The Anatomic Structure of the Inferior Alveolar Neurovascular Bundle in the Third Molar Region

Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, CA 94143-0440, USA.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons (Impact Factor: 1.43). 11/2009; 67(11):2452-4. DOI: 10.1016/j.joms.2009.06.013
Source: PubMed


The arrangement of the structures within the inferior alveolar neurovascular bundle has not been clearly defined. Because this could be of importance in surgery involving the inferior alveolar canal, a study was undertaken.
The inferior alveolar neurovascular bundle was dissected from 8 cadaveric mandibles and examined for the arrangement of the inferior alveolar artery, vein, and nerve. Histologic sections were taken for examination, and simultaneously, the bundle was exposed as part of a clinical surgical procedure for a marginal resection of the mandible.
All 3 studies confirm that the inferior alveolar vein lies superior to the nerve and that there are often multiple veins. The artery appears to be solitary and lies on the lingual side of the nerve, slightly above the horizontal position. This position appeared to be consistent in all cases.
Knowledge of the arrangement of the inferior alveolar artery vein and nerve within the inferior alveolar canal can be of importance in surgical procedures that may involve these structures. Dentoalveolar surgery, implant-related surgery, and surgery for trauma or pathology could involve these structures.

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    • "Chin numbness after dental implant placement has been described as a consequence of direct damage of the inferior alveolar nerve caused by the surgical drill or the implant itself (15). Knowledge of the distribution of the alveolar neurovascular supply in the region of the third molar is important when performing surgical procedures that can affect these structures (16). Permanent damage of the nerve can result after inferior alveolar nerve block (17). "
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    • "Pogrel with co-workers [38] tested the hypothesis that some sensory innervation to the lower incisor teeth comes from re-entry of the terminal branches of the MN through the labial plate of the anterior mandible. They investigated 10 cadaver's heads and concluded: three of 20 (15%) specimens showed unequivocal evidence of nerve re-entry into the labial plate. "
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    ABSTRACT: The purpose of the present study was to review the literature of how to identify the mental foramen, mandibular incisive canal and associated neurovascular bundles during implant surgery and how to detect and avoid the damage of these vital structures during implant therapy. Literature was selected through a search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular incisive canal, mental foramen, mental nerve, anterior mental loop. The search was restricted to English language articles, published from 1979 to November 2009. Additionally, a manual search in the major anatomy, dental implant, and periodontal journals and books was performed. In total, 47 literature sources were obtained and reviewed. The morphology and variations of the mandibular incisive canal, mental foramen and associated neurovascular bundles were presented as two entities. It suggested that clinicians should carefully assess these vital structures to avoid nerve/artery damage. The mandibular incisive canal, mental foramen and associated neurovascular bundles exist in different locations and possess many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that the clinicians should carefully identify these anatomical landmarks, by analyzing all influencing factors, prior to their implant surgical operation.
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