Infratemporal Region Research Articles

A bright future for multidisciplinary approach to cancer care in the setting of limited resource

We report a case of alveolar rhabdomyosarcoma of the infratemporal region in a female child. An 8year old female was diagnosed with alveolar rhabdomyosarcoma 10 years ago. A computed tomography (CT) scan showed large mass in the right pterygopalatine fossa extending into the buccal, masticator and parapharyngeal spaces with involvement of the pterygoid and masseter muscles.Several multidisciplinary discussions were held concerning the case to determine the best treatment strategy. Child received neoadjuvant chemotherapy followed by radiotherapy. Six months post radiotherapy, CT scan reported a residual lesion for which multiple biopsies showed no residual tumor.Patient is doing well 10 years after treatment with no evidence of recurrence,Notably, this was the first case discussed at the inception of the pediatric multidisciplinary tumor board.

Exophthalmos Revealing a Spheno Temporo Orbital Meningioma

Intracranial meningiomas are usually non-cancerous tumors that develop from arachnoid cells in the meningeal envelope. However, there are rare forms called intraosseous meningiomas, which present unique challenges for diagnosis and treatment. In this report, we describe a rare case of a giant sphenotemporal meningioma in a 72-year-old male with diabetes. The patient experienced progressive exophthalmos and visual impairment over a period of five months. Radiological imaging confirmed the diagnosis, showing extensive infiltration into the infra-temporal region. Histopathological examination confirmed a plaque-type meningothelial meningioma. The patient underwent surgical management, which involved maxillofacial surgery. Intraosseous meningiomas are rare but are increasingly being recognized, accounting for about two percent of all meningiomas. The spheno-orbital region is a common site for these tumors. Histologically, there are various subtypes, with meningothelial meningioma being the most common. The differential diagnosis includes Paget’s disease and osteomas. The optimal treatment approach involves extensive surgical resection, followed by adjuvant radiotherapy for any remaining or symptomatic tumors. The prognosis depends on the extent of resection and tumor progression, underscoring the importance of regular monitoring. Early intervention is crucial to preserve visual function and achieve favorable outcomes.

Trismus caused by migration of orthodontic archwire into the infratemporal fossa: a case report.

Soft tissue injuries are known complications of orthodontic treatment. Most of the injuries are mild, but severe complications can arise from deeper penetration or dislodgement of brackets and other foreign bodies into the surrounding tissues of the oropharynx and infratemporal fossa. The patient, accompanied by his parents, presented to the Children's Emergency Department with the concern of gradual limitation of mouth opening and eventual trismus, which occurred over a span of 2 weeks. The patient presented with trismus and slight discomfort at the left cheek region. He reported a history of gradual limitation to his mouth opening 2 weeks prior. He was wearing upper and lower fixed orthodontic appliances and the left distal end of the maxillary archwire was found to have migrated into the left infratemporal fossa. Left medial pterygoid muscle inflammation, or bleeding and haematoma formation, or infection within the infratemporal region. The maxillary archwire was removed in the Children's Emergency Department and a computed tomography (CT) scan performed subsequently confirmed the diagnosis of left medial pterygoid muscle inflammation. The patient was started on an intravenous (IV) antibiotic and a 2-day course of IV dexamethasone to reduce the muscle inflammation. By the second day, the patient was able to achieve a mouth opening of 6 mm, and by the second week, the mouth opening had returned to normal. The potential risk of soft tissue injury and complications from orthodontic treatment is generally mild and limited. Soft tissue injuries can be avoided with careful management by the operator with the proper precautions taken. Clinicians should be familiar with the surrounding soft tissue anatomy and be aware of the potential for more severe complications and provide management or referral to the appropriate specialty accordingly.

Epidermoid Cyst of the Temporal and Infratemporal Region: A Rarity

Epidermoid Cyst of the Temporal and Infratemporal Region: A Rarity

P18.08.B COMPARISON OF DOSE CALCULATION PLANNING SYSTEMS FOR RECCURENT MENENGIOMA TREATED WITH FRACTIONATED RE-IRRIDATION

Abstract PURPOSE Meningioma is among the most common tumors of the central nervous system, accounting for approximately one-third of all brain tumors. Surgery is mainstay treatment and Radiotherapy (RT) provides long-term control in many patients, however recurrences following RT may occur and the safety and efficacy of a second course of RT is not well defined, technical and planning features are yet to be clarified. In this study, we compared various treatment planning systems (TPS) used in RT in a patient who had progressed meningioma after three applications of Gammaknife radiosurgery (GK-SRS). Case Presentation: 55-year-old male patient was diagnosed with grade-1 meningioma of the sphenoid wing in 2014 and subtotal excision was performed, with no further treatment. Progression was detected in 2016, and 11 Gy single fraction GK-SRS was applied in two sessions (inferior and superior parts of the tumor was irradiated in separate GK-SRS applications with 2 months apart) to the recurrent lesion in the right spheno-orbital region in a GK center. Patient was well until June 2022 when progression was detected in the right infratemporal region. Another GK-SRS application of 11 Gy was performed to the patient at the same institute.In April 2023 progression of the tumor was detected, tumor was irresectable and patient referred to our department for fractionated radiotherapy. Recurrent tumor was originating from right sfenoid wing and extending to right infratemporal fossa. We obtained the radiation dose distributions from the previous GK-SRS plans. Due to dose limits on the right optic nerve due to previous radiation dose disturbution , the conventional fractionated radiotherapy was planned . The PTV dose was planned to be 45 Gy/25 fx. Eclipse and Brainlab systems were compared for treatment planning. Right optic nerve dose of EQD2 was already above the limits, thus conventional fractionation (45 Gyin 25 fractions) was prescribed. Two separate plans were generated using Varian-Eclipse and Brainlab-Elements TPS, and the dose distribution of those plans were compared. Plan optimization was performed in both planning systems to provide PTV D%95. While the PTV Dmax was 57.24 Gy in BrainLAB, it was 48.7 Gy in Eclipse. Dmax doses for Brainlab and Eclipse were: right optic nerve 10.11 Gy vs. 26.9 Gy, chiasm 6.68 Gy vs. 20.5 Gy respectively. In Eclipse plan optimization, the collimator and table angles were optimized manually, while in Brainlab planning system, they were automatically handled, therefore normal tissues can be better preserved with increase of hot spots inside the PTV. This situation is observed clearly in this case. CONCLUSION Using different table and collimator angles in plan optimization can yield better results in providing normal tissue dose tolerance, especially in the irradiation of central nervous system.

Analysis of retinal arteriolar and venular parameters in primary open angle glaucoma.

To measure the retinal vessels of primary open angle glaucoma (POAG) patients on spectral domain optical coherence tomography (SD-OCT) with a full-width at half-maximum (FWHM) algorithm to better explore their structural changes in the pathogenesis of POAG. In this retrospective case-control study, the right eyes of 32 patients with POAG and 30 healthy individuals were routinely selected. Images of the supratemporal and infratemporal retinal vessels in the B zones were obtained by SD-OCT, and the edges of the vessels were identified by the FWHM method. The internal and external diameters, wall thickness (WT), wall cross-sectional area (WCSA) and wall-to-lumen ratio (WLR) of the blood vessels were studied. Compared with the healthy control group, the POAG group showed a significantly reduced retinal arteriolar outer diameter (RAOD), retinal arteriolar lumen diameter (RALD) and WSCA in the supratemporal (124.22±12.42 vs 138.32±10.73 µm, 96.09±11.09 vs 108.53±9.89 µm, and 4762.02±913.51 vs 5785.75±1148.28 µm2, respectively, all P<0.05) and infratemporal regions (125.01±15.55 vs 141.57±10.77 µm, 96.27±13.29 vs 110.83±10.99 µm, and 4925.56±1302.88 vs 6087.78±1061.55 µm2, all P<0.05). The arteriolar WT and WLR were not significantly different between the POAG and control groups, nor were the retinal venular outer diameter (RVOD), retinal venular lumen diameter (RVLD) or venular WT in the supratemporal or infratemporal region. There was a positive correlation between the arteriolar parameters and visual function. In POAG, narrowing of the supratemporal and infratemporal arterioles and a significant reduction in the WSCA is observed, while the arteriolar WT and WLR do not change. Among the venular parameters, the external diameter, internal diameter, WT, WLR, and WSCA of the venules are not affected.

Glaucomatous optic nerve damage in the contralateral eye of a patient with peripapillary retinoschisis: a case report

BackgroundPeripapillary retinoschisis (PPRS) is often associated with glaucomatous eyes. It usually occurs in eyes with a more advanced stage of glaucoma with obvious optic nerve damage. We report a patient who was found to have PPRS in one eye during a routine physical examination without obvious glaucoma symptoms. Further examination revealed glaucomatous visual field loss and retinal nerve fiber layer defects in the contralateral eye.Case presentationA 55-year-old man presented for a routine physical examination. The anterior segment was normal in both eyes. Fundus examination revealed an elevated and red optic disc in the right eye. In addition, scattered patchy red lesions were seen on the retina on the temporal side of the optic disc. The color and boundary of the left optic disc were normal, and the cup-to-disc ratio was 0.6. Optical coherence tomography showed retinoschisis on the optic nerve head of the right eye throughout the entire circumference, extending to the retina on the temporal side of the optic disc. The intraocular pressure was 18 mmHg OD and 19 mmHg OS. The patient was diagnosed with PPRS (OD). However, no optic disc pit or optic disc coloboma was found. Further examination showed that the visual field of the patient’s right eye was generally normal, while a glaucomatous visual field defect was found in the left eye, which manifested as a nasal step visual field defect. Moreover, stereophotography and a red-free fundus image revealed two retinal nerve fiber layer defects in the supratemporal and infratemporal regions of the retina of the left eye. Continuous intraocular pressure measurement found that the intraocular pressure fluctuated between 18 and 22 mmHg OD and 19–26 mmHg OS during the daytime. Primary open-angle glaucoma was then diagnosed.ConclusionsIn this case, we found that PPRS was associated with glaucomatous optic nerve changes and visual field defects in the fellow eye.

Atypical metastasis localization, buccal mucosa, in a patient with invasive lobular breast cancer: a case report

Background: Buccal mucosa metastasis is rare in breast cancer patients. Case Presentation: A 50-year-old female breast cancer patient with invasive lobular carcinoma (ILC) in his eight years follow-up period presented with a swelling in the right eye. Head and neck MRI was showed soft tissue formation with dimensions of 59x31 mm was detected in the axial plane, extending from the level of the right infratemporal fossa to the right buccinator muscle and right maxillary sinus in front of the alveolar process. In the right periorbital region, there was a thickness increase of up to 1 cm in the thickest part of the globe, which was evident in the anterolateral. In addition, there was no bone destruction in the right infratemporal region in maxillofacial CT, and no additional organ metastasis was detected in PET-CT performed for systemic scanning. In the histopathological examination of the tissue, carcinoma infiltration was detected. Radiotherapy was applied to the right buccal and orbital region of the patient as 30 Gy in 12 fractions (2.5 Gy per fraction) with volumetric modulated arc therapy technique and then 15 Gy in 6 fractions (2.5 Gy per fraction) boost radiotherapy with the adaptive technique were applied. At the follow-up 2 months later, clinical response was observed in the patient, and significant regression of the lesion was observed in facial and orbital MRI. At the 15th month follow-up of the patient, clinical and radiological remission continues. All clinical complaints regressed. Conclusion: ILC is a subtype of breast cancer that is characterized by unusual metastasis. Therefore, during the follow-up of these patients, it is necessary to monitor both laboratory values and clinical complaints very carefully.

Sinonasal and Infratemporal Schwannoma: Rare Case Report with Literature Review.

Schwann cells are responsible for the production of the myelin sheath around the axons of the peripheral nervous system. Benign neoplasms which originate from Schwann cells are hence termed Schwannomas or Neurilemmomas. They present as slow-growing, solitary, encapsulated, benign masses usually in association with nerve trunks. Schwannomas are relatively rare tumors with 25-45% occurring in the head and neck region. These case reports aim to describe the presentations, work-up, and treatment of two patients with head and neck schwannoma in atypical locations. Both patients had a history of gradually increasing swelling, the first originating from the sino-nasal region and the second from the temporal/ infratemporal region. Complete surgical excision of the tumor was done in both cases with no reported recurrence at 18months follow-up. The final diagnosis was made based on histopathology and immunohistochemistry findings. Schwannomas often present a diagnostic dilemma and should be considered a possibility in all head and neck tumors. Recurrence is rare.

Synovial Sarcoma Arising in the Retromolar Trigone: A Rare Presentation

Synovial sarcoma is a rare malignant neoplasm of young adults with poor survival. These usually arise from large joints and articular tendons. We describe an unusual case of synovial sarcoma arising from the left retromolar trigone upon initial presentation. To the best of our knowledge, this case is the only patient with left retromolar trigone involvement recorded in the literature. A 33-year-old female presented to us with complaints of a lesion in the left retromolar trigone. An ulcerated lesion with irregular margins and a smooth base was noted at the left retromolar trigone. CT scan demonstrated a soft tissue mass predominantly involving the left buccal space measuring 5.0 × 4.2 × 2.8 cm superiorly extending into the left infratemporal region, closely abutting posterior lateral of the left maxillary sinus with gross bone thinning. Biopsy was taken from the temporal and infratemporal region, which was positive for synovial Sarcoma. She received 2 cycles of neoadjuvant chemotherapy AIM protocol followed by wide local excision, however, the margin status could not be ascertained. Subsequently, treatment with a total of 60 Gy adjuvant radiotherapy was given. Patient tolerated the treatment well and remained disease-free for 4.5 years. She then developed biopsy-proven recurrence at the primary site; her metastatic workup was negative. Unfortunately, the patient was lost to follow-up for 2 years and then presented with a very large lobulated mass in the left infratemporal fossa, now measuring 6.2 × 7.6 × 6.3 cm, encasing ramus of mandible, temporomandibular joint and muscle of mastication with intra-orbital extension. She received 2 cycles of chemotherapy with gemcitabine and docetaxel. However, she did not tolerate the chemotherapy well. Subsequently, she developed tumor bleeding and received palliative radiation for bleeding and pain control. Patient is now on the best supportive care, her general condition deteriorating rapidly with the passage of time. Synovial sarcoma of the retromolar trigone is a rare malignant tumor with a poor prognosis. As there is no standard treatment protocol for synovial sarcomas of the head and neck, optimal antineoplastic treatment remains unclear. Mainstay of treatment is surgical resection with high relapse rates. Radiation therapy, with or without chemotherapy, appears to improve survival.

SYNOVIAL SARCOMA ARISING IN THE RETROMOLAR TRIGONE: A RARE PRESENTATION

Case report A 33-year-old female presented with complaints of lesion in the left retromolar trigone. CT scan demonstrated a soft tissue mass in left buccal space extending into the left infratemporal region. Biopsy was positive for Synovial Sarcoma. She received chemotherapy followed by wide local excision.Treatment with a total of 60 Gy radiotherapy was given. Patient tolerated the treatment well and remained disease free for 4.5 years. She developed recurrence and received palliative radiation for bleeding and pain control.

Osteological and taxonomic reassessments of Sahaliyania elunchunorum (Dinosauria, Hadrosauridae) from the Upper Cretaceous Yuliangzi Formation, northeast China

ABSTRACT The osteology and taxonomy of the lambeosaurine Sahaliyania elunchunorum from the upper Yuliangzi Formation (middle Maastrichtian) are reevaluated herein. Based on detailed morphological comparisons among hadrosauroids, we argue that Wulaga lambeosaurine specimens, most of which were previously ascribed to S. elunchunorum, display a combination of features that is typical of Amurosaurus riabinini from the upper Udurchukan Formation (middle Maastrichtian) at the Blagoveschensk locality. This combination includes several anterodorsally-posteroventrally oriented lateral foramina of the maxilla with a very large last one partially obscured by the ventral extremity of the jugal contact, a narrow infratemporal region of the jugal that is ∼70% as wide as the orbit, a relatively low anterior third of the strongly dorsally concave sagittal crest of the parietal, mesiodistally wide maxillary tooth crowns (∼1.2–1.3 teeth per cm), the sternal posterolateral process slightly shorter than the anteromedial plate, and a gently ventrally deflected preacetabular process of the ilium. Considering the osteological similarities and the fact that the Yuliangzi and Udurchukan formations were deposited synchronously in the same basin, S. elunchunorum is regarded here as a junior synonym of A. riabinini. Approximately 70% of the complete Amurosaurus fibulae from the Wulaga bonebed exhibit a total length of more than 85 cm that probably corresponds to the adult stages. Histological sections from these fibulae are moderately remodeled by dense secondary osteons, with poorly developed vascularization of primary osteons along fibrolamellar bone in the outer cortex. The phylogenetic analysis of Lambeosaurinae recovers a sister-taxon relationship between Amurosaurus and Lambeosaurus.

Foramen Ovale and Associated Accessory Foramina

Background: The mandibular nerve exits the cranial cavity by traversing through the foramen ovale (FO) which is located in the greater wing of sphenoid, posterolateral to foramen rotundum. This foramen also provides an entry portal to the accessory middle meningeal artery and helps exit the lesser petrosal nerve apart from the emissary veins. Tumors and masses in infratemporal region require an accurate and precise morphometry of FO, before planning any surgical procedure. The aim of this study is to record and analyze the metric and nonmetric data and compares the morphometry of FO with gender and age. Methodology: Type of study – Retrospective observational study. The sample size was 200 computerized tomography head axial section scans without any disease which might alter the anatomy of foramen, from picture archiving and communication system. Bilateral foraminal parameters were obtained with the help of computer-assisted software. Results: The mean length, breadth, distance from mid-sagittal plane, and size of FO in males were 7.75 ± 1.16, 3.98 ± 0.91, 21.40 ± 1.75, and 30.94 ± 8.79, and in females, measurements were 6.90 ± 0.78, 3.57 ± 1.04, 20.36 ± 1.62, and 24.86 ± 9.08, respectively. Septation was observed in 2% of cases and the most common shape observed was oval (84%). Totally 26% of accessory foramina were observed. Conclusion: Significant gender differences were seen in the morphometry in all the four parameters. A significant difference with age was seen only with distance of foramen from midsagittal plane. Variations in morphometry and shapes of the FO may affect clinical and diagnostic procedures.

LINGUAL NERVE IN RELATION TO MANDIBULAR THIRD MOLAR REGION: A CADAVERIC STUDY

Background: The lingual nerve is the terminal branch of the mandibular division of trigeminal nerve. The spatial relationship of lingual nerve to the mandibular alveolar crest varies widely. This variation can be among the gender, age, dental status and between the right and left side of the same sample. This study was aimed to determine the relationship of lingual nerve to mandibular third molar region. Methods: An observational study was carried out from January 2021 to December 2021.The study sample was 15 cadavers including both right and left sides. The lingual nerve was exposed by dissecting the infra temporal region following the standard procedures of Cunninghams Manual of Dissection. The diameter of the lingual nerve, vertical and horizontal distance were measured. The results of all these measurements were tabulated and mean standard deviation were calculated using SPSS version 16. Results: Out of 30 lingual nerves examined, the mean horizontal distance was 3.99 ± 0.96 mm, the mean vertical distance was 12.67 ± 1.76 mm while the diameter of the lingual nerve was 2.46 ± 0.54 mm. Conclusions: The lingual nerve always lies in close proximity of alveolar bone and surgeons operating in this region need to be aware during any surgical interventions or any procedures in this region. A thorough apprehension of the spatial location of the lingual nerve enable to lessen the lingual nerve injury.

Extracranial Head and Neck Schwannomas: A Case Series and Review of Literature.

Schwannomas are benign nerve tumors of schwann cell origin. Schwann cells are derived from neural crest and are therefore of neuroectodermal origin. 25-40% of all schwannomas arise in the head and neck region. The most common schwannomas are vagal schwannomas and cervical schwannomas in the head and neck region. Here we present two cases of head and neck schwannomas which were not identified as originating from any major nerve. The first patient had a schwannoma in the infratemporal region which was excised by performing transzygomatic approach, and the second patient had a schwannoma in the left lateral part of the neck which was excised using a cervical crease incision.

An Atypical Path of the Lingual Nerve in the Retromolar Region: Incidence in Oral Surgery.

The Lingual nerve is frequently anesthetized during oral, maxillofacial, or otorhinolaryngology surgery. It originates below the oval hole in the infratemporal region, follows its path down and forward, and moves away from the medial surface of the ramus. From there, it goes just above the mylohyoid line. It approaches the lateral margin of the tongue and crosses the Wharton's canal, and divides into numerous branches. Some cases of temporomandibular joint syndrome or myofascial pain syndrome could be a result of its anatomical variations. Also, the jurisprudence has always condemned the practitioner if for not demonstrating that the path of the injured nerve presents an anomaly which makes his involvement inevitable. The purpose is to present one of the multiple atypical paths of the lingual nerve not described in the retromandibular trigone, demonstrating that its damage constitutes a risk that cannot be controlled.

Unsuspected Paraganglioma—Infratemporal Fossa

AbstractParaganglioma of the infratemporal fossa is exceedingly rare, with no more than a handful of documented cases. Undiagnosed paraganglioma poses a great challenge. We present a 39-year-old hypertensive female, who presented with giddiness and headache for 3 months and four episodes of syncope over 3 months. CT and MRI revealed an enhancing infratemporal region space-occupying mass close proximity to petrous carotid artery. Intraoperatively, the patient had hemodynamic instability (tachycardia and hypertension) when the mass was surgically manipulated. Diagnosis of paraganglioma was suspected, based on hemodynamic instability, which was later confirmed by histopathology. Undiagnosed paraganglioma pose a great challenge to the anesthetic management. Low-threshold of suspicion has to be there to avoid significant morbidity and mortality.

Use of Digitally Annotated and Printed 3D Models for Teaching the Pterygopalatine Fossa

Anatomically deep and geometrically complex regions are difficult for students to visualize in gross dissections, overly simplified in models, and not faithfully depicted in 2D images. One such region is the pterygopalatine fossa which communicates with the infratemporal region, middle cranial fossa, cranial base, nasal and oral cavities, and face via 7 osteological foramina or fissures. Given the geometric complexity of this space, we aimed to create a 3D based educational tool for students to use in their pre‐clinical, dissection‐free head and neck anatomy course.A cranium rendered from CT imaging was imported into Medium, a digital sculpting program, using the Oculus Virtual Reality (VR) system. The right half was removed, and the left half was divided into three sections via two parasagittal slices. The lateral parasagittal cut bisected the foramen rotundum and palatine canals, and the medial parasagittal cut bisected the left half of the nasal cavity. The only alterations to the morphology was an exaggeration of the palatine canal and the anterior and posterior openings of the Vidian canal to allow for the passage of wires during the lab exercise. The three sections of the cranium were then 3D printed. In addition to 3D printing, the model was annotated in Medium by drawing in the course of the maxillary artery and nerve and their branches, and the nerve of the Vidian canal in the pterygopalatine fossa and associated regions. The model showing the neurovasculature related to the pterygopalatine fossa was imported into Sketchfab, a 3D model publishing platform, where labels could be placed to identify structures and provide additional information. The labeled model was embedded into the digital lab manual for students to reference during the lab activity where they were directed to pass a wire through the various foramina and fissures in the region to understand the passage of the neurovasculature in and out of the pterygopalatine fossa.The annotated digital model allowed students to visualize the completed course of these nerves and arteries while the printed model gave appreciation for the location, size, and orientation of the canals and foramina through which the pterygopalatine fossa communicates with other regions. This intervention was applied in the 2019 Living Anatomy: Head and Neck course, where students did not perform dissection but did have access to prosected cadavers and plastinations.Student performance on the 2019 exam was statistically identical to the performance of previous cohorts in a traditional dissection‐based anatomy course (2018: 85.9%; 2019: 88.1%). The 2019 cohort on average scored lower on questions derived from the material from the lab that included this intervention compared to the 2018 cohort (2018: 84.82%; 2019: 80.76%). However, the pterygopalatine fossa question (97.09%) outperformed the nasal cavity (80.58%) and larynx/pharynx (78.5%) questions. Additionally, students ranked digitally annotated 3D models the 3rd highest activity or resource following faculty directed case studies and the prosected cadavers. Student exam results and feedback indicate a utility of providing physical objects with digital 3D reference material during anatomy instruction.

A study on abnormal variation in the infratemporal region of human skull: An ossified pterygospinous ligament

A study on abnormal variation in the infratemporal region of human skull: An ossified pterygospinous ligament

The neurovascular contents of a unilateral double mandibular canal: A case study

The occurrence of bifid mandibular canals is unusual but not rare. Previous reviews and case studies have described numerous types of bifid canals based on location, anatomy, and contents. Developmentally, ossification of the mandible begins at the region of the mental foramen and continues posteriorly, forming the mandibular canal around the neurovascular bundle within. This process explains the creation of multiple mandibular canals and the diversity of canal types previously recorded in the literature; the inferior alveolar nerve originates as three distinct bundles and may experience incomplete fusion, or the nerve and artery may be isolated during ossification. However, the presence of two distinct mandibular canals, each originating from its own mandibular foramen, is even more unusual. This case report describes a unilateral variant discovered during the dissection of a 92‐year‐old African American female. On the left side, the cadaver presents two distinct mandibular canals, each containing a branch of the maxillary artery and mandibular nerve, the third division of the trigeminal (CN V). The nerves within the two canals, the inferior alveolar nerve in the superior canal and the mental nerve in the inferior canal, were distinct from each other at the level of the posterior division of the mandibular nerve, within 1 cm of foramen ovale in the infratemporal region. This is the first description of such an occurrence, and emphasizes the need for identification of the contents of a bifid or accessory mandibular canal prior to invasive procedures.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.