorren deben ser conservadas. El propósito del presente estudio fue realizar un análisis morfológico y morfométrico del curso y de las relaciones del canal mandibular en adultos hombres y mujeres, en dos grupos de edades distintas. La muestra fue comprendida por 300 radiografías panorámicas divididas en 4 grupos: Grupos F1 y F2: mujeres (con rangos entre 18 y 40 años, y con más de 40 años de edad, respectivamente); Grupos M1 y M2: hombres (con rangos entre 18 y 40 años, y con mas de 40 años de edad, respectivamente). Siete medidas lineares verticales fueron realizadas en las radiografías para describir el curso del canal mandibular, y sus relaciones con las estructuras anatómicas de la mandíbula. También fueron evaluadas la posición horizontal del foramen mentoniano y la relación de proximidad entre el canal mandibular y las raíces de las piezas dentarias mandibulares. Se encontraron diferencias estadísticamente significativas entre los géneros en cuatro de las medidas tomadas. Sin embargo, no se encontró diferencia entre los grupos de edades para ninguna de las medidas. La posición más frecuente del foramen mentoniano fue entre las raíces de los premolares mandibulares; y el canal mandibular mostró una relación de proximidad con las raíces del tercer molar mandibular, alejándose gradualmente de las raíces de las demás piezas dentarias. Los resultados sugieren que las mediciones realizadas relacionadas al canal mandibular pueden ser influenciadas por el género pero son independientes de la edad.

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The mandibular foramen constitutes an anatomical repair to anesthetics and surgical procedures. Its localization is surrounded by difficulties and a source of disagreement. The goal of this investigation was to identify the MF location in human mandibles presenting variable number of teeth and in edentulous ones. And from the data given by the literature, short anesthetic needles were analyzed as to their suitability to block the inferior alveolar nerve by the pterygomandibular technique. The medial faces of 91 mandibular ramus were photographed. The exemplars presented different number of teeth, from none to 16. Measurements on the digital images were taken. The results revealed great variety on the position of mandibular foramen. They have been localized posterior and inferiorly to the middle point of the ramous on the majority of the exemplars, presenting no relation with the amount of teeth. In 95 percent of the sample, the reported length of short anesthetic needles seemed to be appropriated to the blockage of inferior alveolar nerve through pterygomandibular technique.

El foramen mandibular constituye um punto de reparo anatómico para procedimientos anestésicos y quirúrgicos. Su localización está rodeado de dificultades y divergencias. El objetivo de esta investigación fue identificar la posición del foramen en mandíbulas humanos edentadas totales, parciales y dentados. Además, a partir de datos de la literatura, investigar si la dimensión descrita de las agujas cortas son apropiadas para la ejecución de la técnica anestésica pterigomandibular. Fue fotografiada la cara medial de la rama de 91 mandíbulas con un número de dientes entre cero y dieciséis. Las mediciones fueron realizadas en las imágenes digitales. Los resultados revelaron gran variación en la posición del foramen mandibular, siendo éste localizado, en la mayoría de los ejemplares, posterior e inferiormente al punto medio de la rama mandibular, sin haberse determinado relación de posición con la cantidad de dientes. En el 95 por ciento de la muestra, la longitud de las agujas anestésicas cortas se mostró adecuada para el bloqueo del nervio alveolar inferior por la técnica pterigo-mandibular.

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