J Korean Assoc Oral Maxillofac Surg.  2019 Jun;45(3):158-166. 10.5125/jkaoms.2019.45.3.158.

Measurement of mandibular lingula location using cone-beam computed tomography and internal oblique ridge-guided inferior alveolar nerve block

• Jang HY
• Han SJ

• KMID: 2451323
• DOI: http://doi.org/10.5125/jkaoms.2019.45.3.158

Abstract

OBJECTIVES
Inferior alveolar nerve block (IANB) is the most frequently used treatment for mandibular molars. Successful IANB requires insertion of the dental needle near the mandibular foramen. In this study, we aimed to analyze the anatomic location of the mandibular lingula and evaluate the effects of internal oblique ridge (IOR)-guided IANB.
MATERIALS AND METHODS
The location of the mandibular lingula was measured using cone-beam computed tomography images of the mandibles obtained from 125 patients. We measured the distances from the occlusal plane to the lingula and from the IOR to the lingula in 250 mandibular rami. Based on the mean of these distances, alternative anesthesia was carried out on 300 patients, and the success rate of the technique was evaluated.
RESULTS
The mean vertical distance was 8.85±2.59 mm, and the mean horizontal distance was 14.68±1.44 mm. The vertical (P<0.001) and the horizontal (P<0.05) distances showed significant differences between the sex groups. The success rate of the IOR-guided technique was 97.3%.
CONCLUSION
IANB-based location of mandibular lingula showed a high success rate. From this study, we concluded that analysis of the anatomic locations for mandibular lingula and IOR-guided IANB are useful for restorative and surgical dental procedures of the mandibular molars.

Keyword

Inferior alveolar nerve; Inferior alveolar nerve block; Lingula; Mandibular foramen; Internal oblique ridge

MeSH Terms

Anesthesia
Cone-Beam Computed Tomography*
Dental Occlusion
Humans
Mandible
Mandibular Nerve*
Molar
Needles

Figure

• 

  Fig. 1 Measuring of lingula location using cone-beam computed tomography (CBCT) analysis. A. three-dimensional reconstruction of CBCT images. B. Vertical distance (OP-L) in the coronal view. C. Horizontal distance (IOR-L) in the axial view. (L: lingula, IOR: internal oblique ridge, IOR-L: distance from IOR to lingula, OP: occlusal plane, OP-L: distance from OP to lingula)

• 

  Fig. 2 Comparison diagram of conventional inferior alveolar nerve block (IANB) and internal oblique ridge (IOR)-guided IANB. A. Needle pathway in conventional IANB. B. Needle insertion on IOR after finger palpation. C. Needle access to lingula along medial periosteum of ramus. (P: parotid gland, M: masseter muscle, MP: medial pterygoid muscle, IAN: inferior alveolar nerve, LN: lingual nerve, R: ramus, BM: buccinator muscle, SCM: superior constrictor muscle, TT: temporalis tendon, PMR: pterygomandibular raphe, F: finger palpation and retraction)

• 

  Fig. 3 Internal oblique ridge (IOR)-guided inferior alveolar nerve block technique. A. Palpation of the IOR and lateral retraction of soft tissue. Arrow: finger retraction. B. Initial insertion of needle toward IOR. C. Needle insertion near the mandibular foramen along medial periosteum of ramus. (IP: insertion point)

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