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

Affiliations
  • 1Department of Oral and Maxillofacial Surgery, Konyang University Hospital, Daejeon, Korea. janghy5102@gmail.com
  • 2Medical & Scientific Affairs Team, CGBio Research Center, Seongnam, Korea.

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)


Reference

1. Petrikas AZh, Ol'khovskaia EB, Medvedev DV, Diubaĭlo MV. [Disputable issues of Malamed's “Handbook of local anesthesia” (2004)]. Stomatologiia (Mosk). 2013; 92:71–76. Russian. PMID: 23715461.
2. Robertson WD. Clinical evaluation of mandibular conduction anesthesia. Gen Dent. 1979; 27:49–51. PMID: 297643.
3. Levy TP. An assessment of the Gow-Gates mandibular block for third molar surgery. J Am Dent Assoc. 1981; 103:37–41. PMID: 6942042.
Article
4. Cohen HP, Cha BY, Spångberg LS. Endodontic anesthesia in mandibular molars: a clinical study. J Endod. 1993; 19:370–373. PMID: 8245762.
Article
5. Reisman D, Reader A, Nist R, Beck M, Weaver J. Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:676–682. PMID: 9431539.
Article
6. Potocnik I, Bajrović F. Failure of inferior alveolar nerve block in endodontics. Endod Dent Traumatol. 1999; 15:247–251. PMID: 10825834.
7. Nusstein J, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod. 1998; 24:487–491. PMID: 9693577.
Article
8. Jansisyanont P, Apinhasmit W, Chompoopong S. Shape, height, and location of the lingula for sagittal ramus osteotomy in Thais. Clin Anat. 2009; 22:787–793. PMID: 19644966.
Article
9. Monnazzi MS, Passeri LA, Gabrielli MF, Bolini PD, de Carvalho WR, da Costa Machado H. Anatomic study of the mandibular foramen, lingula and antilingula in dry mandibles, and its statistical relationship between the true lingula and the antilingula. Int J Oral Maxillofac Surg. 2012; 41:74–78. PMID: 21955366.
Article
10. Oguz O, Bozkir MG. Evaluation of location of mandibular and mental foramina in dry, young, adult human male, dentulous mandibles. West Indian Med J. 2002; 51:14–16. PMID: 12089867.
11. Ennes JP, Medeiros RM. Localization of mandibular foramen and clinical implications. Int J Morphol. 2009; 27:1305–1311.
Article
12. Viravudth Y, Plakornkul V. The mandibular foramen in Thais. Siriraj Med J. 1989; 41:551–554.
13. Bremer G. Measurements of special significance in connection with anesthesia of the inferior alveolar nerve. Oral Surg Oral Med Oral Pathol. 1952; 5:966–988. PMID: 12993461.
Article
14. Nicholson ML. A study of the position of the mandibular foramen in the adult human mandible. Anat Rec. 1985; 212:110–112. PMID: 4073538.
Article
15. Thangavelu K, Kannan R, Kumar NS, Rethish E, Sabitha S, Sayeeganesh N. Significance of localization of mandibular foramen in an inferior alveolar nerve block. J Nat Sci Biol Med. 2012; 3:156–160. PMID: 23225978.
Article
16. Yu IH, Wong YK. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images. Int J Oral Maxillofac Surg. 2008; 37:521–528. PMID: 18450425.
Article
17. Hwang TJ, Hsu SC, Huang QF, Guo MK. [Age changes in location of mandibular foramen]. Zhonghua Ya Yi Xue Hui Za Zhi. 1990; 9:98–103. Chinese. PMID: 2135997.
18. Kang SH, Byun IY, Kim JH, Park HK, Kim MK. Three-dimensional anatomic analysis of mandibular foramen with mandibular anatomic landmarks for inferior alveolar nerve block anesthesia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115:e17–e23. PMID: 22771406.
Article
19. Müller HP, Schaller N, Eger T, Heinecke A. Thickness of masticatory mucosa. J Clin Periodontol. 2000; 27:431–436. PMID: 10883873.
Article
20. Matas R. The story of the discovery of dental anesthesia by nerve blocking; achievements of William Stewart Halsted. Surgery. 1952; 32:530–537. PMID: 12984270.
21. Wong MK, Jacobsen PL. Reasons for local anesthesia failures. J Am Dent Assoc. 1992; 123:69–73.
Article
22. Grover PS, Lorton L. Bifid mandibular nerve as a possible cause of inadequate anesthesia in the mandible. J Oral Maxillofac Surg. 1983; 41:177–179. PMID: 6572228.
Article
23. Roda RS, Blanton PL. The anatomy of local anesthesia. Quintessence Int. 1994; 25:27–38. PMID: 8190878.
24. Sillanpää M, Vuori V, Lehtinen R. The mylohyoid nerve and mandibular anesthesia. Int J Oral Maxillofac Surg. 1988; 17:206–207. PMID: 3135351.
Article
25. Thangavelu K, Kannan R, Kumar NS. Inferior alveolar nerve block: alternative technique. Anesth Essays Res. 2012; 6:53–57. PMID: 25885503.
Article
26. Chakranarayan A, Mukherjee B. Arched needle technique for inferior alveolar mandibular nerve block. J Maxillofac Oral Surg. 2013; 12:113–116. PMID: 24431825.
Article
27. Boonsiriseth K, Sirintawat N, Arunakul K, Wongsirichat N. Comparative study of the novel and conventional injection approach for inferior alveolar nerve block. Int J Oral Maxillofac Surg. 2013; 42:852–856. PMID: 23265758.
Article
28. Suazo Galdames IC, Cantín López MG, Zavando Matamala DA. Inferior alveolar nerve block anesthesia via the retromolar triangle, an alternative for patients with blood dyscrasias. Med Oral Patol Oral Cir Bucal. 2008; 13:E43–E47. PMID: 18167480.
29. Takasugi Y, Furuya H, Moriya K, Okamoto Y. Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen. Anesth Prog. 2000; 47:125–129. PMID: 11432177.
30. Gow-Gates GA. Mandibular conduction anesthesia: a new technique using extraoral landmarks. Oral Surg Oral Med Oral Pathol. 1973; 36:321–328. PMID: 4516460.
Article
31. Akinosi JO. A new approach to the mandibular nerve block. Br J Oral Surg. 1977; 15:83–87. PMID: 268212.
Article
32. Smyth J, Marley J. An unusual delayed complication of inferior alveolar nerve block. Br J Oral Maxillofac Surg. 2010; 48:51–52. PMID: 19297060.
Article
33. Wright EF. Medial pterygoid trismus (myospasm) following inferior alveolar nerve block: case report and literature review. Gen Dent. 2011; 59:64–67. PMID: 21613042.
34. Ethunandan M, Tran AL, Anand R, Bowden J, Seal MT, Brennan PA. Needle breakage following inferior alveolar nerve block: implications and management. Br Dent J. 2007; 202:395–397. PMID: 17435721.
Article
35. Chevalier V, Arbab-Chirani R, Tea SH, Roux M. Facial palsy after inferior alveolar nerve block: case report and review of the literature. Int J Oral Maxillofac Surg. 2010; 39:1139–1142. PMID: 20605412.
Article
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