“Primary lesions developing within themandibular canal are frequently neural or vascular in origin.”
common arising from two separateforamina [Fig. 1 & 2].
Suchduplicate canals are found in only0.5 to 1.0 % of studied adultpopulations.
They are sometimestermed “bifid canals.”
That suchbilateral canals are a reality ratherthan a projection artifact has beenproven both by anatomicaldissection (Carter and Keen 1971)
and also by computed tomography(Quattrone et al, 1989)
. Whether thecontents are neural, neurovascularor simply vascular is a contentiouspoint. If nerves were present in thetwo canals, this might account forsome failure to achieve localanesthesia when applying blockinjections.On occasion, appearance ofduplicated mental foramina is alsoobserved [Fig. 3]. Such trueduplication needs to bedistinguished from the separatedepictions of the mental canal atits origin from the mandibular canalcentral within bone, and at its exitfrom the facial cortex of themandible.It is possible that bifid canalsrepresent a minor expression ofstructural twinning. Very rarely, themandible may evidence augnathus,a variant of paragnathus.
Such acase, subsequently treatedsuccessfully by surgeons Davis andBreytenbach in Cape Town, SouthAfrica, is illustrated in Fig. 4. In thiscase, unilateral duplication of themandible was accompanied byduplication of the mandibularcanal – and also of the dentition forthat jaw quadrant.
Pathological conditions of the mandible
The effects of pathologicalconditions of the mandible on thepanoramic appearance of themandibular canal was first reportedby the author of the present report,a quarter of a century ago.
It was found that variousdisease processes canaffect the panoramicradiographic appearanceof the mandibular canal in avariety of ways. Localizedloss of the canal corticalbone was found withchronic apicalperiodontitis, chronicpericorontitis, advancedchronic destructiveperiodontitis (in patientshaving a high mandibularcanal), and rarely also withvery large Stafne’s bonecavities. Generalized loss ofthe canal’s cortical bonewas usually indicative ofsevere infection oraggressive neoplasia, andwas found in associationwith rarefying osteomyelitis,invasive squamous cellcarcinoma, multiplemyeloma, osteogenicsarcoma and occasionallywith ameloblastoma.Displacement of the canalsuggested a benign cysticor neoplastic process, andwas found with largeradicular cysts, residualdental cysts, dentigerouscysts and the cemento-ossifying fibroma amongother benign conditions.
Benign lesions within the mandibular canal
Primary lesions developingwithin the mandibular canalare frequently neural orvascular in origin. Benignneoplasm within the canalwill tend to widen the canaland cause superior andinferior displacement of thecanal as the lesion expands.Especially with slow growing
Examples of“bifid,” or “duplicate,”mandibular canals.Such canals have beenconfirmed in variousstudies both usinganatomical dissectionand by computedtomography.
Detailsfrom panoramicradiographsdemonstratingvarious“duplicate,” or“bifid”mandibularcanals.
Augnathus (avariant of paragnathus)demonstrating anextreme form ofduplication of themandibular canal. (Casetreated by Professors D.Davis and M.Breytenbach, CapeTown, South Africa.)