Arterial blood supply variation in the anterior midline mandible: Significance to dental implantology.

Joseph Gakonyo,Evelyn Wagaiyu,Philip Mwachaka,Fawzia Butt

doi:10.1186/s40729-015-0026-y

Joseph Gakonyo, Evelyn Wagaiyu + Show 2 more

Open Access

https://doi.org/10.1186/s40729-015-0026-y

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Abstract

BackgroundInter-foraminal implant placement poses a risk to the sublingual artery as it enters the mandibular midline lingual foramen. Lack of consensus on the source of this artery poses a dilemma to surgeons during management of haemorrhagic episodes. Determination of the exact source of this artery is therefore pivotal.MethodsThis was a cross-sectional descriptive study involving 34 adult human cadavers. The facial and lingual arteries were followed from the external carotid artery to determine whether they terminated as the sublingual artery. Statistical significance tests were done using the Mann-Whitney U test and Pearson product-moment correlation.ResultsThere were 30 (88.2 %) males and 4 (11.8 %) females (male/female = 15:2) aged between 25 and 40 years. The origin of the sublingual artery was mainly from the lingual artery (73.5 %), the submental artery (17.6 %), or an anastomotic branch from the two arteries (8.9 %). The mean distance between the mandibular midline lingual foramen (MMLF) and the inferior border of the mandible was 15.58 mm (range 11.03–19.62 mm). The mean thickness of the mandible at the level of the MMLF was 10.89 mm (range 8.00–12.91 mm). No statistically significant difference was found between the two genders with regard to the morphometric measurements.ConclusionsThe sublingual artery that enters the MMLF was found to be the sublingual artery as either a branch of the lingual artery (73.5 %), the submental artery (17.6 %) or an anastomosis of the lingual and submental arteries (8.9 %).

Highlights

Inter-foraminal implant placement poses a risk to the sublingual artery as it enters the mandibular midline lingual foramen
Box 54954-00200, Nairobi, Kenya Full list of author information is available at the end of the article attributed to transection of the sublingual artery when a misdirected drill perforates the lingual cortex and damages the blood vessel within the surrounding soft tissues [5] as it enters the mandibular midline lingual foramen (MMLF). This vessel retracts into the floor of the mouth where a haematoma forms in the sublingual and submandibular spaces leading to a compromise of the airway, by swelling and pushing of the tongue against the palate [5, 6]. This foramen is a constant finding and has an intraosseous part, midline mandibular lingual canal (MMLC), which contains a blood vessel that is prone to transection during routine dental implant placement [7–11]
The MMLF is a consistent structure through which the sublingual artery enters the mandible [8, 11]

Summary

Introduction

Inter-foraminal implant placement poses a risk to the sublingual artery as it enters the mandibular midline lingual foramen. The inter-foraminal region of the human mandible is a common elective area for several dental surgery procedures due to its favourable anatomic conditions [1, 2]. Some of the procedures done in this region include insertion of endosseous dental implants, bone harvesting from the chin, genioplasty in orthognathic surgery and placement of screws during plating in management of facial fractures [3]. This foramen is a constant finding and has an intraosseous part, midline mandibular lingual canal (MMLC), which contains a blood vessel that is prone to transection during routine dental implant placement [7–11]. Some clinical protocols require inter-foraminal implant placement, which may lead to placement of an implant in the mandibular midline position [12]

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