Dentomaxillofacial Radiology (2004) 33, 340—341 © 2004 The British Institute of RadioloB’
Lingual vascular canals of the interforaminal region of themandible: evaluation with conventional tomography
H Liang*, NL Frederiksen and BW Benson
Department of Diagnostic Sciences, Division of Oral and Maxillofacial Radiology, Baylor College of Dentistry, Texas A&M Universily System Health Science Center, Dallas, Texas, USA
The presence of lingual vascular foramina and canals in the interforaminal region may increase the risk of surgical complicationsduring implant placement, bone grafting procedures and osteodistraction. Oral and maxillofacial radiologists should recognize thisanatomical variant and include a description in their interpretative report to inform the referring clinician of the potential forsurgical complications. Dentomaxillofacial Radiology (2004) 33, 340—34 1. doi: 10. 1259/dmfr133787240
Keywords: lingual vascular canals; interforaminal region; conventional tomography
Endosseous implants are becoming a routine restorative dental procedure. The placement of dentalimplants in the interforaminal region (the anterior region between the mental foramina) of the mandiblehas been considered to be relatively safe because anatomical structures including the inferior alveolarcanal and submandibular fossa are located posterior to this region. However, clinicians should be awarethat even in this region there are anatomical structures that might compromise the placement of implants.These include an anterior extension of the inferior alveolar canal, a pronounced lingual concavity, asevere concavity of the lingual cortex and lingual vascular canals.Perforation of the lingual plate and inferior border of the mandible have previously been considered to bebenign occurrences. This is often intentional in the presence of a severely atrophic ridge to gain maximumbone-implant surface area retention.
However, several studies have reported the occurrence of life-threatening conditions caused by bleeding secondary to the placement of dental implants into the lingualcortex of the interforaminal region because of the presence of accessory vascular canals.”
In a recentreview article, Kalpidis and Setayesh
reported that 12 cases of severe haernorrhage in the floor of mouthwith subsequent life-threatening upper airway obstruction associated with implant placement in theanterior portion of the mandible were found in the literature from 1986 to 2003. In addition, neweraugmentative techniques undertaken to gain bone volume, such as osteodistraction of theanterior region of the mandible and orthognathic surgical procedures have a potential for vascular injuryand subsequent bleeding in the interforaminal region.
The sublingual branch of the lingual artery and the submental branch of the facial artery are among theprimary nutrient vessels to the floor of the mouth. Anastomoses are formed between these vessels prior topassage through accessory lingual foramina in the mandible into lingual vascular canals and anastomosiswith incisive branches of the inferior alveolar artery.
Anatomical studies have demonstrated two commonlocations for accessory lingual foramina: the lingual midline of the mandible and close to the lingual