Assessment of location and anatomical characteristics of lingual foramen using cone beam computed tomography

Stefan Veličković; Stevo Matijević; Bojan  Jovičić; Marija  Bubalo; Momir  Stevanović; Miroslav  Vasović

doi:10.2298/VSP221208009V

Stefan Veličković University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia
Stevo Matijević University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Bojan Jovičić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Marija Bubalo University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Momir Stevanović University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia
Miroslav Vasović University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP221208009V

Keywords: anatomy, cone-beam computed tomography, mandible

Abstract

Background/Aim. A lingual foramen (LF) is a small opening on the lingual surface of the mandible, most frequently located in the middle of the anterior part of the mandible, and shows significant variations in its location, size, and number. The aim of this study was to assess the location and anatomical characteristics of LF using cone beam computed tomography (CBCT). Methods. The research was designed as a retrospective study in which 99 CBCT scans were analyzed. The analysis covered the number of LF, their location concerning the teeth and the mandibular region itself, diameter, distance from the alveolar ridge crest, distance from the inferior border of the mandible, distance from the tooth apex, and position in relation to the tooth apex. Results. The average frequency of LF per patient was 2.4 ± 1.2. The largest number of LF were localized in the region of lower central incisors. Out of the total number of LF, 82.5% belonged to median LF, while 17.5% belonged to lateral LF. In 63.2% of cases, LF had a diameter of ≤ 1 mm, whereas, in 98.3% of cases, it was localized below the tooth apex. There was a statistically significant difference in the distance of LF from the alveolar ridge crest and the LF diameter in relation to gender (p = 0.019; p = 0.008). Conclusion. LF can be reliably localized and visualized using CBCT. It is recommended that CBCT scanning of the mandible be used while planning an oral surgical procedure and implant placement in order to prevent injuries of the neurovascular bundle, which passes through LF.

References

1. He X, Jiang J, Cai W, Pan Y, Yang Y, Zhu K, et al. Assessment of the appearance, location and morphology of mandibular lingual foramina using cone beam computed tomography. Int Dent J 2016; 66(5): 272–9.

2. Denny CE, Natarajan S, Ahmed J, Binnal A, Jindal R. Anatomic variation in lingual foramen: A cone beam computed tomography study. World J Dent 2016; 7(4): 179–81.

3. Flanagan D. Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident. J Oral Implantol 2003; 29(4): 165–73.

4. Yildirim YD, Güncü GN, Galindo-Moreno P, Velasco-Torres M, Juodzbalys G, Kubilius M, et al. Evaluation of mandibular lingual foramina related to dental implant treatment with computerized tomography: A multicenter clinical study. Implant Dent 2014; 23(1): 57–63.

5. Sheikhi M, Mosavat F, Ahmadi A. Assessing the anatomical variations of lingual foramen and its bony canals with CBCT taken from 102 patients in Isfahan. Dent Res J 2012; 9(Suppl 1): S45–51.

6. Wang YM, Ju YR, Pan WL, Chan CP. Evaluation of location and dimensions of mandibular lingual canals: a cone beam computed tomography study. Int J Oral Maxillofac Surg 2015; 44(9): 1197–203.

7. Demiralp KO, Bayrak S, Orhan M, Alan A, Kursun Cakmak ES, Orhan K. Anatomical characteristics of the lingual foramen in ancient skulls: A cone beam computed tomography study in an Anatolian population. Folia Morphol 2018; 77(3): 514–20.

8. Babiuc I, Tǎrlungeanu I, Pǎuna M. Cone beam computed tomography observations of the lingual foramina and their bony canals in the median region of the mandible. Rom J Morphol Embryol 2011; 52(3): 827–9.

9. Rosano G, Taschieri S, Gaudy JF, Testori T, Del Fabbro M. Anatomic assessment of the anterior mandible and relative hemorrhage risk in implant dentistry: A cadaveric study. Clin Oral Implants Res 2009; 20(8): 791–5.

10. Kawai T, Sato I, Yosue T, Takamori H, Sunohara M. Anastomosis between the inferior alveolar artery branches and submental artery in human mandible. Surg Radiol Anat 2006; 28(3): 308–10.

11. Abd Al-Khuther FM, Fatah AA. Radiological Evaluation of the Anatomic Characteristic of Lingual Foramina and Their Vascular Canals in the Anterior Region of the Mandible Using Cone Beam Computed Tomography. J Baghdad Coll Dent 2018; 30(1): 23–7.

12. Dubois L, de Lange J, Baas E, Van Ingen J. Excessive bleeding in the floor of the mouth after endosseus implant placement: a report of two cases. Int J Oral Maxillofac Surg 2010; 39(4): 412–5.

13. Tomljenovic B, Herrmann S, Filippi A, Kühl S. Life-threatening hemorrhage associated with dental implant surgery: a review of the literature. Clin Oral Implants Res 2016; 27(9): 1079–84.

14. Peñarrocha-Diago M, Balaguer-Martí JC, Peñarrocha-Oltra D, Bagán J, Peñarrocha-Diago M, Flanagan D. Floor of the mouth hemorrhage subsequent to dental implant placement in the anterior mandible. Clin Cosmet Investig Dent 2019; 11: 235–42.

15. Isaacson TJ. Sublingual hematoma formation during immediate placement of mandibular endosseous implants. J Am Dent Assoc 2004; 135(2): 168–72.

16. Balaguer-Martí JC, Peñarrocha-Oltra D, Balaguer-Martínez J, Peñarrocha-Diago M. Immediate bleeding complications in dental implants: A systematic review. Med Oral Patol Oral Cir Bucal 2015; 20(2): e231–8.

17. Mardinger O, Manor Y, Mijiritsky E, Hirshberg A. Lingual perimandibular vessels associated with life-threatening bleeding: An anatomic study. Int J Oral Maxillofac Implants 2007; 22(1): 127–31.

18. Liang X, Jacobs R, Lambrichts I, Vandewalle G. Lingual foramina on the mandibular midline revisited: A macroanatomical study. Clin Anat 2007; 20(3): 246–51.

19. McDonnell D, Reza Nouri M, Todd ME. The mandibular lingual foramen: A consistent arterial foramen in the middle of the mandible. J Anat 1994; 184(Pt 2): 363–9.

20. Nakajima K, Tagaya A, Otonari-Yamamoto M, Seki K, Araki K, Sano T, et al. Composition of the blood supply in the sublingual and submandibular spaces and its relationship to the lateral lingual foramen of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117(1): e32–8.

21. Zivic M, Vasovic M, Acovic A, Lukovic A, Zivanovic-Macuzic I, Velickovic M, et al. Assessment of accessory mental foramen using cone-beam computed tomography and its clinical relevance. J Anat Soc India 2020; 69(2): 91–6.

22. Zhang C, Zhuang L, Fan L, Mo J, Huang Z, Gu Y. Evaluation of mandibular lingual foramina with cone-beam computed tomography. J Craniofac Surg 2018; 29(4): e389–94.

23. Oettlé AC, Fourie J, Human-Baron R, van Zyl AW. The midline mandibular lingual canal: Importance in implant surgery. Clin Implant Dent Relat Res 2015; 17(1): 93–101.

24. Sanhueza Á, Briner M, Calvo M, Cisternas A. The Presence of Lingual Foramina and Canals on CBCT on Patients over 18 Years of Age. Int J Morphol 2018; 36(1): 80–6.

25. Krishnan U, Monsour P, Thaha K, Lalloo R, Moule A. A Limited Field Cone-beam Computed Tomography–based Evaluation of the Mental Foramen, Accessory Mental Foramina, Anterior Loop, Lateral Lingual Foramen, and Lateral Lingual Canal. J Endod 2018; 44(6): 946–51.

26. Przystańska A, Bruska M. Anatomical classification of accessory foramina in human mandibles of adults, infants, and fetuses. Anat Sci Int 2012; 87(3): 141–9.

27. Natsis K, Repousi E, Asouhidou I, Siskos C, Ioannidi A, Piagkou M. Foramina of the anterior mandible in dentate and edentulous mandibles. Folia Morphol 2016; 75(2): 204–10.

28. Bernardi S, Bianchi S, Continenza MA, Macchiarelli G. Frequency and anatomical features of the mandibular lingual foramina: systematic review and meta-analysis. Surg Radiol Anat 2017; 39(12): 1349–57.

29. Kumar GA. Anatomical variations of lingual foramen and it’s bony canals with cone beam computerised tomography in south Indian population – a cross sectional study. Oral Health Care 2017; 2(3): doi: 10.15761/OHC.1000124.

30. Isman O, Kayar S, Surmelioglu D, Ciftci ME, Aktan AM. Evaluation of the relationship between appearances of the lingual foramen on panoramic radiography and cone-beam computed tomography. Niger J Clin Pract 2020; 23(2): 205–11.

31. Soto R, Concha G, Pardo S, Cáceres F. Determination of presence and morphometry of lingual foramina and canals in Chilean mandibles using cone-beam CT images. Surg Radiol Anat 2018; 40(12): 1405–10.

32. He P, Truong MK, Adeeb N, Tubbs RS, Iwanaga J. Clinical anatomy and surgical significance of the lingual foramina and their canals. Clin Anat 2017; 30(2): 194–204.

33. Trost M, Mundt T, Biffar R, Heinemann F. The lingual foramina, a potential risk in oral surgery. A retrospective analysis of location and anatomic variability. Ann Anat 2020; 231: 151515.

34. Chirita AL, Matei T, Predoiu M. Detection of lingual foramina in the mandibular interforaminal region using limited cone beam computed tomography. Rom J Oral Rehabil 2020; 12(2): 267–77.

35. Kim DH, Kim MY, Kim CH. Distribution of the lingual foramina in mandibular cortical bone in Koreans. J Korean Assoc Oral Maxillofac Surg 2013; 39(6): 263–8.