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Nerve canals in the body of the mandible on CBCT: consequences for mandibular anaesthesia

Johan Aps (UGent)
Author
Organization
Abstract
Introduction: Mandibular nerve block (MNB) is traditionally performed by the Halsted technique. Other more complicated techniques, such as Vazirani-Akinosi and Gow-Gates aim at anaesthetizing the mandibular nerve at a higher level, closer to the foramen ovale. However, success of traditional MNB is far from perfect and literature mentions failure rates between 5 and 45%. Reasons for failure of the MNB are anatomical reasons, inflammation of the tissues, technical reasons etc. Aim: The aim of this study was to check the presence of so called “accessory canals” in the body of the mandible on CBCT images, which can explain problems encountered in mandibular nerve anaesthesia. Material and methods: One hundred CBCT images of mandibles were retrospectively checked for accessory canals. The images were taken for dental implantology or odontogenic pathology reasons. These images contained partial and whole mandibles. All images were taken with the Planmeca®Promax 3D Max at 96 kV, with mA varying between 10 and 12 and resolution varying between 200 and 600 µm. The latter parameters depended on the FOV and reason for the scan. All images were viewed under the same conditions on a Sony Bravia® LCD flatscreen TV (resolution 1920 x 1080) in a dimmed room. Results: Different accessory canals trough the mandibular cortex were observed, both near the symphysis and in the posterior part of the mandible and both on the buccal and lingual side and both inferior and superior of the inferior alveolar nerve (IAN) canal level. According to the literature, the lingual canals below the IAN canal will probably contain nerve branches of the facial or first cervical nerve, those above it will probably contain branches of the mylohyoid, lingual of hypoglossus nerve and those on the buccal side will probably contain branches of the buccal, mental or facial nerve. Conclusion: The fact that so many accessory canals were observed, means that these so called accessory canals are not accessorial, but “normal” anatomical variations. This also explains the high failure rate of the traditional MNB and why intra-osseous anaesthesia will always work.
Keywords
radiology, neurovascular bundles, mandibular anatomy

Citation

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Chicago
Aps, Johan. 2011. “Nerve Canals in the Body of the Mandible on CBCT: Consequences for Mandibular Anaesthesia.” In Dento-Maxillo-Facial Radiology, 18th International Congress, Abstracts, 62–62. International Association of Dento-Maxillo-Facial Radiology (IADMFR).
APA
Aps, Johan. (2011). Nerve canals in the body of the mandible on CBCT: consequences for mandibular anaesthesia. Dento-Maxillo-Facial Radiology, 18th International congress, Abstracts (pp. 62–62). Presented at the 18th International congress of Dento-Maxillo-Facial Radiology (IADMFR 2011), International Association of Dento-Maxillo-Facial Radiology (IADMFR).
Vancouver
1.
Aps J. Nerve canals in the body of the mandible on CBCT: consequences for mandibular anaesthesia. Dento-Maxillo-Facial Radiology, 18th International congress, Abstracts. International Association of Dento-Maxillo-Facial Radiology (IADMFR); 2011. p. 62–62.
MLA
Aps, Johan. “Nerve Canals in the Body of the Mandible on CBCT: Consequences for Mandibular Anaesthesia.” Dento-Maxillo-Facial Radiology, 18th International Congress, Abstracts. International Association of Dento-Maxillo-Facial Radiology (IADMFR), 2011. 62–62. Print.
@inproceedings{2004291,
  abstract     = {Introduction: Mandibular nerve block (MNB) is traditionally performed by the Halsted technique. Other more complicated techniques, such as Vazirani-Akinosi and Gow-Gates aim at anaesthetizing the mandibular nerve at a higher level, closer to the foramen ovale. However, success of traditional MNB  is far from perfect and literature mentions failure rates between 5 and 45\%. Reasons for failure of the MNB are anatomical reasons, inflammation of the tissues, technical reasons etc. 
Aim: The aim of this study was to check the presence of so called {\textquotedblleft}accessory canals{\textquotedblright} in the body of the mandible on CBCT images, which can explain problems encountered in mandibular nerve anaesthesia. 
Material and methods: One hundred CBCT images of mandibles were retrospectively checked for accessory canals. The images were taken for dental implantology or odontogenic pathology reasons. These images contained partial and whole mandibles. All images were taken with the Planmeca{\textregistered}Promax 3D Max at 96 kV, with mA varying between 10 and 12 and resolution varying between 200 and 600 {\textmu}m. The latter parameters depended on the FOV and reason for the scan. All images were viewed under the same conditions on a Sony Bravia{\textregistered} LCD flatscreen TV (resolution 1920 x 1080) in a dimmed room.
Results: Different accessory canals trough the mandibular cortex were observed, both near the symphysis and in the posterior part of the mandible and both on the buccal and lingual side and both inferior and superior of the inferior alveolar nerve (IAN) canal level. According to the literature, the lingual canals below the IAN canal will probably contain nerve branches of the facial or first cervical nerve, those above it will probably contain branches of the mylohyoid, lingual of hypoglossus nerve and those on the buccal side will probably contain branches of the buccal, mental or facial nerve.  
Conclusion: The fact that so many accessory canals were observed, means that these so called accessory canals are not accessorial, but {\textquotedblleft}normal{\textquotedblright} anatomical variations. This also explains the high failure rate  of the traditional MNB and why intra-osseous anaesthesia will always work.},
  author       = {Aps, Johan},
  booktitle    = {Dento-Maxillo-Facial Radiology, 18th International congress, Abstracts},
  keyword      = {radiology,neurovascular bundles,mandibular anatomy},
  language     = {eng},
  location     = {Hiroshima, Japan},
  pages        = {62--62},
  publisher    = {International Association of Dento-Maxillo-Facial Radiology (IADMFR)},
  title        = {Nerve canals in the body of the mandible on CBCT: consequences for mandibular anaesthesia},
  year         = {2011},
}