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      Mandibular Foramen Location and Lingula Height in Dentate Dry Mandibles, and its Relationship With Cephalic Index Translated title: Localización del Foramen Mandibular y Altura de la Língula Mandibular en Mandíbulas Dentadas Secas, y su Relación con el Índice Cefálico

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          Abstract

          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.

          Translated abstract

          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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          Most cited references29

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          A study of the position of the mandibular foramen in the adult human mandible.

          Eighty dry, adult human mandibles of East Indian ethnic origin and bilateral eruption of third molar teeth were examined to measure the location of the mandibular foramen. The position of the foramen was found to be variable. However, the foramen was predominantly located at the anteroposterior midpoint of the ramus halfway between the mandibular notch and the lower surface of the mandible and two thirds of the way down a line joining the coronoid process to the angle of the mandible. In the majority of the mandibles studied the foramen was located below the occlusal surfaces of the molar teeth. It is concluded that the marked variability in the position of the mandibular foramen may be responsible for an occasional failure to block the inferior alveolar nerve.
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            Dimorphic study of surgical anatomic landmarks of the lateral ramus of the mandible.

            Sixty-three human cadaver hemimandibles of known sexual origin were studied. The anatomic relationship between the midpoint of the waist of the lateral ramus and the mandibular foramen was examined and compared with that of the antilingula. No statistical differences were found between either these two landmarks or the sexes.
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              Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy.

              The sagittal split ramus osteotomy is probably the most frequently used procedure for correction of mandibular skeletal dentofacial deformities. Despite numerous improvements in the technique in the 30 years since the procedure was introduced, a number of troublesome complications still occur. These include unfavorable fracture during surgery, paresthesia, and relapse. The purpose of this study was to determine where fusion of the buccal and lingual cortical plates occurs in the upper mandibular ramus, as it is thought that placement of the horizontal medial osteotomy above the point of fusion (without any intervening medullary bone) may lead to unfavorable fracture during splitting. Forty-nine human mandibles were sectioned vertically at three locations perpendicular to the surface of the ramus and the occlusal plane. Measurements were made to locate vertically the point of fusion of the buccal and lingual cortical plates relative to the lingula and to the depth of the sigmoid notch. The point of fusion occurred between 7.5 and 13.3 mm above the lingula. Only 2% of mandibles had fusion at or below the level of the lingula in the anterior ramus, whereas in the posterior ramus, 6.1% of mandibles were fused at that level. At a level halfway from the lingula to the sigmoid notch, 20% of mandibles were fused in the anterior ramus, whereas in the mid- to posterior ramus, the incidence was as high as 39%. The location of the medial horizontal osteotomy should be at or just above the tip of the lingula. A higher level of cut may be associated with an increased difficulty in splitting or incidence of unfavorable fracture.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ijmorphol
                International Journal of Morphology
                Int. J. Morphol.
                Sociedad Chilena de Anatomía (Temuco )
                0717-9502
                September 2015
                : 33
                : 3
                : 1038-1044
                Affiliations
                [1 ] Universidade do Estado da Bahia Brazil
                [2 ] Escola Bahiana de Medicina e Saúde Pública Brazil
                [3 ] Universidade de Campinas Brazil
                Article
                S0717-95022015000300037
                b073429c-2458-4cf0-a98b-16e0b75ece08

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Chile

                Self URI (journal page): http://www.scielo.cl/scielo.php?script=sci_serial&pid=0717-9502&lng=en
                Categories
                ANATOMY & MORPHOLOGY

                Anatomy & Physiology
                Lingula,Mandibular foramen,Cephalic index,Língula mandibular,Foramen mandibular,Índice cefálico

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