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Unnamed foramina are known to be present in the mandible. The present research paper reports the presence of an accessory foramen on the medial surface of the mandible, highlighting its anatomico-radiological details. Accessory foramina in the mandible have been known to transmit branches of nerves supplying the roots of the teeth. Nerve block techniques by local anaesthetics might fail if any of these nerves or their branches pass through these accessory foramina and thus escape the nerve block. Dental surgeons performing extractions should be aware of accessory foramina on the mandible and thus plan anaesthesia at an appropriate anatomical site. The presence of such foramina might also be an alternate route for tumour spread following radiation therapy. Precise knowledge and awareness of such accessory mandibular foramina would therefore be important for dental surgeons performing nerve block and also for oncologists in planning radiation therapy.
The aim of this paper is to summarise the knowledge about the anatomy, embryology and anthropology of the mandible and the mandibular foramen and also to highlight the most important clinical implications of the current studies regarding anaesthesia performed in the region of the mandible. An electronic journal search was undertaken to identify all the relevant studies published in English. The search included MEDLINE and EMBASE databases and years from 1950 to 2012. The subject search used a combination of controlled vocabulary and free text based on the search strategy for MEDLINE using key words: ‘mandible’, ‘mandibular’, ‘foramen’, ‘anatomy’, ‘embryology’, ‘anthropology’, and ‘mental’. The reference lists of all the relevant studies and existing reviews were screened for additional relevant publications. Basing on relevant manuscripts, this short review about the anatomy, embryology and anthropology of the mandible and the mandibular foramen was written. (Folia Morphol 2013; 71, 4: 285–292)
Mylohyoid bridging (MB) is a non-metrical variant of the human mandible. The incidence and types of MB were investigated in 264 mandibles (edentulous 116, semi-dentulous 90 and dentulous 58). No mandible showed a complete type of MB, although 19 (7.2%) mandibles had a partial type. These were classified into two subtypes: distal partial (DP; Type I) and proximal partial (PP; Type II), depending on their location over the mylohyoid groove. The MB was present unilaterally in 7.76% of edentulous mandibles: right side 5.17% (3.45% PP type and 1.72% DP type) and left side 2.59% (1.72% PP type and 0.86% DP type). Of the semi-dentulous mandibles 3.33% had DP type of MB, 1.11% on the right side and 2.22% on the left side, and of the dentulous mandibles 1.72% had DP type of MB on the right side. A total of 13 mandibles out of 264 (4.92%) had unilateral MB. No dentulous mandible had bilateral MB, but 3.45% of edentulous and 2.22% of semi-dentulous mandibles did have. In total, 6 mandibles out of 264 bones (2.27%) had bilateral MB. Of the bilateral incidences 1.72% of edentulous mandibles had a DP-DP combination and the remaining 1.72% had a PP-DP combination. However, both instances of bilateral MB in semi-dentulous mandibles were of PP-DP combination. The incidence or types of MB showed no statistically significant differences between the groups or sides (p > 0.5; χ² test). In conclusion, the complete type of MB is a rare occurrence. The incidence increases with age, as edentulous mandibles had a higher incidence of MB than the other two groups. Clinically, MB may compress the mylohyoid neurovascular bundle, leading to neurological or vascular disorders.
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